IT Band Syndrome: Causes, Symptoms & Rehab for Runners

IT band syndrome is one of the most common running injuries. It usually starts as a sharp or burning pain on the outside of the knee a few miles into a run, and it often gets worse until you have to stop. Rest calms it down, but the pain tends to come right back when you start running again. Here is what causes IT band syndrome, how to recognize it, and how physical therapy gets runners back on the road.

What Is the IT Band?

The iliotibial (IT) band is a thick band of connective tissue that runs along the outside of the thigh, from the hip to just below the knee. It helps stabilize the knee and hip during running, walking, and cycling. IT band syndrome (ITBS), sometimes called IT band friction syndrome, happens when the tissue near the outside of the knee becomes irritated from repetitive loading.

It is especially common in runners, cyclists, and hikers, but it can show up in any sport with a lot of repetitive knee bending.

Symptoms of IT Band Syndrome

• Pain on the outside of the knee: sharp or burning, often starting at the same point in every run and getting worse the longer you go
• Pain on hills and stairs: downhill running is often the worst
• Tenderness or swelling over the outside of the knee
• Clicking or snapping on the outside of the knee in some cases
• Pain that can sometimes reach up toward the outside of the hip

What Causes IT Band Syndrome?

The IT band itself is usually the victim, not the cause. Most runners develop ITBS because something is overloading the outside of the leg:

• Too much, too soon: increasing mileage, speed, or hills faster than your body can adapt
• Weak hips and glutes: when the glutes can’t control the pelvis and thigh, the knee drifts inward and the tissue on the outside of the leg takes extra strain
• Running mechanics: overstriding, a narrow crossover stride, or excessive foot pronation
• Skipping the warm-up or cool-down
• Repetitive terrain: always running the same direction on a sloped road or track
• Not enough recovery between hard runs

How IT Band Syndrome Is Diagnosed

A physical therapist diagnoses ITBS with a combination of your history, a hands-on exam, and functional testing. We look at where it hurts and what brings it on, check your hip and core strength, and watch how you squat, step down, and run. In some cases, imaging such as MRI or ultrasound is used to rule out other causes of outside knee pain, like a meniscus or ligament injury.

How Physical Therapy Treats IT Band Syndrome

Effective treatment calms the irritated tissue and fixes the reason it got overloaded:

• Load management: adjusting mileage, pace, and hills instead of stopping completely, so you keep your fitness
• Hip and glute strengthening: progressive exercises that improve control of the pelvis and knee
• Manual therapy and soft tissue work: such as manual therapy, dry needling, and the Graston Technique to ease tension in the surrounding muscles
• Mobility work for the hips and ankles, when they are limited
• Running mechanics: small changes such as stride length or step width that reduce stress on the outside of the knee
• Short-term relief: ice after runs, and over-the-counter anti-inflammatories only under a healthcare professional’s guidance
• A graded return to running that builds back to your normal mileage without a flare-up

The Gray Methodâ„¢ helps us find which of these factors is driving your pain, so the plan fixes the cause and not just the symptom.

How to Prevent IT Band Syndrome

• Increase your mileage and intensity gradually
• Warm up before you run and cool down afterward
• Strength train your hips, glutes, and core year-round. Try these runner strength exercises
• Choose shoes that suit your foot type and replace them when they wear out
• Vary your routes and running surfaces

For more on staying healthy, read how to prevent running injuries.

Get Back to Running Pain-Free

IT band syndrome affects runners and athletes of every level, and it usually responds well to the right plan. If the outside of your knee keeps cutting your runs short, our running injury treatment in Fort Myers can help. Every visit is one-on-one with a Doctor of Physical Therapy, as part of our sports physical therapy for runners and athletes. You can also browse our guide to the most common sports injuries.

Start with our Fixing the Cause & Not Just the Symptoms Assessment, or Inquire About an Appointment →

Call our office at (239) 223-0484 to schedule your appointment.