Iliotibial Band Syndrome & Knee Pain in Runners


Iliotibial Band Syndrome

Written by Dr. Laura Mizumoto, Physical Therapist
Experience Momentum Physical Therapy


The iliotibial band, also known as the IT band (ITB), is a thick band of tissue that starts at the front of the pelvis and courses down across the thigh to the outer knee, just below the joint line anchoring on the shin bone, the tibia. It acts as a stabilizer and force diffuser, supporting the lateral aspect of the knee along with converting load from the muscles it attaches to. It is commonly injured in the active population and causes lateral knee pain, hip pain, or both that ranges from minor soreness, to intense stabbing pain making it almost impossible to walk. The irritation is usually caused from either friction of the band at the lateral knee due to the repetitive bending and extending of the knee while under load, or due to excessive loading of the tissue as a result of overuse and too much stress placed on the tissue from poor mechanics of the leg. It tends to affect more women than men and can severely limit training and progress to other aliments if untreated.

Symptoms of IT band syndrome                                               

  1. Pain with squatting
  2. Pain with standing after prolonged sitting
  3. Pain with descending stairs                                        
  4. Sharp pain at the outside of the patella (knee cap) and knee while running
  5. A snapping sound or sensation at the lateral aspect of your knee  

Causes of IT band injuries

  1. Inhibited or weak gluteal/lateral hip muscles
  2. Restricted hip mobility and tight hip muscles
  3. Improper footwear causing excessive foot pronation                                                
  4. Increasing activity or intensity too quickly
  5. Running on uneven surfaces (slanted road, running only one direction on the track)     

Diagnosis and Treatment for IT band pain

To diagnose, your Physical Therapist (Doctor of Physical Therapy, DPT) will assess your knee and additional joints and rule out meniscus or LCL pathology. Then, your Physical Therapist will perform soft tissue techniques to immediately change your pain, showing a positive result for ITB. This will be followed up with additional movement assessments.

For treatment, we recommend consulting a Physical Therapist specifically, as moderate to sever pain is conclusive that you have significant mechanical problem areas needing to be addressed. However, if your pain is minor, try the following:

  1. Control Inflammation: it is important to decrease the inflammation that is present at the lateral aspect of the knee. Ice massage, is a good treatment strategy to perform 1-3 times per day for about 10 minutes. Fill a Dixie cup with water and put in the freezer. Once the cup is frozen, peel away the top edge of the paper and move the ice cup around the injured area in a circular pattern. Please note, ice is not always a first defense. We recommend wearing compression garments as well. Research does is inconclusive on Ultrasound and Laser technology, so we don't recommend it due to the expense. Performing 
  2. Activity modification: Cross training (Anti-gravity treadmill, elliptical, recumbent bike) is a good way to keep up your aerobic fitness while rehabilitating your ITB syndrome. Once you can workout without pain, ease back into training, but make sure to discover and fix the CAUSE of the IT band injury to prevent re-injury. If there is no change in your symptoms after entering back into training, consult your Physical Therapist. 
  3. Mobility: It is critical that you have the range of motion necessary in your hip. Foam rolling, massage, and hip stretching (especially the hip external rotators) can all be incorporated into treatment immedately, but be sure to NOT over-stretch the area that is in pain. The foam roller will be your new best friend! At Experience Momentum, we like to tell our patients, β€œIt hurts so good!”
  4. Hip strengthening is a major component of rehabilitation after an IT band injury. Some common exercises include: balance, multi-planar lunges, single leg squats, and monster walks and lateral walks with a resistance band. Because this injury tends to significantly impact runners, Experience Momentum has designed a class specific for runners, called Run Strong. It is taught by Dr. Laura (Mickelson) Mizumoto and Physical Therapist/Triathlete Dr. Geoff Gabler. 

If you feel that your pain is in the moderate category, contact us today so we can get you back at it.

Additional Resources

Blake Stephens