Iliotibial (IT) Band Syndrome

Your iliotibial band is a thick band of soft tissue that runs along the outside of your thigh. It stretches from your hip to your shinbone (tibia) and crosses over your knee joint. 

The IT band is like a rubber band that helps stabilize your knee and hip when you walk, run or climb stairs. It works with and serves as an attachment site for various muscles around your hip and thigh to keep your leg steady and properly aligned. 

When the band becomes tight or irritated, it can rub against the outside of the hip or knee. Over time, that friction can lead to pain, swelling and stiffness, symptoms of IT band syndrome (ITBS). 

ITBS can occur in one leg or both legs. When it occurs in both legs, it is called bilateral iliotibial band syndrome. 

Who is most at risk for IT band syndrome?

Anyone can develop IT band syndrome but it is most common among athletes and active people, especially those who repeat the same movements over and over. Athletes most prone to ITBS include:

• Runners
• Cyclists
• Hikers
• Basketball players
• Hockey players
• Skiers
• Soccer players
• Military personnel during training

You may also be at more risk for ITBS if you:

• Have bowed legs (curve outward at the knees)
• Have one leg longer than the other
• Have knee arthritis
• Have weakness in your hip muscles, glutes or abdominal muscles 

IT band syndrome happens when your IT band becomes tight or overworked. This tightness pulls on the tissue, creating friction (rubbing) where the band crosses the hip or knee. It can cause inflammation in the bone, tendons and small, fluid-filled sacs (called bursae) in the area. 

Possible causes include:

• Overuse or repetitive motion: Running, cycling, hiking or walking long distances without enough rest.
• Sudden spikes in activity: Increasing mileage or intensity too quickly before your body can adapt.
• Weak hip or glute muscles: When your hip muscles don't stabilize your leg properly, your IT band has to work harder.
• Running or walking on uneven surfaces: Slanted roads or trails can tilt the body and put more strain on one leg more than the other.
• Foot pronation (rolling your foot inward): When your foot turns inward too much as you walk or run, it changes the alignment of your leg and increases stress on your IT band.
• Improper footwear or worn-out shoes: Lack of support can change how your legs move and create extra tension.
• Tight muscles: Limited flexibility in your hips, thighs or hamstrings can increase tension on the IT band. 

Sitting for long periods or standing with your weight on one leg can worsen the problem. 

If your pain doesn’t improve with rest or gets worse over time, see a health care provider. You should also make an appointment if you notice:

• Pain that affects walking or daily activities
• Swelling around the knee
• A popping or snapping sensation
• Pain that spreads up the thigh or down the leg

Early treatment can help prevent chronic irritation and get you back to feeling your best.  

If you have pain that won’t go away, see a health care provider. Your provider, physical therapist or sports medicine specialist can help you find the cause and rule out other injuries. 

During your visit, they may:

• Ask about your symptoms and activity level
• Examine your leg, knee and hip for tenderness or swelling
• Check your range of motion and strength (known as the Ober test)
• Watch how you walk or run
• Possibly order an MRI or ultrasound (if needed) to rule out other causes of knee pain but this is usually not necessary. 

The goal is to confirm that the pain is coming from your IT band, not another issue like a torn meniscus or arthritis. 

To heal IT band syndrome, the goal is to reduce inflammation, improve flexibility and restore strength and balance in your hips and legs. Your health care provider might suggest different treatment options to help you recover. These might include:

1. Rest

Give your body a break from activities that cause pain, especially running, squatting or cycling. Rest gives the tissue time to heal. 

To relieve discomfort:

• Apply ice packs to the outside of your knee for 15 to 20 minutes several times a day.
• Use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen if your provider recommends it.
• Avoid stretching or massaging over the painful areas too aggressively during the early stages of inflammation.

Once the pain begins to ease, gentle movement, stretching and massage or foam rolling over the soft tissues can help you recover.

2. Physical therapy

Physical therapy is the most effective treatment for IT band syndrome. It helps you heal faster and teaches you how to avoid future flare-ups. 

A licensed physical therapist can identify what’s causing the irritation, whether it’s muscle weakness, tightness, poor alignment or training habits, and build a plan just for you.

Your program may include:

• Stretching and flexibility exercises: These target tight muscles in your hips, thighs and outer leg to relieve tension on the IT band. Common stretches include hip flexor stretches, IT band stretches and foam rolling along the outer thigh.
• Strengthening exercises: Building strength in your glutes, hips and core helps support your knees and improves your legs’ movement. Exercises like bridges, clamshells and side-lying leg lifts are often used.
• Manual therapy or massage: Your therapist may use hands-on techniques to release tight tissue and improve movement.

3. Footwear and orthotics

Supportive, well-cushioned shoes can correct issues like foot pronation and absorb impact with each step.   

If you have flat feet or uneven leg length, your provider may recommend orthotics or custom inserts to improve balance and reduce tension along your leg. 

4. Injections or surgery

Most people recover fully with physical therapy and rest. In rare cases, if pain continues after several months, your provider may recommend a trigger point corticosteroid injection to reduce inflammation.

Surgery for IT band syndrome is very rare and usually reserved for chronic cases that don’t respond to other treatments. 

5. Gradual return

Once your pain improves, your therapist or provider will help you safely return to your usual activities. You will start back slowly and increase gradually; about 10% more distance or intensity per week is a good rule of thumb.

If you’re a runner, try switching to softer surfaces or alternating sides of the road to balance stress on your legs. Cyclists can check their seat height and posture to reduce knee strain.

Listen to your body to avoid reinjury. If pain starts again, it’s a sign to back off. 

Pain from IT band syndrome usually appears on the outside of your knee but it can also spread up the thigh toward your hip. 

You might notice:

• Sharp or burning pain on the outside of your knee or on the outside of your hip
• Pain that starts after running or exercising and gets worse over time
• Soreness that lingers after activity
• A clicking or snapping feeling on the outside of your knee
• Tightness along the outer thigh or hip

At first, you might feel discomfort during longer runs or workouts. Over time, the pain can start earlier, sometimes even after simple activities like walking or climbing stairs. 

At Banner Health, our sports medicine and rehabilitation teams work together to diagnose, treat and prevent overuse injuries like IT band syndrome. We offer:

• Experienced sports medicine physicians, orthopedic specialists and physical therapists
• On-site imaging tests, including MRI and ultrasound
• Personalized rehabilitation and strengthening programs
• Performance and conditioning programs designed for active adults and athletes

Schedule an appointment with Banner Health today.