Understanding Iliotibial Band Syndrome and Knee Pain: Things To Know

Understanding Iliotibial Band Syndrome and Knee Pain: Things To Know

For both seasoned marathoners and casual joggers alike, there’s a common adversary known to interrupt many a training regimen: Iliotibial Band Syndrome, or ITBS. In this blog, we will dive into the intricacies of ITBS and knee pain, exploring its causes, and symptoms, and offering solutions to get you back on track – literally and figuratively.

What Is The Iliotibial Band And Why Does it Matter?

What Is The Iliotibial Band And Why Does it Matter?The Iliotibial Band (ITB) is a thick, fibrous band of tissue that runs along the outside of the thigh. It is starting from the hip and extends down to the outer part of the shinbone just below the knee joint. This band is crucial in providing stability to the knee and assists in joint movement. Especially during activities that require repetitive bending and straightening of the knee, such as walking, running, and cycling.

Its significance is especially pronounced in runners and cyclists. Due to its role in stabilizing the knee, any imbalance or tension in the ITB can lead to painful friction against the bony structures of the knee. This friction is typically the cause of the condition known as Iliotibial Band Syndrome (ITBS), a common overuse injury in athletes. An understanding of the ITB’s function and anatomy is thus vital for those seeking to prevent or treat ITBS and maintain optimal joint health.

How To Know If ITBS Causing Knee Pain?

Identifying whether ITBS is the cause of knee pain involves recognizing its distinctive symptoms, understanding its risk factors, and occasionally undergoing clinical assessment. Here’s a guide to help determine if ITBS might be the culprit behind your knee discomfort:

  • Location of the Pain

ITBS specifically causes pain on the outside (lateral aspect) of the knee. This is unlike many other knee issues which may cause pain in the front, back, or inside of the knee.

  • Nature of the Pain

The pain associated with ITBS typically starts as a sharp or burning sensation. It might worsen when the heel strikes the ground during walking or running.

  • Onset during Activity

Many people with ITBS experience pain after a certain distance or time of activity. For example, a runner might notice the pain consistently setting in after 2 miles of running.

  • Tenderness on Touch

Pressing on the outside of the knee, where the ITB crosses the joint, often results in tenderness or sharp pain.

  • Aggravating Activities

The pain is commonly aggravated by downhill running, prolonged sitting, or any activity that involves repetitive bending and straightening of the knee.

  • Audible Snap or Click

In some cases, a snapping or clicking sound may accompany the pain. As the band slides over the lateral femoral epicondyle, a bony prominence on the thigh bone.

  • Relief with Rest

Taking a break from the activity that triggers the pain, like running, usually provides temporary relief, though the pain might return once the activity is resumed.

  • Risk Factors

Being aware of certain risk factors can also hint towards ITBS. These include sudden increases in activity, running on sloped surfaces, cycling with an improper seat height, or inherent biomechanical issues such as overpronation of the foot.

  • Physical Examination

If you suspect ITBS, it’s advisable to see a physical therapist or orthopedic specialist. They will perform specific clinical tests, such as the Ober’s test, to check the tightness of the ITB and confirm the diagnosis.

If you suspect ITBS, it’s essential to address the condition promptly. Early intervention can prevent the condition from worsening and decrease recovery time.

What Causes ITBS Knee Pain?

What Causes ITBS Knee Pain?Iliotibial Band Syndrome (ITBS) knee pain arises from inflammation and irritation of the iliotibial band. As it rubs against the lateral femoral epicondyle, a bony prominence on the outside of the knee. Several factors can lead to this friction and the subsequent development of ITBS:

  • Overuse: ITBS is commonly classified as an overuse injury. It often occurs in runners, cyclists, and other athletes who suddenly increase their training intensity, duration, or frequency without allowing adequate time for recovery.
  • Tightness of the IT Band: Some individuals naturally have a tighter IT band. That increases the likelihood of it rubbing against the knee, causing irritation.
  • Muscular Imbalances: Weakness in certain hip muscles, like the gluteus medius, can result in altered biomechanics. This can cause the IT band to become overstressed. Additionally, dominance or tightness in the quadriceps relative to the hamstrings can contribute to ITBS.
  • Poor Running Form: Improper running mechanics, such as excessive inward rolling of the foot (overpronation), can increase strain on the IT band.
  • Running on Banked Surfaces: Consistently running on sloped surfaces, like the side of a road, can cause one hip to remain higher than the other, leading to added stress on the IT band of the downhill leg.
  • Inadequate Footwear: Wearing worn-out or inappropriate shoes for one’s foot type and running style can negatively influence foot. And knee mechanics, contributing to ITBS.
  • Bowlegs or Genu Varum: People with bowlegs have a naturally increased angle between the thigh and lower leg, which might make them more susceptible to ITBS.
  • Lack of Flexibility: Not stretching or warming up adequately before exercises can result in decreased flexibility. Eventually, making the IT band more susceptible to friction and inflammation.

Understanding the specific causes and risk factors associated with ITBS is pivotal for prevention and treatment. Addressing the root causes, whether biomechanical or activity-related, is essential for a successful recovery and to prevent recurrence.

How Do You Treat An IT Band Knee Pain?

How Do You Treat An IT Band Knee Pain?Treating Iliotibial Band Syndrome (ITBS) or IT band knee pain involves a combination of immediate interventions to reduce pain and inflammation, followed by rehabilitation strategies to address the root causes and prevent recurrence. Here’s a step-by-step approach:

Rest and Activity Modification

The first step is to reduce or stop the activities causing the pain, especially running or cycling. It’s important to allow the inflamed tissue to heal.


Applying cold packs to the affected area for 15-20 minutes several times a day can help reduce inflammation and alleviate pain. Ensure you have a cloth or barrier between the ice and skin to avoid frostbite.

Over-the-counter Pain Relievers

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can help reduce pain and inflammation. However, it’s essential to use these medications as directed and ensure they don’t interfere with any other medications or medical conditions.

Physical Therapy

Physical therapists can provide targeted exercises and stretches to strengthen the hip, thigh, and core muscles and improve flexibility in the IT band. They can also offer techniques like myofascial release or instrument-assisted soft tissue mobilization (IASTM) to help release tightness in the band.

Strengthening Exercises & Stretching

Weak hip and core muscles can contribute to ITBS. Exercises like clamshells, side leg lifts, and hip bridges can help strengthen these areas, promoting proper alignment and reducing stress on the IT band. Regular stretching of the hips, glutes, and thighs can help alleviate and prevent IT band tightness. Some effective stretches include the IT band stretch, standing hip stretch, and the pigeon pose.

Foam Rolling

While it can be painful, gently foam rolling the muscles around the IT band (rather than the IT band itself) can help in loosening tight tissues and improving flexibility. This includes rolling the quadriceps and hamstrings.


For those with biomechanical issues such as overpronation, custom-made orthotics or appropriate footwear can help correct alignment and reduce stress on the IT band.

Corticosteroid Injections

In severe cases that don’t respond to conservative treatments, a doctor might recommend a corticosteroid injection to reduce inflammation. However, this is typically a last-resort option due to potential side effects.


In very rare cases where non-surgical treatments do not help, surgery to release a portion of the IT band may be considered.

Remember, while ITBS can be a frustrating and painful condition, with the right approach to treatment, most individuals can recover fully. And return to their normal activities. Always consult with a healthcare professional for a personalized treatment plan.


Iliotibial Band Syndrome (ITBS) stands as a common challenge for athletes and fitness enthusiasts, often arising from a blend of overuse, biomechanical imbalances, and inadequate training practices. Recognizing the distinct symptoms of ITBS, understanding its underlying causes, and adopting a comprehensive approach to treatment are pivotal in not only alleviating pain but also preventing recurrence.

As with many musculoskeletal conditions, the key lies in early intervention, informed care, and a commitment to holistic well-being – ensuring that the passion for movement remains both enjoyable and sustainable. If you’re experiencing Knee pain, physical therapy for knee pain at PhysioMantra can help: Book an online physical therapy session.