IT Band Syndrome

What is it? How is does it occur?

The Iliotibial band or IT band is a long band of dense connective tissue that runs from the hip to the outside of the lower leg.  The IT band works to help prevent the leg from turning inward during activities like walking and running and helps us as humans to stand in an upright posture.

The main cause of IT band syndrome is overuse.  This injury is common in many athletes like runners and cyclists due to the fact that their legs are repetitively moving in one direction.  As the knee bends and straightens, the IT band moves back and forth over the bony portion of the femur or thigh bone.  This can irritate the tissue and cause inflammation which leads to pain over the outside portion of the knee and lower thigh.  Another cause of pain from IT band syndrome is compression of a fat pad located underneath the IT band.  The fat pad has many nerve cells and when the IT band swells the nerve cells get compressed or squished which can cause pain.


Some key contributing factors that can lead to IT band syndrome include:

  • Over training – This includes suddenly increasing mileage or increasing the duration if exercising, especially downhill.  Constant rubbing over the lower portion of the thigh bone causes irritation and inflammation to the IT band and surrounding muscles.
  • Weakness – Many of the problems associated with IT band syndrome are related to muscular imbalances.  The muscles of the hip that prevent the leg from turning and pulling inward when walking and running are usually weak in patients with IT band syndrome.  The weakness causes them to have to work harder to prevent these unwanted motions.  This cycle causes further weakness and can lead to the creation of trigger points or “knots” in the muscle tissue which can be very painful.
  • Foot wear – Improper foot wear can cause the foot to have a higher or lower arch.  Changing the mechanics of the foot can lead to other changes up the leg leading to IT band tightness and pain.
  • Predisposition– Unfortunately because we are all built slightly different, some of us are more prone to encountering IT band syndrome with repeated activity.  A couple of examples of body mechanics that can lead to IT band syndrome include:
    • Flat feet or high arches can both affect the IT band the same way as improper foot wear.
    • “Knock kneed” – This term is not necessarily a bad thing.  This just means that the knees are closer together in a standing position.  This position however can cause increased pressures on the knee joint that must be compensated by the hip muscles and IT band leading to extra wear and tear.
  • Sudden weight gain – Sudden increases in weight leads to increased muscle activity to accommodate compensate which ultimately increases wear and tear on the IT band and hip muscles.

Signs and Symptoms

  • Pain on the outside of the knee and lower part of the thigh, especially when the heel first contacts the ground during walking or running, during squatting activities, or when going up/down stairs.
  • Pain on the outside of the knee that comes on during activity and goes away with rest.
  • Tenderness to touch on the outside of the affected knee
  • Increased tightness of the IT band

Diagnosis and Treatment

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If you feel pain on the outside of the knee that does not go away within 1-2 weeks, it is recommended that you see your physical therapist.  Your physical therapist can diagnose IT band syndrome using information from a brief medical and social history, as well as a comprehensive examination where special tests will be used to test the strength, flexibility, and integrity of the muscles of the hips and IT band itself.  Once the causes of IT band syndrome are teased out a program to enhance strength, endurance, and flexibility will be prescribed to address them.  Your physical therapist will also discuss modification of activities to help reduce pain and promote healing during your recovery process.

  • If you cannot make it to your physical therapist right away, there are a couple of things you can do at home in the meantime:
    • Stop doing the activities that are causing you pain.  If they are unavoidable, discuss these things with you physical therapist as soon as possible to incorporate ways of performing the tasks with less pain.
    • Ice – Ice is your friend when it comes to pain and swelling.  Icing the area of tenderness can help ease pain and decrease swelling that is being caused by excessive use.  A good 10-15 min should help.

    When you can, make an appointment to see your physical therapist for a full evaluation and initiation of treatment.  Most patients, if they followed directions from their physical therapists and really stopped all unnecessary activity, had a decrease in pain within 6-8 weeks of treatment.  It is recommended to continue seeing you physical therapist routinely in order to progress your treatment plan into one of prevention.

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