If you’ve ever felt a nagging pain on the outside of your knee during or after a run, you might be dealing with iliotibial band syndrome—aka ITBS. It’s one of the most common overuse injuries among runners, and if you try to just “run through it,” it can quickly go from annoying to completely sidelining.
That classic pain around the outside of the knee? That’s the hallmark symptom of ITBS, which affects an estimated 5% to 14% of runners.1van der Worp, M. P., van der Horst, N., de Wijer, A., Backx, F. J. G., & Nijhuis-van der Sanden, M. W. G. (2012). Iliotibial Band Syndrome in Runners. Sports Medicine, 42(11), 969–992. https://doi.org/10.2165/11635400-000000000-00000
And the tricky thing is, it doesn’t always behave the same way. Sometimes it flares up during runs, sometimes after, and sometimes it seems to vanish… until it doesn’t.
Because it can be unpredictable and stubborn, ITBS recovery calls for more than just rest or foam rolling. It requires a smart, structured rehab plan based on the latest science, and that’s exactly what this guide is here to help with.
Let’s dig into what causes ITBS, how to treat it, and what you can do to get back to running pain-free.
What is ITB Syndrome?
The iliotibial band, or IT band, is the thick band of fibrous fascia that runs along the outside of your upper leg, connecting your hip to your knee.
Its main functions are pelvic stabilization and lower leg motion.
It has long been thought that ITBS results from the friction of the iliotibial tract over the lateral femoral epicondyle during knee flexion.
Either way, the result is pain, usually felt on the outside of the knee and around the IT Band.
There are two prevailing thoughts as to the specific mechanical cause of ITBS.
#1: ITB Friction (“Slipping Band”)
For many years, it was thought that during repeated flexion and extension movements, the ITB moved back and forth over the lateral femoral epicondyle.
This biomechanically induced frictional force aggravates a sub-tendinous bursa that separates the bone from the tendinous aspect of the ITB.
Repeated aggravation can cause localized inflammation in the bursa and ITB.
There is little high-quality evidence to support the idea that the ITB “slips.”
#2: ITB Impingement (“Compression”)
Unlike the “friction” theory, the impingement theory states that the ITB does not move across the lateral femoral condyle. Therefore, friction-related inflammation cannot occur.
Instead, this condition is now thought to be caused by compression of local innervated adipose tissue.
Studies have proposed that an ‘impingement zone’ occurs when the knee is near 30 degrees of flexion during footstrike and the early stance phase of running.2Geisler, P. R., & Lazenby, T. (2017). Iliotibial Band Impingement Syndrome: An Evidence-Informed Clinical Paradigm Change. International Journal of Athletic Therapy and Training, 22(3), 1–11. https://doi.org/10.1123/ijatt.2016-0075
During this phase of the running gait, eccentric contraction of the gluteus maximus and hip causes the leg to decelerate, generating compression in the ITB.
Research reports that when the painful area is scanned, it is usually the fat pad and bursa tissue between the IT band and the thigh bone that shows signs of injury, rather than the IT band itself.3Friede, M. C., Innerhofer, G., Fink, C., Alegre, L. M., & Csapo, R. (2022). Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals? Physical Therapy in Sport, 54, 44–52. https://doi.org/10.1016/j.ptsp.2021.12.006
How To Diagnose ITB Syndrome
If you are experiencing pain on the outer side of the knee, you may be suffering from ITBS.
More specifically, ITBS usually presents with pain or tenderness when palpating the outside of the knee.
To properly diagnose ITBS, it is recommended to see a physical therapist who can perform the relevant diagnostic tests, such as Ober’s test or Noble’s Test.
ITB Syndrome Symptoms
Here are the main symptoms of ITBS:
- Particularly sharp pain on the outer side of the affected knee.
- Pain radiating up to the outer side of the thigh or calf muscle.
- Increased pain when walking downstairs or downhill.
- Swelling around the outer portion of the knee.
- Tenderness when palpating around the lateral aspect of the knee.
- Crepitus (popping sound) or grinding feeling in the knee during flexion.
The 3 Likely Causes of ITB Syndrome
There are multiple possible causes of ITBS, such as muscle weakness/tightness, running gait, and training methods.
1. Muscle Weakness/Tightness
If the muscles involved in hip abduction are excessively weak or tight, it can lead to increased hip internal rotation and knee adduction. 4Your hips can drop, and your knees turn in.Mucha, M. D., Caldwell, W., Schlueter, E. L., Walters, C., & Hassen, A. (2017). Hip abductor strength and lower extremity running related injury in distance runners: A systematic review. Journal of Science and Medicine in Sport, 20(4), 349–355. https://doi.org/10.1016/j.jsams.2016.09.002
Strengthening of the gluteus maximus/medius and tensor fasciae latae will help reduce internal rotation and excessive compression on the IT band and lateral femoral condyle.
Internal hip rotation and knee adduction are found to be significant factors for runners with ITB syndrome.
Check below for exercises aimed at strengthening the hip abductors.
2. Running Gait
Running gait refers to your running stride when you run.
During the stance phase, when your foot hits the ground, excessive pronation in your foot (when your foot rolls inward) can cause your lower leg to turn in more, leading to the ITB pulling tight and compressing against the outer part of the knee.
3. Training Methods
ITBS is most commonly thought to be a non-traumatic overuse injury. The most common risk factor in runners is usually due to a sudden increase in training volume.
Not allowing your body adequate time to rest and repair after a training run will lead to accumulated stress.
If you are new to running, increase your volume slowly. If you are a seasoned runner, check for recent inconsistencies or spikes in your training.
Sudden increases in downhill running, in particular, can lead to excessive force on the knee and IT band.
Additionally, running on banked ground can provide further aggravation as the subtle drop of the outside of the foot stretches the ITB. Keep the terrain varied.
Can you run with ITB Syndrome?
To get an accurate diagnosis for you, check with a medical professional.
The answer is not a straightforward yes or no, and whether you can will usually differ from whether you should.
Recovery from ITBS can take anywhere from 4 to 12 weeks, sometimes longer. How long that takes will be influenced by your active participation in the recovery process.
The most common mistake runners make is jumping back into running too quickly.
ITBS is particularly tricky as the onset of pain can happen mid-way through a run and quickly ramp up until you have to walk home.
The likelihood is that if you’re suffering from acute ITBS and you feel pain when walking or as soon as you start running, your body could probably do with some rest.
Continuing to run with ITBS may slow the healing process and prolong the course of the injury.
However, injury isn’t straightforward, and the body can often deal with low loads when aggravated.
If the symptoms are mild and don’t deteriorate with exercise, then a substantially reduced volume of running is certainly possible.
How to effectively treat ITB Syndrome
There are many things you can do to help effectively treat your ITB syndrome. The effectiveness of each will be dependent on the specific factor that triggered it.
#1: Active Rest
Activity modification to prevent further aggravation is a must. If we continue to ignore the pain, it will continue to worsen.
An initial period of active rest is usually crucial in effective treatment.
The key to active rest is to remain active but modify the types of activity.
It is advised to cross-train to maintain a level of conditioning while not being able to run, as long as these activities do not aggravate your symptoms.
Swimming in your local pool, cycling, and other non-impact-based activities are all good options.
Injury can be tough on the mind, too; remaining active will help you keep sane.
#2: Anti-inflammatory medication (NSAIDs)
Using anti-inflammatory medication like ibuprofen or naproxen may be helpful in the reduction of inflammation in the fat pad during the early stages of treatment.
Always discuss the use of NSAIDs with your doctor before using them.
#3: Radial Shockwave Therapy (RSWT)
RSWT is thought to stimulate the healing process of soft tissue and to inhibit nociceptors.
Studies have shown it to be an effective part of a rehabilitation program for runners suffering from iliotibial band syndrome.5Weckström, K., & Söderström, J. (2016). Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome. Journal of Back and Musculoskeletal Rehabilitation, 29(1), 161–170. https://doi.org/10.3233/bmr-150612
#4: Manual Therapy
Deep friction massage from a sports massage therapist or the use of a foam roller on the tight muscles can also be beneficial.
Trigger point work in the biceps femoris (hamstring), vastus lateralis (lateral quadriceps), gluteus maximus, and tensor fascia latae muscles can all help in pain management.
It is important to note that there is little evidence that working directly over the ITB helps relieve symptoms or promotes healing. It is a thick band of connective tissue.
Instead, work to help loosen the connecting muscles, such as the gluteus maximus, gluteus medius, and tensor fasciae latae, to improve stabilization of the knee.
Check out our guide to foam rolling the ITB here.
#5: Strength and Conditioning
As previously discussed, many of the factors surrounding ITBS can be attributed to the weakness of supporting muscles.
If it is clinically indicated that muscle weakness was a contributing factor, then a progressive strengthening program has been shown to be highly effective.
Here are a few exercises to strengthen the hip abductors:
Standing Leg Abduction
Hip abduction is a great way to isolate and engage the glute medius.
1. Loop one end of the resistance band around your active leg and the other around your ankle on the ground.
2. Lift your outer leg out to the side as far as is comfortable. Pause for 1 second, then return your leg to the starting position.
3 sets, 12 repetitions
Resistance Band Glute Bridge
Adding the resistance band will help engage your gluteus medius.
1. Place a resistance band just above your knees.
2. Lie on your back, your knees bent, your feet flat on the floor, and your arms by your sides.
3. Squeeze your glutes, engage your core, and lift your hips up toward the ceiling as far as you can without arching your back. You want your body to be in a straight line from knees to shoulders.
4. Slowly lower your hips down to the starting position.
3 sets, 15 repetitions
Resistance Band Squat
1. Place the resistance band just above your knees.
2. With feet slightly wider than your hips and your feet slightly turned out, lower yourself down and push your hips back. Keep your knees pushing out sideways into the band.
3. Stand up and repeat.
Dealing with ITBS can be frustrating, especially when it flares up right in the middle of a training block or race prep. But with the right approach, recovery is absolutely possible, and often quicker than you think.
The key is not to ignore the pain or try to push through it, but to take smart, proactive steps: dial back your mileage, modify your activity, address strength imbalances, and follow a targeted rehab plan.
Remember, ITBS is one of the most common running injuries for a reason, but that also means there’s plenty of solid science behind how to treat it.
Stick with your recovery work, build back gradually, and stay patient. With time and consistency, you’ll not only get back to running pain-free, but you’ll likely return stronger and more resilient than before. Keep going—you’ve got this.
To ensure you increase your mileage gradually to reduce the risk of ITBS, check out this next guide:
