Iliotibial Band Syndrome For Runners: Diagnosis, Symptoms, and Treatment

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Iliotibial band syndrome (ITBS) is one of the most common running injuries that can seriously hamper your training. If ignored, it can end up leaving you completely sidelined.

ITBS is often categorized by pain or discomfort near the lateral aspect of the knee, with an incidence rate estimated between 5% and 14%.

ITBS can be unpredictable. For this reason, effective treatment requires adherence to a structured rehab program.

This article will provide up-to-date science regarding ITBS, giving you the tools to help evaluate and treat this problematic syndrome.

In this article, we will be looking to answer the following:

  • What Is ITB Syndrome?
  • ITB Syndrome Diagnosis
  • ITB Syndrome Symptoms
  • Causes of ITB Syndrome
  • Can You Run With ITB Syndrome?
  • How To Effectively Treat ITB Syndrome

Let’s jump into it!

knee inflammation pain from running

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 biomechanical-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 an ‘impingement zone’ occurs when the knee is near 30 degrees of flexion during footstrike and the early stance phase of running.

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.

pain on the outside of the knee

ITB Syndrome Diagnosis

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 relative 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.
running down road at sunset

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. Your hips can drop, and your knees turn in.

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 in) 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 down 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!

running downhill, fell running

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.

runner's knee iliotibial band syndrome

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 causal factor that triggered it. t56

#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 whilst 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.

swimming in the pool for crosstraining

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 useful 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.  

#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 causal factors surrounding ITBS can be down 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

leg abduction with a resistance band

Hip abduction is a great way to isolate and engage 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.

Photo of author
Ben is a qualified Personal Trainer and Sports Massage Therapist with a particular interest in running performance and injury. He has spent the last 9 years working with runners at his clinic in Brighton. Ben is a keen runner and avid cyclist. Evenly splitting his time between trail running, road biking, and MTB.

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