What Is Iliotibial Band Syndrome?

Medically Reviewed by Zilpah Sheikh, MD on December 25, 2023
6 min read

If you’ve got a nagging pain on the outer part of your knee, especially if you’re a runner, it could be a symptom of iliotibial band (IT band) syndrome. It’s an injury often caused by activities where you bend your knee repeatedly, like running, cycling, hiking, and walking long distances.

Your IT band is a thick bunch of fibers that runs from the outside of your hips to the outside of your thigh and knee down to the top of your shinbone. If your IT band gets too tight, it can lead to swelling and pain around your knee.

IT band syndrome usually gets better with time and treatment. You don’t typically need surgery.

The problem is friction where the IT band crosses over your knee. A fluid-filled sac called a bursa normally helps the IT band glide smoothly over your knee as you bend and straighten your leg.

But if your IT band is too tight, bending your knee creates friction. Your IT band and the bursa can both start to swell, which leads to the pain of IT band syndrome.

Several things can up your odds of getting iliotibial band syndrome. Some you can help, and others you can’t.

Not using the right training techniques.

  • Not doing enough to stretch, warm up, and cool down
  • Pushing too hard -- you go too far or for too long
  • Not resting long enough between workouts
  • Wearing worn-out sneakers

Running or training on the wrong surfaces.

  • Running downhill
  • Running only on one side of the road. Because roads slope toward the curb, your outside foot is lower, which tilts your hips and throws your body off.
  • Training on banked, rather than flat, surfaces. Most running tracks are slightly banked.

Iliotibial band syndrome tends to mainly affect distance runners. But you can also get it if you take part in these other sports:

  • Cycling
  • Skiing
  • Rowing
  • Soccer
  • Basketball
  • Hockey

You also have a higher chance of iliotibial band syndrome if you’re young and exercise a lot. And certain physical conditionsraise your chances of getting it, including:

  • Bowed legs
  • Knee arthritis
  • One leg that’s longer than the other
  • Rotating your foot or ankle inward when you walk or run
  • Rotating your whole leg inward when you walk or run
  • Weakness in your abs, glutes, or hip muscles

The main symptom of iliotibial band syndrome is pain on the outer side of your knee, just above the joint. Early on, the pain might go away after you warm up. Over time though, you may notice it gets worse as you exercise.

Other symptoms of iliotibial band syndrome include:

  • Aching, burning, or tenderness on the outside of your knee
  • Feeling a click, pop, or snap on the outside of your knee
  • Pain up and down your leg
  • Warmth and redness on the outside of your knee

See your doctor if you have these symptoms, especially if any existing ones get worse.

Typically, your doctor can tell you have IT band syndrome based on your symptoms, health history, and a physical exam. It’s not the only cause of outer knee pain, so you may get an X-ray to rule out other causes.

Your doctor may also perform the Noble compression test and Ober test. Here are the steps involved:

  • Your doctor will feel the outside of your knee to figure out if the pain stems from that area.

  • They'll rotate your hip away from your body while supporting your knee. This could be painful and your hip movement may be limited.

  • Finally, your doctor will see if it causes pain to move your knee at different angles.

If you closely follow your doctor’s orders and give yourself the rest you need, you can usually recover from it in about 6 weeks.

Some basic steps can help ease the pain and swelling:

  • Don’t do activities that trigger the pain.
  • Take over-the-counter pain relievers.
  • Wrap an ice pack in a towel and put it on the outside of your knee for 10-15 minutes at a time.

A physical therapist can:

  • Give you tips for how to best warm up and cool down
  • Help you choose footwear and, if you need them, shoe inserts
  • Show you exercises to help strengthen and stretch your IT band and leg muscles
  • Talk to you about how to adjust your training schedule
  • Teach you how to improve your form to go easier on your body
  • Use friction massage, ice, or ultrasound to help with pain and swelling

That may be all you need, though some people need cortisone injections to help with pain and swelling.

You won't be able to stretch your IT band, but you can stretch the muscles around it for better flexibility and range of motion. Here are some exercises that you can do a couple of times a day: 

Standing iliotibial band stretch 

  1. In a standing position, cross your right leg in front of your left at the ankle, bending the front leg if needed.
  2. Raise your left arm over your head and stretch toward your right side. If you feel unsteady, lean against a wall or hold a chair.
  3. Hold the stretch for 20 to 30 seconds, pushing deeper if you don't feel a stretch.
  4. Repeat on the other side, alternating three to five times.

Seated cross-over twist

  1. Sit on the floor and straighten your legs in front of you.
  2. Put your hands flat on either side of your hips, with your fingers facing front. 
  3. Bend your right knee and put your right foot on the outside of your left knee. 
  4. Hold your right knee using your left hand (or elbow for a deeper stretch), keeping your bottom firmly planted on the floor. 
  5. Rotate your upper body, including your head, to the right.
  6. Breathe in and out for 30 to 45 seconds.
  7. Repeat these steps with your other leg.

Pigeon pose

  1. Lie on your back and bend both knees while keeping your feet flat on the floor.
  2. Lift your right leg and position your right ankle on your left thigh, right under your knee. Your legs will look like an upside-down "4." 
  3. Use your hands to grasp the back of your left thigh.
  4. Gently lift your left leg while pushing your right thigh away with your right elbow. 
  5. You should feel a stretch in your right glute.
  6. Hold this position for 30 to 45 seconds, then switch legs.

Supine IT band cross-over

  1. Lie on your back and bend both knees while keeping your feet flat on the floor.
  2. Keep your pelvis neutral as you stretch.
  3. Lift your right leg and loop a yoga strap or rolled-up towel around your right foot. 
  4. Straighten your right leg, angling the bottom of your foot toward the ceiling.
  5. Move your right leg toward the left side, keeping your hips planted on the floor. 
  6. Breathe in and out for at least 20 to 30 seconds (or longer if you want)
  7. Repeat these steps with the opposite leg.

Standing quad stretch

  1. Stand near a wall or chair with your legs hip-width apart.
  2. Use the chair or wall to keep your balance, holding it with your left hand.
  3. Bend your right leg, gently grasping your ankle with your right hand. 
  4. Pull your ankle up, keeping your right shoulder relaxed and open.
  5. Squeeze your right glute and tuck your pelvis under to stretch your right quad.
  6. Hold for 30 to 45 seconds and repeat these steps with the opposite leg.

IT band syndrome exercises to avoid

If you have IT band syndrome, it's best to avoid: 

  • Squatting too much
  • Walking or running on ground that's uneven or hilly 
  • Long-distance running or walking

To help prevent IT band syndrome, you can:

  • Allow plenty of time to properly stretch, warm up, and cool down.
  • Give your body enough time to recover between workouts or events.
  • Run with a shorter stride.
  • Run on flat surfaces or alternate which side of the road you run on.
  • Replace your shoes regularly.
  • Stretch your IT band, hip muscles, thigh muscles, and hamstrings often.
  • Use a foam roller to loosen your IT band.

What happens if IT band syndrome is left untreated?

Ignoring the symptoms of IT band syndrome may cause scarring in the bursa, which acts as a cushion. When there's scarring, range of motion in your knee or hip becomes limited, leaving you in pain.

What is the best position to sleep with IT band syndrome?

With hip or knee pain, the best sleeping position is lying on your back with a pillow under your knees.