IT Band syndrome

Definition/Description

What Is Iliotibial Band Syndrome (ITBS)?

Iliotibial Band Syndrome—also called ITB pain or lateral knee pain—is a common overuse injury that causes pain on the outer side of the knee, just below the thigh bone. It's often seen in runners and athletes who repeat the same leg movements, like cyclists. Think of the IT band like a tight strap running along the side of your thigh. When that strap gets too tight or rubs against the bone during motion, it can become irritated and painful.

New research suggests that this pain might actually come from pressure on sensitive fat tissue beneath the IT band. During running, especially when the knee bends around 30 degrees (like during foot strike), the IT band can squeeze this area. Muscles like the gluteus maximus and tensor fascia latae tighten the IT band at this moment, adding to the pressure.

Clinically Relevant Anatomy

The iliotibial (IT) band is a strong strip of connective tissue that runs down the outside of your thigh—from the top of your hip (iliac crest) to the outer part of your shin bone (Gerdy’s tubercle). It’s supported by muscles like the gluteus maximus and tensor fascia latae. Think of it as a bungee cord that helps stabilize your leg during movement.

At the knee, the IT band passes over the bony bump of the thigh bone (the lateral femoral epicondyle) but doesn’t directly attach there. This allows it to slide forward and back as the knee bends and straightens, which can cause irritation if movement is repetitive or alignment is off.

Recent studies suggest the IT band may also serve as a sensor, helping the body react to pressure and adjust movement patterns. This could explain why problems with the IT band can feel so sharp and reactive.

Causes and Who It Affects

ITBS is one of the most common running injuries, making up 5–14% of all cases. In sports like running, cycling, or any activity that involves frequent knee bending, the IT band can get irritated from rubbing or being compressed repeatedly.

ITBS is complex and can be caused by multiple things:

• Rubbing of the IT band against the thigh bone
• Compression during knee movement
• Weak hip muscles, especially abductors
• Inflammation in small structures like bursae (fluid-filled sacs)
• Misalignment or poor movement patterns

Recent evidence even suggests the IT band helps control rotation in the knee—so sports that involve quick turning or pivoting can increase the risk.

Risk Factors

Risk factors vary between men and women due to differences in anatomy and biomechanics:

In Female Runners:

• More inward movement (adduction) and rotation at the hip
• Weaker hip abductor strength
• Less internal hip rotation during stance phase

In Male Runners:

• Peak hip adduction angle plays a role, but the relationship is less clear

Across all groups, weak hip muscles—especially those that stabilize the pelvis and leg—are strongly linked to ITBS.

How It Presents (Signs and Symptoms)

People with ITBS often report:

• Sharp or burning pain on the outside of the knee
• Pain that worsens during running or going downstairs
• A snapping or popping feeling as the knee bends
• Tenderness or swelling over the outer knee

Symptoms usually show up after a certain distance or time running, especially when going downhill. Some describe it like rubbing your finger over a balloon—smooth at first, then suddenly taut and sore.

ITBS often becomes clear during a physical exam when pushing on the outer knee causes pain—especially around 30 degrees of knee bend. This is the “impingement zone” where the IT band presses hardest against the bone.

Other Conditions That Can Look Similar (Differential Diagnosis)

Before diagnosing ITBS, clinicians must rule out other possible causes of outer knee pain, including:

• Hamstring (biceps femoris) tendinopathy
• Meniscus injuries
• LCL (lateral collateral ligament) injury
• Patellofemoral pain syndrome
• Nerve pain (like from the lower back)
• Stress fractures
• Popliteal or peroneal tendon issues
• Trochanteric bursitis

Tests and Diagnosis

Common Tests Include:

• Renne Test
• Noble’s Compression Test: Pressure on the outer knee at 30–40 degrees of bend causes pain
• Ober’s Test: Checks for tightness in the IT band

Combination Testing: Combining the Ober and Noble tests increases accuracy. Movement tests and palpation during these exams help reproduce symptoms and pinpoint the irritated area.

Medical Management

Initial Steps:

• Reduce or modify activity
• Switch to low-impact exercises like swimming
• Use ice or heat to manage symptoms

If Symptoms Persist:

• Ultrasound therapy
• Muscle stimulation
• Anti-inflammatory delivery via iontophoresis or phonophoresis

Shockwave Therapy: Radial Shockwave Therapy (RSWT) uses sound waves to stimulate healing and reduce pain. It’s safe, though temporary soreness and redness can occur. It’s especially promising in runners who haven’t improved with other treatments.

Physiotherapy Management

Most cases of ITBS are successfully managed without surgery. Physical therapy focuses on:

• Identifying Weaknesses: Especially in the glutes and hip stabilizers
• Myofascial Release: Targeting trigger points in the outer thigh and hip muscles
• Foam Rolling: Used to reduce tension and pain in tight areas

Key Exercises Include:

1. Glute Bridge with Resistance Band: Strengthens glutes and stabilizes pelvis
2. Side-Lying Hip Abduction: Targets glute medius to control hip movement
3. Lateral Band Walk: Builds hip strength for dynamic stability
4. Side Plank: Improves core and hip stability

Other Helpful Exercises:

• Hip hikes
• Step-downs
• Wall squats
• Single-leg deadlifts

Modifying running or cycling form is also essential. Cyclists should avoid pedaling with their toes turned in, and runners may benefit from gait retraining.

Surgery

Surgery is usually a last resort, only considered when physiotherapy and other treatments fail. During surgery, a small portion of the IT band may be removed or adjusted. Outcomes are generally good, with 81–100% of athletes returning to sport.

Some cases also involve removing inflamed bursae or tissue. Though evidence for surgery is limited, it may be beneficial for those with chronic symptoms who haven’t improved with conservative care.