Iliotibial Band Syndrome

ITBS or Iliotibial Band Syndrome is a knee injury which is common amongst cyclists, runners, and military personnel. It causes unusual pain due to irritation and inflammation of the distal part of the ilibiotal tendon as it abrades against the lateral femoral condyle.

Image Source:

It is presumed as the non-traumatic injury often associated with weakness of hip muscles. Moreover, overuse is considered to be caused by the monotonous extension and knee flexion often seen in athletes. Repetitive motion results in excessive friction between the iliotibial tract and the lateral femoral epicondyle.

Studies show that ‘impingement zone’ occurs slightly below or at 300 of knee flexion during running or foot strike. During the impingement period, the eccentric contraction of the gluteus maximus and tensor fascia latae muscle allows the leg to decelerate which generates tension in the iliotibial band.

Iliotibial Band Syndrome Causes

The cause of IT Band syndrome is a tight iliotibial band. While normal working, IT Band drifts outside the knee over bursa, a fluid-filled sac. When this grows too tight, band abrades against the knee causing pain, swelling, etc.

Moreover, excessive physical activity results in ITBS syndrome. Some people are prone to develop this problem, but some factors can increase the chances which include:

  • Foot rolling while running
  • Walking or running on uneven surfaces
  • Hips muscle weakness
  • Inadequate or poor running form
  • Leg length difference
  • Wide or naturally tight IT band
  • Insufficient stretching
  • Flattening foot

IT Band Symptoms

  • A clicking feeling when the knee and band abrades
  • After exercising a lingering pain
  • The knee is tender to touch
  • Buttocks tenderness
  • Pain during movement or while completing other activities
  • Warmth and redness around knees

The symptoms begin after a short time of physical activity. The most common symptom is the pain on the outside knee which worsens with continuity of movement. If the person continues to perform the activity that causes pain, IT band will rub against the knee resulting in severe pain and swelling.

Iliotibial Band Syndrome Diagnosis

A physical therapist or simply the family doctor can diagnose this syndrome. To determine the problem, a healthcare professional talks about the symptoms and clarifies about the activities that cause pain.

Professionals ask for some tests which include Renne tests, Ober’s test, and Noble’s test. For Ober’s test, the patient needs to lie down on the pain-free side with the hip and bottom knee at 900 angles. The physiotherapist steadies the pelvis and lifts the affected leg, bringing the hip back towards the ground.

The test result is positive for this syndrome if the natural horizontal position is less than 100. The physician also checks the patients walking and standing style, also the foot pronation. Muscle tightness in hips and upper leg muscles are also checked.

Iliotibial Band Syndrome Treatment

IT Band Syndrome is easy to treat, and there are two primary procedures to address this syndrome:

  • Preventing further injury and stretching
  • Reducing swelling and pain


In some cases, physical therapy and conservative treatment are ineffective, and it becomes crucial to opt for surgery. In ITBS surgery, the small posterior part of the iliotibial band which covers the lateral femoral epicondyle is resected. Also, in some cases, surgeries are held to minimize the tension of cyst, bursa or lateral synovial recess.  The surgical method is not the ideal way to treat ITBS, but only in rare cases in which the symptom has alleviated. Other common ways to treat IT band syndrome are:

  • Knee massage that improves blood circulation and reduces knee tension
  • Ice application on IT Band reduces swelling and pain
  • Avoiding activities which aggravate IT Band and resting prevents knee abrasion resulting in reducing pain
  • Medications that are anti-inflammatory and available easily
  • Electrotherapies and ultrasounds to minimize tension

The essential way of treating this syndrome is to stop the activity that results in pain. Moreover, for about 5 to 6 weeks, it will gradually heal the affected area thoroughly.

IT Band Syndrome Exercises

Apart from treatment and medications, some exercises and stretches will help not only to treat but prevent the condition. Focusing on the IT Band, the patient should aim to do some specific activities and stretching to heal the syndrome. Some crucial stretches and exercises are listed below:

Glute Stretch

  • Lie flat on the ground and outstretch one leg
  • Hold the leg at the shin, lift the leg and pull the knee towards the midsection
  • Pull the leg gently unless feeling stretched
  • After stretched feeling, hold it for few seconds and rest

Foam roller stretch

  • It helps to massage and stretches the IT band gently
  • Use a wide foam roller or a yoga mat
  • Use forearm for better support and then lay sideways on the mat
  • Position the roller under the hip, move the body towards the front to allow the roller to move up and down the leg

Standing Stretch

It should be felt on the muscles outer the hamstring
Stand normally, with both feet together
Hold the supporting leg and place one foot behind and past the other foot
Lower the body and bend to the supporting knee

Lying or Standing hip abduction


  • Stand with two feet together
  • Lift one leg to same side way and remove from the center
  • Repeat another leg


  • Lay on the side and lift the leg in the air
  • Repeat 10 to 15 times on both the sides

Hip Abduction Machine

People who have access to a gym might use equipment that targets hip abductors. It allows the muscles that move the leg out from the body. This stretching by using equipment helps to prevent and treat knee pain.

A user should sit with legs together with bent knees and feet on the footrest. The pads on the machine are attached to a weighted pulley, designed to sit outside of the legs above the knees. The person opens leg pressing against the machine’s resistance.


Patients with IT syndrome should consult a physical therapist and identify better ways in which they can modify while running or while performing other activities. Training modification might include:

  • Avoiding running for longer durations on sloped surfaces
  • Avoiding downhill exercising
  • Minimizing running distances
  • Using proper shoes to correct foot arch collapsing

Iliotibial Band Syndrome Prevention Tips

Patients should stop the activity that results in pain or the symptoms. Activities like long steps, cycling, running and another heavy exercising should be restricted. While getting back to these activities, people should ease down slowly to prevent the syndrome from coming back. Runners should gradually increase their distance.

Leave a Reply