Iliotibial Band Syndrome: Symptoms, Causes & Treatment

Iliotibial band syndrome (ITBS) is an overuse injury that causes pain on the outer side of the knee, most often in runners and cyclists. It happens when the iliotibial band, a thick band of connective tissue along the outer thigh, becomes irritated as it rubs against the thigh bone during repetitive knee movements.

This condition develops gradually and is often linked to muscle weakness, training errors, or biomechanical imbalances that increase stress on the knee. Common symptoms include sharp pain on the outside of the knee, swelling, or tenderness that worsens with activities like running downhill or climbing stairs.

Treatment for iliotibial band syndrome focuses on reducing inflammation, restoring strength and flexibility, and correcting movement patterns. Most people recover with conservative treatment, but persistent cases may need corticosteroid injections or, in rare situations, surgery.

Main symptoms

Iliotibial band syndrome usually causes pain and discomfort around the outer side of the knee. The pain often starts gradually and can worsen with continued activity.

Common symptoms include:

• Sharp or burning pain on the outside of the knee

• Swelling or tenderness over the outer knee bone

• Pain that gets worse with running, cycling, or going down stairs

• A snapping or popping sensation when bending or straightening the knee

• Stiffness after sitting for long periods or after exercise

Symptoms typically improve with rest but can return if the underlying causes are not addressed.

Common causes

Iliotibial band syndrome is caused by a mix of biomechanical, anatomical, and training-related factors that lead to friction or pressure where the iliotibial band crosses the thigh bone.

1. Biomechanical factors

Biomechanical imbalances are among the main contributors to iliotibial band syndrome. Weakness in the hip abductor or gluteal muscles can cause instability in the hip and knee during movement. Excessive inward rotation of the knee or overpronation of the foot increases tension along the iliotibial band, while pelvic drop or leaning the trunk toward the affected side adds extra strain on the outer knee.

2. Anatomical factors

Certain anatomical characteristics can make some people more prone to developing iliotibial band syndrome. A tight or thickened iliotibial band can increase friction as it moves over the bone. A prominent outer knee bone (lateral femoral epicondyle) or reduced flexibility in the tensor fasciae latae and nearby muscles can also heighten stress in the area, leading to irritation and inflammation.

3. Training factors

Training habits are another common cause of iliotibial band syndrome. Rapid increases in running distance or intensity can overload the structures around the knee. Running on sloped or uneven surfaces may alter leg alignment, increasing friction along the iliotibial band. Inadequate warm-up, wearing poorly fitted footwear, or using an improperly adjusted bicycle setup can further contribute to the development of this condition.

Confirming a diagnosis

Diagnosis of iliotibial band syndrome is usually based on a person’s medical history and physical examination. Tests such as the Noble compression test or Ober test are used to reproduce the pain and assess tightness in the iliotibial band.

Imaging tests, including ultrasound or MRI, may be done to confirm inflammation or rule out other knee problems. Ultrasound can show thickening of the iliotibial band or fluid between the band and the bone.

Treatment options

Treatment for iliotibial band syndrome focuses on reducing inflammation, restoring strength and flexibility, and correcting movement patterns, according to the American Academy of Orthopaedic Surgeons. This can be achieved with the following approaches:

1. Conservative treatment

Most cases of iliotibial band syndrome improve with conservative care. This includes resting from activities that worsen symptoms, applying ice, and using nonsteroidal anti-inflammatory drugs (NSAIDs) for short-term relief. Gentle stretching and massage of the outer thigh can help reduce tightness and pain.

2. Physical therapy

Physical therapy is a key part of recovery. Exercises that strengthen the hip abductors, gluteus medius, and core muscles help correct imbalances and improve movement control. Manual therapy, soft tissue techniques, and treatments such as ultrasound or shockwave therapy may also reduce pain and improve flexibility.

3. Gait retraining

Gait retraining focuses on improving stride length, cadence, and hip stability to decrease stress on the iliotibial band. Research shows that addressing these biomechanical issues helps prevent recurrence, especially in runners.

4. Injections

If pain continues despite physical therapy, corticosteroid injections guided by ultrasound can provide short-term relief by reducing inflammation in the irritated area.

5. Surgical treatment

Surgery is rarely needed and is reserved for chronic cases that do not improve with other treatments. Procedures typically involve releasing or lengthening the lower part of the iliotibial band to reduce friction over the bone.

Prevention

Preventing iliotibial band syndrome involves keeping the muscles around the hips and thighs strong and flexible.

Effective prevention strategies include:

• Gradually increasing training distance and intensity

• Strengthening the hip and core muscles

• Stretching the iliotibial band and surrounding muscles after workouts

• Wearing proper footwear and maintaining correct running or cycling mechanics

• Avoiding repetitive downhill or sloped running surfaces

Recognizing early signs of discomfort and adjusting training routines can help prevent iliotibial band syndrome from becoming a long-term problem.