What Is IT Band Syndrome?

IT band syndrome, also called IT friction syndrome or runner's knee, causes pain on the outside of your knee. IT band syndrome is most common in runners and cyclists, but it can also affect skiers, basketball, soccer and hockey players - anyone who participates in activities with repetitive leg movements.

Key Takeaways: IT Band Syndrome

• IT band syndrome is a common overuse injury. It causes pain on the outside of the knee and is most often seen in runners, cyclists and athletes with repetitive leg movements.
• Pain in the IT band is often caused by friction and inflammation. The IT band rubs against the thigh bone, leading to irritation, swelling and pain — often due to overtraining, poor form or lack of stretching.
• Treatment is usually simple and effective. Most cases of IT band syndrome improve with rest, activity modification, stretching, ice, anti-inflammatory medications and sometimes physical therapy.
• Preventing pain in the IT band focuses on proper training habits. Regular stretching, warming up, strengthening hips and core, avoiding uneven surfaces and cross-training can help prevent this pain from coming back.

What Is My IT Band?

Your IT band, short for iliotibial band, is a band of tissue that runs along the outside of your leg between your hip and knee. This structure provides stability to your outer knee and hip during movement. When your knee bends, your iliotibial band moves over a bump in the thigh bone on the outside of your knee. Fluid-filled sacs, call bursal sacs, reduce the friction between the IT band and the bone when your knee bends.

What Is IT Band Syndrome?

IT band syndrome is an overuse injury usually caused by overtraining and training mistakes made by runners, cyclists, and other athletes. Iliotibial band syndrome also can happen due to skeletal misalignment in your body.

"The bursal sac receives too much friction which causes inflammation and pain when the IT band moves over the bone," said Gregory Rowdon, MD, a sports medicine doctor with Franciscan Physician Network Primary Care & Sports Medicine Lafayette.

What Are Symptoms Of IT Band Syndrome?

The most common symptoms of IT band syndrome are pain and tenderness around the bump. Pain can feel dull and achy or sharp. The area may also be red, swollen or feel warm.

“A lot of times you'll feel this when running or doing prolonged activity such as walking or going up or down stairs,” said Joe Bell, physical therapist at Franciscan Health Indianapolis. “It's this intense pulling sensation on the side of the leg that can cause pain around the outside of your knee.”

What Increases My Risk Of IT Band Syndrome?

Some physical characteristics can increase your risk of IT band syndrome, such as:

• Bowed legs (knees curve outward)
• Feet that roll outward (supination).
• Weak hip or core muscles

Rubbing between your IT band and bone can also happen if you don't stretch or warm up enough before exercising. It may also happen when running downhill or on a tilted surface, such as a track or slanted road.

How Can I Prevent IT Band Syndrome?

To help prevent IT band syndrome, make stretching the outside of your leg part of your routine. Additionally, take a few minutes to warm up your legs before you start running or cycling – such as marching in place, knee lifts, lunges or jumping jacks. If you're a runner, try to avoid slanted surfaces, or switch directions often.

Cross-training is a great way to exercise different muscles, give your legs a break, and improve whole-body strength and fitness.

"Triathletes are a great example of cross-training athletes," Dr. Rowdon said. "We probably see fewer IT band issues in triathletes than in runners."

When Should I See A Doctor For IT Band Pain?

Bell recommends stretching, strengthening the hips and knees and doing simple massage along the side of the leg to help reduce muscle soreness.

"Usually if trying some of these things on your own at home doesn't go well within the first couple of weeks, that's when reaching out to someone for physical therapy would be great,” he said. “These things are going to be most beneficial early on versus waiting longer periods.

You may see a physical therapist for IT band pain without a physician referral, or IT band syndrome may be diagnosed by your physician.

How Is IT Band Syndrome Diagnosed?

Doctors determine if you have IT band syndrome with a physical exam and X-rays.

"We examine the knee to rule out other problems," Dr. Rowdon said. "When the knee exam doesn't demonstrate any other problems, we check for IT band tightness. Generally, we also take X-rays to make sure something else isn't causing the pain."

How Is IT Band Syndrome Treated?

Typically, IT band syndrome responds well to conservative treatments. It rarely requires surgery.

"Treatment includes activity modification, ice and anti-inflammatory medicines to relieve swelling, and stretching," Dr. Rowdon said.

When foot problems like supination are the source of the problem, treatment may include orthotic devices, such as shoe inserts to correct abnormal foot movement.

Activity modification

Activity modification may include running or cycling shorter distances or incorporating another exercise – such as swimming – while your IT band is healing.

"It may mean a seat height adjustment for a cyclist," Dr. Rowdon said. "For track runners, it may mean changing direction on the track or road so the affected leg is the downside leg."

Reduce swelling and pain

Anti-inflammatory medicines – such as ibuprofen -–and icing help reduce swelling, which relieves pain.

"Because the painful area is near the surface of the skin, we often use topical anti-inflammatory creams instead of oral anti-inflammatories," Dr. Rowdon said.

Massage therapy including foam rolling also can relieve pain.

IT Band Stretching

Stretching is an essential part of treatment. Working with a physical therapist can help you recover as quickly as possible and prevent IT band syndrome from recurring.

The common thing to do for IT band pain is to work on the areas around it.

“We're going to try to stretch out the tissue of the side of the leg and try to strengthen the hips and knees,” said Bell. “The more strength we can get in the hips, the better alignment of the knee and therefore less loading andpressure at the different structures around the knee such as the iliotibial band."   

Your physical therapist will show you how to stretch the outside of your leg and give you hip- and core-strengthening exercises to prevent IT band syndrome. They can also provide posture training to improve your form.

"Once you have IT band syndrome, it's important to continue IT band stretches even after you heal – being proactive can help prevent it from recurring," Dr. Rowdon said. "Using a foam roller can also help, but it's not enough on its own. Combine it with stretching, icing and medicine to get the best results."

How Long Does It Take To Recover From IT Band Syndrome?

"Recovery time depends on how inflamed your IT band is," Dr. Rowdon said. "Generally, you can return to running or cycling within a few weeks. For athletes who have an upcoming race, they may choose to have a corticosteroid shot to reduce swelling, but typically we recommend activity modification, anti-inflammatories and ice, and physical therapy/stretching."