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IT Band Syndrome

What is it and what can be done about it?

Author: Dr. Britt Dalton, PT, DPT, OCS, COMT, FAAOMPT

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 Iliotibial band syndrome, also known as IT band syndrome or ITBS, is a common condition responsible for lower body pain. Research has shown it can account for anywhere from 5% to 20% of lower extremity running injuries and is also commonly seen in cyclists.

The iliotibial band is named as such because it connects to your ilium, or pelvis, runs down the side of your thigh, and attaches to your tibia, or shin bone, just below the knee joint. It is a thick layer of fascia (fascia=tissue in the body that acts like webbing, connecting to muscles, bones, and other body structures and acts as structural support for these areas, keeps different tissues separated, etc). Fascia is thicker in certain areas of the body, with the IT band being one of these areas. Muscles at the top of your thigh, which support your hip and trunk, connect to the band. They are responsible for stabilizing your hip and pelvis when standing and in doing so control how much tension there is on the IT band.  

The current consensus is that pain associated with IT band syndrome comes from compression of a fat pad along the side of your knee. As such, in the majority of cases of ITBS, pain is most often felt along the outside of the knee. It is often felt when you bend and straighten your knee, particularly when the knee only slightly bends. This is why people who do activities that require frequent or excessive amounts of bending and straightening of their knees, such as runners and cyclists, are most prone to developing this problem.

IT band syndrome can be very painful and can have a significant effect on one’s activity level. It is often slow to resolve, even when the correct treatments are provided, and many times requires addressing multiple different biomechanical and training flaws.

To try and keep things concise, here is a list of common points of concern that we often try to address when someone comes in with IT band syndrome. While every case is different and someone might not require specific work on all these areas, or may have other issues not on the list, being attentive to each of these points in the beginning can oftentimes help to get the symptoms of ITBS under control.

 Points to consider:

Weekly mileage: IT band syndrome is most often considered to be a problem of overuse, or doing too much too soon. Reducing weekly mileage when running or cycling is often a crucial first step in getting symptoms under control.

Volume of training: while it is still important to maintain some level of activity when dealing with ITBS, taking an extra day or two a week to rest can aid with recovery and prevent symptoms from gradually building as the week progresses.

Change your terrain: hills and uneven terrain can often be more painful to run or bike on. Temporarily switching to flatter, more even surfaces when running and cycling may help to reduce symptoms.

Watch your stride: over-striding when running can often increase the force through the hip. Reducing your stride or increasing your cadence (steps per minute) by as little as 10% beyond your normal can help lessen stress through the hip and knee.

Build your hip strength: increasing strength in your hip muscles, particularly those muscles which control side-to-side and rotational movements, can greatly help to reduce strain on the hip and tension on the IT band.  

Check your feet: a tendency to over-pronate, or flatten your foot too quickly or too much, when walking and running may mechanically contribute to excessive tension being placed on the IT band. Addressing this with strengthening of the foot and ankle musculature, wearing appropriate shoes, and/or using orthotics may be needed to reduce symptoms.

Don’t spend too much time stretching or rolling: while you may hear about or see IT band stretches performed, it is not usually the IT band which is stretching. What’s more, there are arguments that we cannot really stretch the IT band, and doing so may actually be more detrimental. Stretching of the surrounding hip musculature, particularly the glutes, may help to temporarily relieve symptoms, but rarely is the answer to resolving the problem. Similarly, foam rolling of the glutes, quadriceps, and IT band may help to temporarily reduce symptoms, but does very little to create any long-term change. My advice to most people is to use stretching and rolling if it feels good, but make sure you are addressing the other factors listed above before devoting a lot of time to either.

Remember, IT band syndrome can be a stubborn and slow condition to resolve. It will usually require addressing multiple areas and will likely test your patience many times throughout the process. However, if you have a good plan and are persistent with it, IT band syndrome can be fixed, and you can get back to those activities you love.

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Released: July 28, 2025