IT Band Syndrome: Causes and Treatments

The IT Band, or iliotibial band, is a tough fibrous tissue found on the outside of the leg. It runs all the way from the hip down to the knee.   Problems with the IT Band are often called IT Band Syndrome or IT Band tendinitis.

When you have problems with the IT Band it usually is pain that can be found anywhere on the knee. The pain could be on the outside of the knee, on the inside of the knee or under the knee cap. Because of the role that the IT Band can play and how influential it can be over the entire leg, it can present as pain in many different areas in the knee.

IT Band tendinitis or syndrome is not something that comes on suddenly, although it can feel like that. You will not fall down the steps and then the next day have IT Band syndrome. It takes time to develop and most likely you ignore the first warning signs.  It usually starts as a twinge of pain in the knee, usually on the outside. But this twinge can be ignored. And when you ignore it allows time for it to grow worse and more inflamed.  Ignoring it does not make it better, in fact it makes it much, much worse.

Eventually the pain in the knee gets to the point where you cannot ignore it. You may not be able to run or go up steps or cycle or walk without limping.  The pain can be severe and can cause you to stop in your tracks when it gets bad enough. The problem is that if you go into see your doctor and they do an X-Ray or an MRI there is no problem that will show up on either one of them that is related to IT Band Syndrome, you need someone like a physical therapist to feel the muscles to determine that it is in fact IT Band syndrome.

What causes IT Band Tendinitis?


The type of footwear you wear or do not wear play s a major part in developing and curing IT Band tendinitis.  High heels, flats shore, flip flops and bare feet all can be contributing factors to irritating the IT Band. Improper running shoes and running shoes that have too many miles on them can also lead to IT Band issues. Therefore, it is very important during recovery that you wear properly fitted sneakers and that you avoid walking barefoot.

Going to a running store to get fitted for proper shoes, regardless of whether you are a runner is very important.  Whether you are flat footed or high arched, there are thigs that a shoe can fix that can allow your foot to function better and therefore take the pressure off the IT Band.  Having this proper footwear is necessary to keeping the knee and foot in good alignment.

2.  Weakness

Weakness of several muscles can play into the irritation of the IT Band.  It should be noted here that very rarely does one thing and one thing only cause IT Band tendinitis.  It is usually a combination of factors that we are discussing here and without addressing all the factors that can cause inflammation of the IT Band and treating all of them you will not have the best success with returning to pain free running and walking.

Weakness of your abdominals, your hips, your hamstrings and even your foot can cause irritation of the IT Band. This weakness causes the IT Band to have to work harder to make up for the support those muscles are not providing. This overuse can cause irritation and this irritation causes IT Band syndrome.  It is important that no matter what the sport is that you do, even if it is just for recreation, that there be a strength training component combined with the cardio.

3.  Tightness

Weakness and tightness generally go hand in hand which is why I noted earlier that there usually is more than one cause of the IT Band tendinitis.  Tightness of the hips, the hamstrings, the Achilles, the foot, all can cause the IT Band to work harder, therefore causing irritation and making it painful.

4.  Running Form

I hate to mention this because this is the first thing people like to focus on fixing if they have IT band symptoms.  The reality is if you have weakness or tightness in your muscles you will not be able to fix your running form.  And if you try to force change to your running form without strengthening and loosening up your muscles, you will find that you will develop more problems than just the IT Band tendinitis.  Therefore, while we must consider this a factor in IT Band issues, this is the last thing that we need to fix.

Treatments for IT Band Syndrome and IT Band tendinitis

  1.  Footwear

Footwear is the easiest thing to change and correct when dealing with IT Band issues. You need to walk in good sneakers that are always fitted for your foot.  Do not walk in bare feet or in flip flops while there is inflammation. Even around the house you should walk in good supportive running shoes to help take all the pressure you can off the IT Band.

2.  Strengthening

You need to perform exercises to strengthen the muscles that are weak. There are specific exercises for each muscle group, but it is important that you consult a physical therapist before you begin so you can identify exactly which muscles are weak and need to be strengthened before diving in.

One of the muscles that most often is weak in people is the glue medius and it is an integral part in hip stabilization. We have several videos on our You Tube channel, Total Performance Physical Therapy, that can help you with hip and abdominal strengthening exercises. The one show in the video here is hip hikes.  You need to stand on one leg, keep the knee straight and drop your hip down and then raise it up. Do this nice and slow.  Repeat this 30 times on each side and try to do 3 sets. You do not need to worry about adding weight since you are looking to develop endurance as well as strength. You should feel a burn in the standing leg if you do this correctly.

The next strengthening exercise is just a side leg kick. Stand on one leg and try not to hold onto anything, maintain unassisted balance is also going to help strengthen the leg and take pressure off your IT Band. Standing on one leg you want to kick the opposite leg out to the side and back, almost on a 45-degree angle.  This can also be seen in the video. This will also be strengthening of multiple hip muscles.  You do not want to add a weight to this but do it slow and controlled.  Doing 3 sets of 30 of these is a good start to strengthening and if you can complete those sets with no issue then you can move onto another exercise.

3.  Stretching and Loosening up the IT Band

While there are no real good stretches for the IT Band there are people that do insist that the stretch where you put the hip against the wall feels good.  If you feel that stretch works for you then continue to do it. You can see that stretch performed on our You Tube channel Total Performance Physical Therapy.

However, the most effective way to loosen up your IT Band, although it is painful, is with the foam roller. Foam rolling the IT Band is an effective way to get it to loosen up and it will become less painful over time. Many people stop foam rolling their IT Band because it is too painful, when in fact this is when you should be foam rolling the IT Band.

When it is painful to foam roll the IT Band that means that there is a lot of knots in the muscle and these knots can cause pain and can be the sole cause of the pain you are experiencing. It is imperative that you loosen them to feel better. Stretching will not loosen up these knots, you can only do it through foam rolling.

Start by lying on the foam roller on your side where the affected IT Band is. Put the top leg in front on the floor.  You can put the top leg in front with the foot flat on the floor to take the most amount of pressure off the IT Band. You can see this on the video. Pushing up on your hands and your foot roll along the IT Band. Be sure not to roll off the IT Band.  Make sure that you stay on your side when you are rolling. It is easy to rotate and roll on the back or your leg or roll more on the front of your leg but then you will not be rolling the IT Band. Even though it is less painful and tempting make sure to stay on the side and roll out the IT Band.

If you or someone you know is suffering from knee pain, lives in Montgomery or Bucks County PA and wants a FREE consultation with a Doctor of Physical Therapy click here and enter your information or call our office at 215-997-9898 and we will be happy to get you in.


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