People who exercise regularly, particularly runners, are prone to experience pain in the outer part of the knee. When this occurs, iliotibial band syndrome may be the cause.
Iliotibial (IT) band syndrome is often
The IT band is made up of fascia, or connective tissue. It is an elastic group of fibers that runs along the thigh from the hip to below the knee. The band supports the knee and facilitates hip extension and rotation. A sac-like bursa lubricates the band as it slides against the greater trochanter, the quad muscles, and the lateral femur.
When overused, the IT band can become tight. The tightening can cause the band to rub against the knee or hip. This rubbing can lead to pain and swelling. It may also lead to inflammation in the bursa, which can cause a related condition known as trochanteric bursitis.
In addition to affecting athletes and people who engage in strenuous physical activity, IT band syndrome may occur in people with tight hip abductor muscles or prominent greater trochanters.
People who already have trochanteric bursitis are particularly susceptible to IT band syndrome. In fact, trochanteric bursitis and IT band syndrome are part of what many medical researchers
IT band syndrome may begin as mild pain and intensify if left untreated. In the early stages, there is pain only during overexertion late in an activity such as running or cycling. As the syndrome gets worse, pain sets in earlier during a session.
The best treatment is often to stop doing the activity causing the pain. In more severe cases, a person may need to consider surgical options. Improved biomechanics and changes to training routines may help prevent IT band syndrome.
IT band syndrome is often relatively easy to treat. The most important treatment is to stop the activity that causes the pain. Reducing or changing physical activity will typically allow the leg to fully heal.
There are two other main types of nonsurgical treatment for the condition:
- reducing pain and swelling
- stretching and preventing further injury
These methods help
Some of the most common ways to reduce the pain and swelling of IT band syndrome include:
- resting and avoiding activities that aggravate the IT band
- applying ice to the IT band
- massaging the area
- taking anti-inflammatory medications, which are often available over the counter
- receiving ultrasounds and electrotherapies to reduce tension
- undergoing physical therapy
In addition, to reduce pain, doctors can perform a steroid injection into the IT band around the lateral femoral condyle or into the bursa, if it is affected.
IT band lengthening surgery may be an option for those who still
Symptoms of IT band syndrome may vary slightly in intensity and appearance from person to person.
- pain when running or doing other activities involving the bending of the knee
- a clicking sensation where the band rubs against the knee
- lingering pain after exercise
- a knee that is tender to the touch
- tenderness in the buttocks
- redness and warmth around the knee, especially the outer aspect
Symptoms typically begin a short time after starting the physical activity.
The most common symptom of IT band syndrome is pain around the lateral part of the hip that gets worse if the person continues the activity causing the pain.
As a person continues to run or participate in a similar activity, the IT band will continue to rub against the outside of the knee, leading to swelling and severe pain.
IT band syndrome is usually not permanent. With proper treatment, a person’s return to regular activities will depend on how long it takes the injury to heal. In many cases, a person may begin a gradual return after 3–4 weeks of treatment.
Doctors may recommend surgery for those who do not get better after 6 months of activity changes, rest, stretching, icing, and anti-inflammatory medicines.
Anyone who runs enough can develop IT band syndrome. However, some stretches and exercises may help both prevent and treat the condition.
People should aim to do a combination of stretching and specific exercises that focus on the IT band. Some of these exercises and stretches are described below.
Lying glute stretch
This stretch is easy to perform.
- Lie flat on the back with one leg outstretched.
- Lift the leg and, holding the leg at the shin, pull the knee toward the midsection.
- Gently pull the leg until feeling a stretch.
- Hold the stretch for a few seconds.
A person should feel this stretch on the outer muscles of the hamstring.
- Stand with both feet together.
- While holding the supporting leg, place one foot behind and just past the other foot.
- Lower the body, bending at the supporting knee.
Foam roller stretch
This exercise helps massage out and gently stretch the tight IT band.
- Place a wide foam roller on the ground or a yoga mat.
- Using the forearm for support, lie sideways on the roller.
- With the roller positioned under the hip, move the body forward so that the roller moves up and down the leg as far as the knee.
Standing or lying hip abduction
In the standing position:
- Stand with both legs together.
- Lift one leg to the same side away from the center.
- Repeat with both legs.
In the lying position:
- Lay on the side and lift the leg into the air.
- Repeat 10 to 15 times on each side.
A person may add a weight or resistance band to their stretching as they get stronger. These are also available online.
Hip abduction machine
People with access to a gym may be able to use a piece of equipment that targets the hip abductors — the muscles that move the leg out away from the body. Stretching these muscles can help treat and prevent knee pain.
The machine requires the user to sit with their legs together, knees bent, and feet on the footrest.
The machine has pads attached to a weighted pulley system designed to sit on the outside of the legs just above the knees. The person then opens their legs, pressing against the machine’s resistance.
Things to avoid
A person with IT band syndrome
When returning to these activities, people typically need to ease back in slowly to help prevent a recurrence of symptoms.
Runners should always increase the distance of their runs gradually.
Physical therapists and trainers
To determine whether a person has IT band syndrome, a healthcare professional will likely talk with the person about their symptoms. They will need to know when the pain began and what activities cause the pain.
The doctor or other healthcare professional will then likely
The healthcare professional may also watch how the person stands and walks to check for pronation of the foot. They will also look for tightness in the upper leg muscles and hips.
A tight iliotibial band is the main cause of IT band syndrome.
When working normally, the IT band will glide across the outside of the knee over a fluid-filled sac called a bursa. If the IT band becomes too tight, the band will rub against the knee, causing friction, swelling, and pain.
Some people may be more prone to developing IT band syndrome than others. Some factors that can increase a person’s risk include:
- running on uneven surfaces
- rolling the foot while running
- a difference in leg length
- poor running form
- naturally tight or wide IT band
- weakness in the hips
- flattening foot or pronating when running
- not stretching enough
A person can help prevent IT band syndrome by modifying physical activity and making changes to footwear. Tips for avoiding IT band syndrome include:
- Altering the training routine: Someone with IT band syndrome should avoid running on hills or uneven surfaces. They should avoid overtraining and ensure adequate rest periods between sessions. They might also find a new training environment that reduces stress on the knee.
- Stretching to prevent tightness: To maintain flexibility in the hip and upper leg, a person should frequently stretch the IT band area, including the outer thigh and hamstrings.
- Getting new shoes for athletic activity: Replacing old shoes with new ones can prevent uneven gait due to worn soles. The correct shoe can also help
correctpronation, a risk factor for IT band syndrome. There are also inserts available to support the foot’s arch and help stabilize the foot.
- Consulting with a physiotherapist or sports medicine specialist: An expert can work with an individual to identify biomechanical causes of IT band syndrome. They may also develop a rehabilitation program to work on flexibility, strength, and controlled movement of the hip, pelvis, foot, ankle, and knee.
IT band syndrome is preventable, and athletes can usually return to their sport with modifications in place.
A person with IT band syndrome should experience a full recovery once they have stopped the offending activity for a while.
People can reduce the risk of reinjury through stretches and exercises that strengthen the legs and keep them flexible.
Once rested and healed, a person should be able to return to their preferred activity, though easing back in gently is a good idea.