Understanding Iliotibial Band Syndrome (ITBS)

Whether you’re training for a marathon, hiking on the weekends, or simply staying active, pain on the outside of your knee can interrupt your routine. One common cause of this discomfort is iliotibial band syndrome, often referred to as IT Band Syndrome.

This guide explains what ITBS is, what causes it, the symptoms to watch for, and how it can be treated. You’ll also learn about helpful exercises, prevention strategies, and when to consider seeing a specialist.

What Is Iliotibial Band Syndrome?

Iliotibial band syndrome is an overuse injury that affects the outer part of the knee. Also known as bilateral iliotibial band syndrome. It develops when the iliotibial band—a strong band of connective tissue running along the outside of your thigh—becomes tight or irritated.

This tissue helps stabilize your knee during movement. But when it becomes irritated from repetitive motion, it can cause pain and limit your ability to stay active.

What Causes ITBS?

Common Causes

• Repetitive knee bending: Activities like running, biking, or hiking can put repeated stress on the IT band.
• Sudden increases in activity: Adding mileage or intensity too quickly can lead to irritation.
• Hip abductor weakness or glute muscles: Muscle imbalances may shift stress to the IT band and cause hip pain.
• Improper form or posture: Poor running or cycling mechanics can affect how the IT band moves.
• Excessive foot pronation: When your foot rolls inward more than normal, it can affect knee alignment and increase stress on the IT band over time.
• Worn-out footwear or poor support: Shoes that lack cushioning or arch support may contribute to strain.

Who Is at Risk?

Iliotibial band syndrome is the most common risk factor in runners, cyclists, and hikers. But it can also affect people with active jobs or anyone doing repetitive movements involving the legs.

People with muscle imbalances or poor flexibility may also be at higher risk.

Symptoms of Iliotibial Band Syndrome

The most common symptom of ITBS is pain on the outside of the knee. It may begin as a mild ache and gradually become sharper or more intense.

Common Signs

• Sharp or burning pain on the outside of the knee
• Pain that worsens with activity, especially going downhill or climbing stairs
• Tenderness or tightness along the outside of the thigh
• Discomfort during or after exercise

In many cases, symptoms improve with rest but may return when activity resumes.

How ITBS Is Diagnosed

A healthcare provider can often diagnose ITBS through a physical exam and a discussion of your symptoms and activity levels. In some cases, imaging tests such as an MRI may be used to rule out other knee conditions.

Diagnosis often includes:

• A review of your exercise or activity routine
• An exam to check muscle strength, flexibility, and pain areas
• Tests to evaluate movement and range of motion

Treatment Options

Most cases of iliotibial band syndrome improve with non-surgical care. Treatment usually includes rest, stretching, strengthening exercises, and supportive iliotibial band syndrome therapies.

Common Treatments

• Rest and activity modification: Taking a break from high-impact activities allows inflammation to settle.
• Ice and anti-inflammatory medications: These can reduce swelling and ease pain in the early stages.
• Stretching and foam rolling: Targeting the hips, quads, and IT band can relieve tension.
• Strengthening exercises: Building strength in the hips and glutes helps reduce stress on the IT band.
• Physical therapy: A physical therapist can guide your recovery and help correct movement patterns.

In more severe or prolonged cases, other options may include:

• Corticosteroid injections to reduce inflammation
• Platelet-rich plasma (PRP) therapy in select cases
• Surgery, though rarely needed, may be considered if other treatments are not effective

Iliotibial Band Syndrome Exercises

Exercise plays a key role in recovery and prevention. These exercises can be guided by a physical therapist and tailored to your needs.

Stretching Exercises

• Standing IT band stretch
• Hip flexor stretch
• Hamstring stretch

Strengthening Exercises

• Clamshells
• Glute bridges
• Side leg raises
• Lateral band walks

Foam Rolling

Using a foam roller on the outer thigh and hip can improve flexibility and reduce tension. It’s best to use proper technique to avoid overdoing it.

Prevention Tips

Taking steps to prevent ITBS can help you stay active and reduce your risk of reinjury.

Helpful Strategies

1. Warm up and cool down before and after exercise: Begin each workout with a gentle warm-up to prepare your muscles and knee joints for movement, and finish with a cool-down period that includes stretching to support recovery and reduce stiffness.
2. Build up activity levels gradually: Avoid sudden increases in intensity or duration. Instead, increase your activity level by no more than 10% per week to give your body time to adapt and reduce the risk of overuse injuries.
3. Wear well-fitted shoes with good support: Choose footwear that matches your activity type and foot structure. Well-cushioned, supportive shoes help absorb impact and promote healthy alignment during movement.
4. Cross-train to avoid overuse from one activity: Incorporate a variety of exercises into your routine—such as swimming, cycling, or strength training—to avoid putting repeated stress on the same muscles and joints.
5. Incorporate strength and flexibility training into your weekly routine: Dedicate time each week to build strength in key muscle groups like the hip muscles, glutes, and core, while also stretching regularly to maintain flexibility and joint mobility.
6. Listen to your body—early signs of discomfort should not be ignored: Pay attention to pain, tightness, or fatigue. Taking action early, such as modifying your routine or seeking medical advice, can prevent minor issues from becoming more serious.

When to See a Doctor

If your symptoms don’t improve with rest and self-care, it’s a good idea to see a healthcare provider. You should also seek care if:

• Pain limits your ability to walk, run, or perform daily activities
• There is swelling or redness around the knee
• You have pain that worsens over time

A sports medicine specialist or orthopedic provider can help determine the best course of treatment and support your return to activity.

One Stat to Know

According to Sports Medicine, iliotibial band syndrome accounts for up to 14 % of running-related injuries to the knee—making it one of the most common overuse injuries for runners.
Source: https://pubmed.ncbi.nlm.nih.gov/26701812/

Staying Active with Confidence

Iliotibial band syndrome can be frustrating, especially when it interrupts your ability to move comfortably. But with the right care plan—including rest, targeted exercises, and expert guidance—most people recover fully and return to their favorite activities.

At OPA Ortho, our team takes a thoughtful approach to iliotibial band syndrome treatment, helping you manage symptoms, rebuild strength, and prevent future issues. Whether you’re training hard or simply looking to stay active without pain, we’re here to support your movement and recovery goals.

Want to Learn More?

If you’re experiencing iliotibial band syndrome symptoms or looking for guidance on injury prevention, schedule a consultation with one of our specialists today. At OPA Ortho, we’re here to help you move better, feel stronger, and stay active for the long run.