Overview and Prevention of Iliotibial Syndrome

IT Band pain in athletes
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The iliotibial (IT) band is often the hidden cause of outer knee or hip pain. Iliotibial band friction syndrome can cause a nagging, dull ache, or flare into a sharp, acute pain felt at a specific spot on the outside of the knee and lower thigh. For some athletes, a tight IT band may cause hip pain as well.

The Iliotibial Band

The iliotibial band is a strong, thick band of fibrous tissue that runs along the outside of the leg. The IT band starts at the hip and runs along the outer thigh and attaches on the outside edge of the shin bone (tibia) just below the knee joint. The band works with the quadriceps (thigh muscles) to provide stability to the outside of the knee joint during movement.

Causes of Iliotibial Band Pain

Iliotibial band syndrome is the result of inflammation of the iliotibial band. IT band syndrome is a common injury in runners or other athletes that run for training or during their sports. The IT band acts primarily as a stabilizer during running and may become irritated from overuse. The pain is typically felt on the outside (lateral) aspect of the knee or lower thigh, but may be felt near the hip. The pain is often more intense when descending stairs or getting up from a seated position.

The most common causes of IT band syndrome are:

  • Overuse
  • Increasing training too quickly
  • Overtraining syndrome
  • Returning from injury too soon
  • Faulty biomechanics
  • Other training errors

IT band syndrome is common in runners who perform unbalanced, repetitive exercise such as running only on one side of a crowned road or only running one way around a track. Most roads slope off to the sides and running along the edge causes to the outside foot to be lower than the inside foot. This, in turn, causes the pelvis to tilt to one side and stresses the IT band.

The biomechanical abnormalities that may lead to IT band problems include excessive pronation of the foot, leg length discrepancy, lateral pelvic tilt, and "bowed" legs. Muscle tightness or lack of flexibility in the gluteal (buttock) or quadriceps (thigh) muscles may increase the risk of IT band injuries. Sports physical therapists often use videotape analysis to uncover any biomechanical problems and make corrections in technique or muscle weakness or tightness.


Treating IT band friction syndrome generally includes a comprehensive approach, including:

  • R.I.C.E.: Rest, ice, compression, and elevation is the best way to treat initial IT band pain.
  • Physical therapy: A therapist may use ultrasound and other modalities to help the injured tissues heal more quickly. A skilled PT can also help you correct any biomechanical or training errors, and teach you how to perform the right flexibility exercises.
  • Reduced activity: Runners with IT band pain should reduce running mileage and be alert for signs of overtraining syndrome.
  • Foam roller myofascial release. Using a foam roller to release the tissues may be painful, but many athletes have success with this technique.
  • Anti-inflammatory medications: These may also be used to reduce pain and inflammation.
  • Rest and recovery: Rest is an important part of your recovery and should be maintained as part of a balanced training program.

Preventing IT Band Syndrome

The following tips may help you prevent chronic IT band syndrome:

  1. If you are a runner, review how to prevent running overuse injuries. This includes increasing your distance my no more than 10 percent per week, taking a rest day between running days, and building speed or incline intensity gradually.
  2. IT band strengthening exercises include those that target the external hip rotators. One simple way to do this is with the one-leg squat exercise. Perform these in front of a mirror and make sure your pelvis does not drop on one side during the reps.
  3. IT band stretching exercises may help prevent irritation from IT band tightness.
  4. Use the right shoes. The amount of support or cushion in your shoes can either aggravate or alleviate IT band issues, so be sure to choose the right shoes for your sport.
  5. Consider using orthotics or inserts. Some IT band trouble can be helped by using either custom or commercial orthotics, particularly if you have high arches.
  6. Replace aging running shoes. Running in old, worn shoes can increase IT band pain, so switch out your shoes at regular intervals, at least every 400 miles.
  1. Avoid overtraining. Training too much or too often can make any aches and pains worse, so rest and recover after hard workouts.
  2. Cross train. Doing the same thing over and over makes recovery more difficult. Mix up your training to balance out your body.
  3. Get adequate rest and recovery. Frequent high-intensity workouts can do more harm than good. Learn how rest can improve your training.
  4. Try backward running to correct muscle imbalance and reduce pressure on the knees.
  5. Run on a soft, level surface or alternate directions on the road to avoid stressing the IT band.

IT band friction syndrome doesn't have to be a chronic, debilitating problem. A little bit of prevention and careful diagnosis of the cause can lead to a full recovery.

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