Iliotibial (IT) Band Syndrome

Are you a runner or other endurance athlete who has recently increased mileage and is now having pain on your outer thigh or outer part of your knee? Does it hurt worse going down stairs? Is there popping or snapping at your outer knee with these activities?

The iliotibial band (or IT band for short) is a thick band of fascia that connects a muscle in your hip (the Tensor Fasciae Latae) to just below your outer knee. Since the IT Band runs along the outer thigh, sometimes pain is felt here, though it is more commonly felt at the outer knee.

IT Band Syndrome can cause pain, slow your training, and stop you from meeting your goals. Don’t let it! Physical therapy can get you back on track.

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Causes of Iliotibial (IT) Band Syndrome

IT Band Syndrome is usually classified as an overuse injury caused by doing “too much too soon” or not varying your training (i.e cross training). Repetitive knee flexion and extension begins to cause a friction on the outer knee which becomes painful over time. Other factors may include weakness of the hip abductors (including tensor fasciae latae), over pronating at the foot and ankle, and weakness or tightness of the hamstrings and quadriceps.

There are several things runners do that can irritate and place stress on the iliotibial tendon: increasing mileage too soon, running in the same direction around a track or loop, poor biomechanics or over pronation, running on an uneven surface, running with tight hamstrings, or wearing old shoes that don't provide necessary support.

Studies have also shown that a weak hip abductor, or lateral gluteal muscle, can be a factor. When the hip abductor is weak, the ITB will compensate in an effort to create stability around the hip and pelvis. This creates stress on the ITB, which can become painful.

  • Overuse
  • Not Varying Training
  • Repetitive Knee Flexion or Extension
  • Weakness of the Hip Abductors
  • Overpronating at the Foot and Ankle
  • Weakness or Tightness in Hamstrings and Quadriceps

Symptoms of Iliotibial (IT) Band Syndrome

Symptoms are usually felt on the outside of the knee when you bend your knee. The pain may be sharp or burning in nature. It’s tender on the outside of the knee, and sometimes it’s red and warm. Your knee feels better when it’s straight, and there may be a snapping or popping on the outside of your knee when bending it.

It is usually described as feeling tight, inflamed, stiff, or achy. Repetitive activity makes it worse, which is why it primarily affects runners, though cyclists often suffer from it. Sometimes, pain is felt more along the outer thigh, though this is less common.

  • Pain or Burning Sensation Outside of the Knee While Bending
  • Tender to the Touch Outside of the Knee
  • Red and Warm Knee
  • Snapping or "Popping" Sensation on the Outside of the Knee When Bending
  • Pain Alongside the Outer Thigh

"Our understanding of the causes of hip pain, as well as many other running injuries, has helped us become the go-to Physical Therapy provider in the running community." — Craig O'Neil, Results VP of Learning and Affiliation

Diagnosis of Iliotibial (IT) Band Syndrome

A physical therapist can quickly and easily diagnose this condition, or you may be referred to physical therapy after first seeing a primary care physician or specialist like an orthopedist. During your initial evaluation, your physical therapist will thoroughly review the history of your pain, perform a functional movement assessment (which may include watching you run), look at your foot posture, and then assess the ligaments, joints, muscles, and tendons of the hip and knee to ensure proper diagnosis.

Depending on the examination findings, treatment options will be discussed. After a plan is agreed upon, treatment will begin.

Treatment of Iliotibial (IT) Band Syndrome with Physical Therapy

All Results PTs are trained to provide hands-on care for pain relief and to assist how well you are able to move and train. This may include the physical therapist stretching the muscles and joints of the hip and knee, performing soft tissue work to tender muscles or muscles in spasm, or assisting the range of motion of the hip, knee, or foot and ankle with specific joint mobilizations for specific movements.

Hands-on treatments are paired with exercises and may include stretching, strengthening of the core, hip, knee, and foot and ankle, motor control or stabilization exercises, and aerobic exercise. All exercise programs will be custom made and tailored to your specific needs and goals.

Full recovery is generally possible and expected. Significant improvements in pain and function are usually made in the first 1-3 visits, and are definitely expected within two weeks of active physical therapy. Full recovery may take only a few weeks for milder pain or conditions, while more severe pain is often expected to heal within 1-2 months. You usually do not have to stop your training, though modifications to your training are often needed.

The first step is to identify which factors are causing the pain. They can then be addressed through corrective exercises, strengthening and re-educating the gluteal muscles, and improving flexibility of the hip flexors and hamstrings. If necessary, changes can be made to footwear or orthotics can be introduced to stabilize the foot and allow greater shock absorption while running. 

"I thought I was going to have to either lay off for three months or give up running altogether. But after working with Results, I'm back on the roads seven mornings a week."

Hands-on, manual physical therapy produces the optimal outcomes for ITB Syndrome. Specific deep tissue mobilization of the ITB and hip muscles can relieve stress. When these tissues are relaxed and loosened, myofascial release techniques can be introduced that provide greater relief.

Every Results Physical Therapist has received specific training in how to treat ITB Syndrome. Our understanding of and experience with running injuries has made us a favorite in the running world.

If you are experiencing hip pain and haven't been treated successfully, or are only finding temporary relief, contact a Results clinic and schedule an appointment for an evaluation. Don't wait until the condition becomes chronic and threatens your training program. Most insurance companies no longer require a physician's referral for physical therapy.

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Prevention Tips for Iliotibial (IT) Band Syndrome

IT Band Syndrome is best prevented with a slow increase in mileage with training, participating in cross training (especially strengthening), wearing appropriate footwear and changing your shoes when they are worn, and stretching to maintain the mobility of your feet and ankles, knees, and hips. You may also benefit from active recovery strategies like foam rolling and self-massage.

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