Key Points about Iliotibial Band Syndrome (ITBS)

  • ITBS is most commonly experienced by runners, cyclists, and weightlifters who perform squatting exercises repeatedly and it is the most common type of lateral knee pain amongst those groups.
  • The condition is characterized by pain in the outer knee, hip or thigh.
  • Physical therapy is the most common way to treat ITBS.
  • Iliotibial Band Syndrome is also referred to as ITB syndrome, ITBFS (iliotibial band friction syndrome).
Common related conditions
Anterior Cruciate Ligament (ACL) Injury Lateral Collateral Ligament (LCL) Injury Medial Collateral Ligament (MCL) Injury Meniscus Tear or Strain Thigh or Calf Strain or Sprain

Overview

The iliotibial band (IT band) is a thick piece of connective tissue (fascia) that runs along the outside of the thigh from the hip to the knee joint, providing flexibility and stability to the knee. When the band becomes inflamed or tight due to overuse or improper movement, the resulting inflammation and pain around the knee is referred to as Iliotibial Band Syndrome, or ITBS. 

Most cases of ITBS are treated with various physical therapy measures. Surgery is rarely used as a treatment.

Call your doctor if your pain persists or worsens over time.

ITBS causes

Common causes of ITBS include training habits, muscular imbalances, and abnormalities in anatomy.

The motions of long-distance runners, cyclists and squatting weightlifters are conducive to developing the syndrome. Common causes amongst these groups are:

  • Repetitive movement over many miles
  • Muscle weaknesses and imbalances of the inner quadriceps, hips, core gluteal muscles
  • Worn out footwear
  • Downhill run training 
  • Inward turning toe position on bike
  • Improper squat positioning (misalignment of knees during strain)

Anatomical presentations like an abnormally tilted pelvis, bowed legs, or leg length differences, contribute to ITBS by causing increased tightness and irritation as the band moves. Over time this movement leads to inflammation and pain. 

ITBS risk factors

You may be more likely to develop ITBS if you:

  • Have an abnormally tilted pelvis, bowed legs, or leg length differences
  • Are an endurance athlete
  • Have muscle weaknesses or imbalances allowing the knee to destabilize

ITBS Symptoms

The main symptom of ITBS is pain above the outer part of the knee. This pain may:

  • Worsen during running or other repetitive activities
  • Be accompanied by swelling
  • Run up and down the side of the leg

You may also experience a popping, clicking, or painful feeling while bending the knee.

ITBS complications

Unaddressed ITBS can lead to:

  • Continued pain
  • Development of detrimental biomechanics during movement to compensate for injury
  • Inability to continue training or keep up an exercise routine

ITBS prevention

To lower your risk of developing ITBS:

  • Take time off from activities that cause outside knee pain
  • Wear properly supportive footwear
  • Avoid squat positions
  • Run on flat surfaces (avoid sloped roadsides)
  • Proper bike fitting and seat height
  • Stretching exercises for IT Band
  • Targeted muscle strengthening of hips, abdomen and lower back
  • Warm up before exercise

ITBS diagnosis

When diagnosing ITBS, your doctor will perform a physical examination and review your symptoms. The diagnosis is usually fairly easy to make, but in some cases, your doctor may order an X-ray to rule out other issues or conditions.

ITBS treatment

Treatment for ITBS generally involves following a physical therapy regimen, which may include:

  • Iliotibial band stretches
  • Exercises to strengthen the gluteus medius
  • Stretching exercises
  • Activity modification

If pain and swelling persist, your doctor may recommend corticosteroid injections. In rare cases where conservative treatments do not relieve pain, surgery may be considered.

When to seek care

Set up an appointment with your doctor if your outer knee pain doesn’t go away or gets worse after several weeks of rest or activity reduction.

Next Steps

Your doctor will work with you to set up the best treatment plan for ITBS.