IT Band Syndrome

August 8, 2018

What is IT Band Syndrome?


IT band syndrome, or ITB syndrome, is a tightness of the iliotibial (IT) band. Commonly diagnosed as an overuse injury, ITB syndrome is felt on the outside of the leg between or near the hip and knee where a tight IT band rubs aside prominent bony landmarks. IT band syndrome can cause conditions like runner's knee in which the IT band moves over bony landmarks in the leg. Repetitive activities like cycling, walking, or climbing stairs may cause IT band syndrome.


IT Band Syndrome Causes


The cause of IT band syndrome varies depending on lifestyle. Whether ITB syndrome is mild or chronic, three common causes include improper gait, weak hip muscles, and poor orthotics for those wearing them.

Improper Gait


ITB syndrome is often caused by improper form when walking or running. A person's gait can place the IT band in a compromised position, causing the ligament to rub or snap over bony landmarks in the leg. 


Excessive internal rotation of the thigh while walking or running (known as knock knees) places stress on the IT band near the knee, causing the tendon to rub over the lateral epicondyle of the femur. Not keeping the pelvis level while running or walking will lead to the same problem.

Weak Hip Muscles


Weak hips can also cause IT band syndrome. Weak hip muscles strain the ligaments in the lower body, especially the IT band, which leads to inflammation and IT band tightness. Prolonged sitting and excessive flexion can weaken hip muscles which in turn puts unwanted stress on the IT band itself.

Poor Orthotics


Misalignment of the feet and ankles places the rest of the body in a compromised position, leading to poor posture and weak or tight hip and leg muscles.


Wearing poor orthotics that do not support the arch or ankle can cause the knees to internally rotate and the leg to cross over during gait. This internal rotation and cross-over gait causes the IT band to move over the lateral condyle of the femur, resulting in inflammation and tightness.


IT Band Syndrome Symptoms


IT band syndrome symptoms are apparent at the knee and hip. If you have any of the following symptoms, its best to consult your doctor for a professional diagnosis or seek other healthcare professionals.

  • Tightness or Loss of Flexibility

A common symptom is tightness and loss of flexibility on the outside of the leg. Adduction movements of the leg become more difficult and painful. The TFL muscle (tensor fasciae latae), which attaches to the IT band near the hip, often becomes tight, resulting in poor knee and hip flexibility.

  • Tenderness and Pain

Most commonly found on the outside of the upper knee, a stabbing or throbbing feeling while running, walking, or cycling is a key symptoms of IT band syndrome.


More specifically, if pain is felt in the knee when the joint is flexed 30 degrees, IT band syndrome is likely the cause. Standing or sitting with legs crossed can cause tenderness on the outside of the leg. Running with IT band syndrome will worsen the pain.


IT Band Syndrome Test


Testing to confirm you have IT band syndrome is important to creating the proper treatment plan for your injury. Test for IT band syndrome using one of the three following methods.

Ober’s Test
  • Lie on the non-affected side with your hip and knee flexed at 90-degree angles.

  • Supporting the hip, raise the affected leg until it is in line with hip.

  • Extend your leg, and slowly lower your hip.

  • If your leg remains elevated, you have IT band tightness.

    Renne Test
    • Stand up straight with your legs shoulder width apart.

    • Stand on the affected leg.

    • Have someone place a hand around your knee, with the thumb at the lateral epicondyle of the femur.

    • Squat 30 degrees on the affected leg.

    • If you feel pain underneath examiner's thumb, you have IT band tightness.

      Noble’s Test
      • Lie flat on your back.

      • Flex your knee to 90 degrees.

      • Have someone place pressure on or near the lateral femoral condyle and gently extend the knee.

      • If you feel pain at roughly 30 degrees of flexion, you have IT band tightness.

        IT Band Syndrome Treatment


        Treating IT band syndrome will lead to a timely recovery and will prevent chronic IT band syndrome. Utilize the R.I.C.E protocol, anti-inflammatory medications, braces, and professional help to treat your injury.



        Treatment for IT band syndrome should begin with the R.I.C.E. protocol.

        • Rest. Avoid exercises and activities that cause pain to the IT band—specifically running, power walking, or cycling.

        • Ice. Apply an ice pack to affected areas 10 to 12 minutes, 2 to 4 times a day.

        • Compress. Apply compression with a bandage to reduce inflammation and swelling.

        • Elevate. During icing, elevate the leg to a position above the heart.


        If daily activity is still painful after utilizing R.I.C.E and anti-inflammatory medications, supporting your IT band with external tools and equipment can help. Ultimately, lifestyle changes and posture correction will yield the best long term results, but let's touch on a few possible solutions available to you know. 


        Always consult with a professional first to see what best choice for you.

        IT Band Knee Brace Strap


        Patella knee straps is a comfortable and effective treatments for IT band syndrome. 


        These straps are a simple, discreet choice that won't limit your range of motion. IT band straps work by compressing the IT band, just above the knee. If you don't need a massive amount of support and you want to maintain your joint's full range of motion, straps are a good option.

        Knee Sleeves


        Compression sleeves relieve pain associated with IT band syndrome, especially during or after activity. 


        For someone who needs more pain relief than straps provide, but doesn't want the bulk of a full brace, knee compression sleeves are perfect to relieve pain associated with IT band syndrome. They're easy to wear, fit under clothes, and provide pain relief. 

        IT Band Braces


        A hamstring brace stabilizes your injured IT band and helps prevent further damage.


        For the greatest amount of support for supporting the surrounding are, go with a brace. 

        Speaking with a Specialist


        If home remedies are not successful, seek professional guidance for treating your IT band syndrome. Your doctor may recommend physical therapy for IT band syndrome, IT band syndrome rehab, and in rare cases, IT band syndrome surgery. Diagnosing your injury will involve a physical examination and possible MRI scan.


        IT Band Syndrome Exercises


        Exercises for IT band syndrome stretch the IT band and strengthen the weak hip muscles contributing to the injury. Here are four exercises to get you started. Of course, consult your doctor before beginning any new exercise regimen.

        1. Hip Abduction


        While standing, place a resistance band around affected leg, near the ankle. Attach the band to a fixed object. Keeping the knee straight, abduct the leg straight out against the band resistance. Perform as tolerated and increase volume over time.


        2. Hip Thrust


        Lie on your back and place your feet flat on the floor with the knees flexed. Thrust your hip upward in a controlled manner, squeezing the glutes at the top of the movement. Slowly lower your hips to the bottom position. This exercise will activate weak glute muscles and will help relieve tension of the IT band over time.


        3. Standing Side Stretch


        Stand with your feet together and arms fully extended above your head. Drop one arm to the side, and slowly lean to that side focusing on stretching the hip and respective side of the body.


        Hold this position, slowly count to three, and then exhale. You should notice your range of motion improve. Repeat twice more on that side or as tolerated. Complete the same process on the other side .


        4. Side Shuffle


        Stand with your feet shoulder width apart and with an exercise band around your ankles. Widen your stance to hip width. Squat slightly to engage your hip flexors. Shuffle 15 steps to the right, then 15 to the left. Rest 30 seconds, and repeat. Increase your volume each week.


        Note- exercises should be done every day and as tolerated given your pain level. If you see improvements in range of motion, pain, and exercise efficiency, your IT band will most likely be relieved of some stress.


        Preventing IT Band Syndrome


        Prevent IT band syndrome from recurring through simple lifestyle changes. Here are a few things you can do to prevent injury to the IT band.

        1. Use Proper Gear


        Replace worn-out running shoes and utilize a  knee brace to keep ankles, knees, and hips in alignment. The best running shoes for IT band syndrome keep the ankles and knees from internally rotating. Look for shoes with good arch support, especially if you have flat feet.


        Brace support should be used if pain persists after the R.I.C.E protocol. Options include knee brace straps for IT band syndrome, knee sleeves, and leg sleeves. Braces keep joints and connective tissue in alignment and can be used with orthotics to prevent IT band syndrome.

        2. Practice Good Form


        Good exercise form is crucial to preventing an IT band injury. Focus on keeping your hips in alignment during all lower body activity, including running, cycling, walking, sitting, or squatting. And never let your knees internally rotate. This will keep your hip muscles and extensor muscles healthy.

        3. Warm Up


        Always warm up before physical activity to prime the body and prepare your muscles. A thorough lower body warmup that includes light cardio, mobility exercises, and dynamic stretching is ideal to prevent injury.

        4. Massage Surrounding Muscles

        Massaging surrounding muscles, especially the tight ones you've acquired, will help relieve the tension associated with IT band syndrome.


        Similar to having a personal masseuse, actively working to loosen up surrounding muscles will help the IT band to function pain free.


        Always foam roll surrounding muscles and not the connective tissues themselves which includes the IT band. Reason being is becuase tendons and ligaments would require high levels of pressure to even benefit from activities like foam rolling. 


        Remember to avoid intense pain and to aim for a subtle discomfort.

        5. Strengthen Weak Areas


        Focus on strengthening weak muscles to prevent ITB syndrome. Implement a regular strengthening routine throughout the week while working in daily stretching and foam rolling for improved ITB function. Building a strong muscular foundation will strengthen weak points that cause IT band syndrome.


        Recovery Time + Long-Term Chronic IT Band Syndrome Solution


        Depending upon the severity of tightness and inflammation, IT band syndrome can subside in a few weeks or months. Recovery time hinges on proper rest and implementation of exercises and stretches for IT band syndrome.


        Simple lifestyle adjustments can prevent and ease pain associated with IT band syndrome. Adopt a new approach to daily movement and body posture, and maintain good body awareness to prevent injury.


        Of course, stay active to keep your lower body strong and functioning properly, and consult your doctor or physical therapist for further treatment options.


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