What is iliotibial (IT) band syndrome?

Gautam P. Yagnik, MD
Orthopedic Surgery
Iliotibial band syndrome is an overuse injury of tissues of the outer thigh and knee. The iliotibial band stabilizes the leg, so when it flares up it can debilitate runners or bikers severely.

The symptoms include a sharp pain or tightness on the outside of the knee just below the joint. The iliotibial band starts in the muscles of the gluteus and hip, then moves down the outside of your thigh. You can aggravate the iliotibial band by ramping up your mileage too quickly, on foot or on the bike.
Scott D. Martin, MD
Orthopedic Surgery
The iliotibial (IT) band is a thick cord of tissue extending from the hip bone down the outside of the thigh to the tibia. When the knee bends, the IT band slides over the outside knob of the femur. If it becomes inflamed, the outside of the knee hurts. In athletes, the condition is so common it is sometimes called "runner's knee," occurring in up to 12% of runners.

In older people, IT band syndrome usually occurs when something else, such as a bad back or another joint problem, has thrown off the gait. But IT band syndrome can occur in anyone who increases running mileage too rapidly or overdoes it while cycling, skiing, or playing soccer. The syndrome is more common in those who fail to warm up properly and those who have tight IT bands, unbalanced leg muscle strength, high or low arches, or unequal leg lengths.

Symptoms of iliotal (IT) band syndrome (runner's knee) include:
  • Pain in the upper outside of the knee
  • Pain along the IT band, from the hip to below the knee
  • Pain on the outside of the hip exacerbated by pressure, such as when lying on the affected side
  • Dull, sharp, or stinging pain
  • Pain that arises gradually or after a single intense workout
Anthony L. Komaroff, MD
Internal Medicine
"ITB syndrome" is short for iliotibial band syndrome. It refers to a common cause of knee pain.

The iliotibial band is a tough fibrous (scar-like) tissue that extends from the region of the hip to the knee along the outside of the leg. Along with other muscles of the leg, the IT band helps stabilize the knee, especially when the knee is stressed during physical activity.

ITB syndrome develops when there is damage, irritation or inflammation of the IT band. The most common site is at the outside of the knee where the tissue of the IT band rubs over a bony bump.

Pain over the outside of the knee is the most common symptom, although some people complain of pain higher up, along the outside of the thigh or hip. Repetitive knee flexing tends to make it worse. Rest usually relieves the symptoms.

While ITB syndrome may occur for no apparent reason, it's common among people who are:
  • young or middle age athletes, particularly if not very flexible
  • engaging in activities that require repetitive flexing and extending of the knee (especially running)
  • increasing their exercise intensity (such as upping the miles they run)
  • bow-legged, have flat feet, or have legs of unequal length
Treatment options include:
  • adjusting one's exercise routine
  • physical therapy that includes stretching and strengthening exercises
  • applying ice to the area where you feel the strongest pain
  • improving footwear (including using shoe inserts for flat feet)
  • anti-inflammatory medications (such as ibuprofen or naproxen)
In cases where these measures don't work, doctors may recommend a cortisone injection or even surgery to remove a bony bump that's irritating the IT band.
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Daniel Bockmann, DC
Chiropractic Medicine

ITBFS is an overuse syndrome, otherwise known as "too  much, too fast or too soon". The iliotibial band is a long tendon that runs down the outside of the thigh, crossing both the hip and knee joints. It connects the glutes, tensor fascia latae muscle and pelvis to the lower leg and kneecap.

Friction of this band against the side of the knee can cause inflammation, scarring, and subsequent shortening of the ITB. And since the friction is caused by bending at the knee, runners and cyclists are especially prone to this injury. Shortening or contraction of the ITB increases tension on the outside of the knee, which may force the knee and kneecap to move abnormally, causing knee pain. This same tension may also cause hip pain by creating inward compression at the hip joint, or even lower back pain by preventing normal movement of the pelvis and sacrum. 

ITBFS is remarkably easy to fix. Depending on the number of complicating factors (like muscle imbalances, faulty footwear, running surface issues, joint restrictions, etc.), our treatment protocol usually resolves the problem in less than a month. No drugs or surgery. A typical treatment program may look like this: 

  • Myofascial release, to lengthen the ITB and break up scar tissue
  • Proprioceptive training, to speed muscle response time
  • Core training, to increase stride efficiency & distribute stresses more evenly
  • Eccentric training, to increase tendon strength
  • Training modification, to avoid recurrences and maximize performance

And once the tendon is longer, stronger & pain-free, it's relatively easy to keep it that way. A simple knee maintenance rehab program is all it usually takes, along with some rules of thumb about training techniques. 

Even though we've talked about ITBFS as it relates to endurance athletes, it can occur in non-athletes -- or 'normal' people -- too!  If you think you have IT band friction syndrome, speak with a sports medicine and rehab specialist. In our office we typically recommend 4-6 treatments for patients with this condition. Outcomes are consistently good, return-to-play occurs quickly and re-injury rates are low. 

Aaron Nelson
Sports Medicine
IT Band syndrome is an acute inflammatory condition that occurs when the iliotibial band continually rubs against the bony prominence of the lateral femoral epicondyle. This injury is most common in runners, but can occur in anyone who is involved in activities with continuous flexion/extension of the knee. The inflammation usually occurs in the soft tissue and can be alleviated by ice, rest, anti-inflammatory medications and by addressing/correcting any malalignment that may be causing the problem.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
The IT band, or iliotibial band, runs from the hip down to the knee on the outside of the thigh. If this band is overused, it become tight and can cause pain and bursitis on the side of the hip. Watch Dr. Oz talk more about hip joint pain.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.