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IT Band Syndrome: The Top 5 Causes and Solutions

by Dave Heidloff | 20 Comments

Running season has arrived and a lot of you wanted to hit the ground running, but instead, you hit the ground hurting…hurting on the outside of your knee. If that’s the case, you could have iliotibial band syndrome or IT band syndrome for short. IT band syndrome is an overuse injury that is common in endurance athletes like runners and bikers. It affects a tissue that runs from the side of your hip all of the way down past your knee. Most of the time, the inflammation manifests itself as pain on the outside of the knee. It can be incredibly painful and is typically a frustratingly stubborn injury to deal with. One quick look at the anatomy below can help you realize that the cause of the pain can be anywhere from the hip to the knee, so getting to the root cause can be a little tricky, but here are some solutions to a few of the most common causes of IT band syndrome.

Iliotibial Band

1.  Overuse
Technically, IT band syndrome is an overuse injury. It’s kind of a misleading classification since there are usually other factors than overuse, but approaching IT band syndrome as an overuse injury is an important first step towards recovery. After icing and resting for a few days, you may need to change up your training regimen. Sometimes this can be as easy as avoiding repetition. Try changing your running route or getting away from the treadmill or track for a jog outside. If getting in shape or building up your endurance is your goal, try some cross-training while you slowly ramp up your mileage. Keep in mind that while overuse is usually one of the causes of IT band syndrome, there are usually other factors contributing to your pain, so some of the other interventions below may be necessary.

2.  Tight Tissues
Tight muscles in your hips or along the side of the leg can be a major contributing factor to IT band syndrome. All of these tissues are connected, so even though the location of the pain is in the knee, the hips can very well be the area that need the most attention.

Stretching the IT band and the connected muscle is fairly simple. Just cross your legs, keeping the affected leg in back (position 1). Lean away from the painful leg until you feel a stretch along the side of the leg (position 2). Hold that for 30 seconds and repeat 5 times.
IT Band StretchIn addition to stretching I’ve had success by utilizing foam rolling or work with a tennis ball to loosen up tight tissues and release any tightness in your hip muscles. I strongly encourage you to stretch and roll both of your legs as tight tissues on one leg can cause pain on the opposite side. If there still seems to be some lingering tight spots after you try the at-home solutions, you may need to see a professional for some individualized hands-on work.

3.  Weak Hip Muscles
Researchers at Stanford found that weak hip muscles can be one of the biggest reasons people get IT band syndrome. Weak muscles in the hip tend to cause your running form to break down, which puts a lot of stress on the tissues in the knee. To strengthen the muscles most commonly affected, you can try some of the exercises suggested at this link. In addition, another one of my favorites (pictured below) is referred to as “the clam.” While on your side, bend your knees to 90 degrees. Keeping your ankles together, rotate the knee of your tip leg towards the ceiling. Return to the starting position and repeat 30 times. Again, it’s important to strengthen both legs as one side of the body can easily affect the other.

Clam Exercise for IT Band Syndrome

4.  Poor Running Form
Sometimes getting rid of IT band syndrome can be as simple as changing the way that you run. Having a professional look at your running gait can reveal some problems that you may have never noticed. Some of the more common problems are overstriding (taking too long of steps) and strides that cross over the midline of the body. These are pretty easy to notice and can sometimes be pointed about by an experienced runner. Sometimes, however, the breakdown in form can be more subtle and require something more involved like a video gait analysis.

Video Gait Analysis

5.  Shoe or Orthotic Issues
You can correct every issue in your body, but if what comes between your foot and the ground is the cause of your problem, you’ll never see relief. Overworn shoes can cause your foot to land at awkward angles, which transfers a lot of stress up to the knee and hip, so keeping your shoes within their recommended mileage is critical. Also, adjusting to minimalist shoes (or none at all) will require you to adjust your running style, so be sure to do your research and be patient while adjusting. Finally, arch or ankle problems may require you to get orthotics so you can run with a safer gait.

With all of these suggestions, you can expect for improvement to take some time. If your pain lingers for longer than a few weeks, it may be time to talk to a healthcare provider for some more individualized treatment.

20 Comments

  1. Dean Marquez

    Great article, I’ve always thought I just had hip issues but I learned through re-hab that it was a IT band issue. I recovered last year and completed about 8 triathlons,I was off the last 4 months due to a divorce and just started to train again. My IT band is hurting again. Thanks for your article it will be a great reminder of what I did in re-hab and it will help me get back where I was before.

    I think it may also be caused by an uneven pelvis?

  3. Megan @ Fiterature

    Thanks for sharing all of these details. I’m training for Chicago and have had some slight outer knee issues – immediately grabbed my foam roller and made a date!! The pain went away the next day and has stayed away if I continue to roll!

  4. Chris

    @Dean: good news on the divorce. Now with the healthy hip you can do 10 triathlons next year.

  5. Christy Schafer

    I am an avid tennis players and have been experiencing pain in the hip that often radiates down to the knee area. I did have a lower back strain a couple of years ago and have rehabed that area. Are IT band problems common in tennis players? Thanks

  6. daveheidloff

    @Christy – I’ve seen IT band problems pop up in athletes of almost every sport- tennis players included. If your pain is truly radiating, it would be worth seeing a physician or getting a screen to rule your back out as the source of your pain. Whether it’s your back or not, you would probably benefit from beginning to do the “clam” exercises listed above. If your back is ruled out as the cause, it would definitely be worth getting started on the stretches as well. I hope that helps. Thanks for reading!

  7. Amy Storer

    Has anyone tried the Graston technique? Running has become the love of my life and I am desperate to get back in the groove. So far a few things seem to be working for me. One has been getting the custom orthodics done – expensive as hell – but totally worth it! Like one person mentioned it is a godsend and I could feel the pain dissipate when I put them in my shoes at the store. Acupunture and the cupping technique have mysteriously and incredibly helped my ITBS condition! I highly recommend going to a reliable place that has good reviews.

    I have done the GRaston technqiue two times so far but I am worried that I have been sore and feel the ITB symptoms after but I am told this is normal for a few days… time will tell! Has anyone else had this experience after graston? What did it feel like?

  9. Alberto Douss

    I have this pain on the tight at the upper parts and sometime on the middle!
    I has been in therapy for about 2 month twice per week but I don’t see a result . I can feel better today but next day I can feel the pain. I don’t have a pain on the side of my knee.. They are doing the ultrasound and massage(not deep one). It been about 4 month with me having this..
    Any advise?

  10. Fannie

    I am in constant pain and this is making me miserable. That said, having broken a tailbone in childbirth, it is a pain that I CAN tolerate on a daily basis; I just dont want to. I am a cross trainer. I do lots of strength training. I do not run but my workouts involve a lot of high kicking, deep squats and jumping. My hips feel enflamed. I’ve used Aspercreme and warm baths. I am very limber and stretch daily…. still capable of doing splits and V sits. I actually feel best working out but yesterday the pain radiated all through the afternoon, night and right into this morning. Im guessing this is IT related but everything Ive read indicates that kind of pain is more associated with knees. Guidance?

  11. Julie

    I have had this ITB Pain for about a month . Now I’ve got pain on the inside of my knee and along the front of my knee. Had Physical therapy yesterday and a light massage on lower back last night . Today it’s still painful , it’s on the outside mid thigh to around the inside of my knee. Please Advise. Thanks a lot !

  12. Julie

    I have problems with my knee and now have ITB pain. It starts about mid thigh and the Inside of my knee is painful also . Need advise on what to do about this ongoing pain , I did have a treatment yesterday morning with one of those battery / cortisone pulse patches . Felt somewhat better but don’t know what else to do . Need advise on what to do next .

  13. Annabelle

    I just have one question, it is track season and I started off with shin splints which heals quite quickly. I now have the I T band syndrome but it’s not hurting on my knee it’s on the whole side of my leg. I’m not even sure if it IS I T band syndrome.
    It has been hurting for two weeks now, my first meet was on Thursday and I could not stand it. My coach will only let me do the 1500 m race because of it. I decided after the meet to not run until Monday at my practice which was yesterday. I ended up not going to practice because my parents weren’t home to take me so I ran by myself for an easy run. Within 5 minutes that I started the pain came, I rested but it only seems to be getting worse as it gets.
    I’m starting to think it’s not I T band syndrome but I’m really confused ’cause all of the pain I’m having is described whenever I read about I T band syndrome. I have another meet today and I am not sure if I should even go if it’s getting like this.

  16. Elizabeth

    I have been in pain since Nov. 2012. I am just finishing with my PT and am scheduled for an MRI of my back next week. I am quite confident it is my IT band. Pain is from my hip to my knee. Sleeping is very difficult. Stairs.. getting in and out of a seated position also difiicult. I have just started golf for the season and am in a great deal of pain from the even services and pushing a cart.
    Is there something other than all these stretches that I have been doing for months to help me rid of this pain?

  17. Donna

    Elizabeth does it feel like everything ripples from hip to knee when you lie on your side. This pain is killing me. I have had it since October and need it to be gone. When Isrand up from sittingit moves to the top of my thigh.

  18. Donna

    I have the same feeling. When you sleep does it feel like it shifts down your side? This pain is awful.

  19. Joni

    I have the ITBAND Syndrome , But side of my kneee pops , snaps everytime I get up from sitting , What’s the cause of that ?

  20. Chris

    I have never been a runner and started running just about everyday on the treadmill for 20-30 minutes at a relatively slow 5.0 pace. My pain started in my hips and now has moved to my right knee and no pain in my hips. I feel a popping in my knee when I go from sitting to standing and pain and a little swelling on the outer portion of my knee. I occasionally will have pain on the inside as well. I thought I tore something, but could this be IT syndrome?

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