IT Band Syndrome

Iliotibial Band (ITB) Syndrome is one of the most common injuries in runners. It is also associated with cycling, hiking and other activities that include repeated bending of the knee. ITBS can be one of the most frustrating injuries. Often the pain can seem to disappear, only to return without warning in the middle of your run.

I previously wrote an overview of the most common knee injuries. If you wish to read more generally about knee injuries then please click here.

Read on to learn more about how to beat this frustrating injury and get back to doing what you love.

Symptoms of ITB Syndrome

Runner with an injured knee

If you have any of these symptoms you could be suffering from IT Band Syndrome…

  • Pain towards the outside of the knee.
  • Swelling or redness on the outside of the knee or up the side of the thigh.
  • Sharp or stabbing pain.
  • Running downhill or descending stairs makes the pain worse.
  • Pain disappears on rest but reappears 5-10 minutes into your activity.

My ITBS story: My own struggle with IT Band pain was one of the catalysts behind my entry into the sports injury profession. The injury took two consecutive winters of training off me. I suffered months of frustration with this injury and dissatisfaction with the advice of the physios I went to with it. This led me to spend long hours researching the causes and treatments for the injury. I successfully recovered using the tactics I developed from my research, and have managed to keep it at bay ever since. This research ignited a passion in me to learn more about the mechanisms of injury. More so, it inspired me to cut through the mountains of inaccurate information out there and to deliver the real picture to others in need.

What is the IT Band?

The ITB is a long, thick band of connective tissue. It runs down the outside of your thigh, connecting hip to knee. It helps to stabilise the knee constantly during walking, running and squatting. Importantly, at the hip it is connected to your Gluteus Maximus and Tensor Fascia Lata (TFL) muscles. 

What causes the pain of ITBS?

This cause of the pain in ITBS is actually much disputed.  Despite many sources claiming to know the exact cause of the pain, experts still cannot agree.


It used to be thought that friction of the IT band rubbing over a bony knob at the bottom of your thighbone (the femoral epicondyle). It was thought that this friction caused irritation to a bursa (a fluid filled sac under the ITB). It has since been shown however that this bursa does not actually exist! Furthermore, the IT Band is so well anchored to the femur and the knee joint that it can’t move enough to cause any friction. Nevertheless, is widely accepted that tissue underneath the ITB at the knee (possibly a sensitive fat-pad) gets irritated by a dysfunctional IT Band.

The anatomy of IT Band Pain
Image courtesy of BodyHeal - click for original blog post

Why do we get ITB Syndrome?

Essentially the injury is caused by a dysfunction of the IT Band. This can have a number of underlying causes such as….

  • Weak hip/glute muscles, quadriceps, lower back or core.
  • Lack of control and co-ordination at the hip, knee and/or ankle.
  • Sudden increases or changes in training.
  • Lack of hip, knee or ankle mobility.
  • Muscular tension in the hip, glutes, lower back or thigh.

How do we treat IT Band Syndrome?

Physio or sports therapist working on the knee of an injured client

Most IT Band pain can be resolved in a matter of weeks with an appropriate rehab plan. If you want to find out more about how my sports therapy services can help with your IT Band injury, you can find out more by clicking here.

When a client comes to me with IT Band pain we will start with a full assessment. This will help establish the most likely cause of the pain. Rehabilitation will then be built around the findings from this assessment and tailored to the individual. However aspects of all of the following are usually taken into account when forming the rehab plan…

  • An honest assessment of training routines. Usually volume will be lowered and cross-training will be advised for a period.
  • Exercises to increase hip mobility – especially rotation which is commonly lacking in many athletes.
  • Strength training for the glutes and hip muscles. Extra attention is paid to the lateral muscles and those which control rotation at the hip.
  • Sports massage to relieve muscular tension at the hip and knee and to reduce levels of pain.
  • Assessment of running technique.
  • Exercises to improve proprioception, agility and balance.

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