Iliotibial Band Syndrome (ITBS)

What is ITBS?

Iliotibial band syndrome occurs when a tendon called the iliotibial (IT) band becomes irritated or inflamed from repeatedly rubbing against the bones of your hip or knee. This tendon runs along the outside of your leg, stretching from the top of your pelvis down to your knee. When the IT band becomes too tight, it can start to rub against surrounding bones, causing discomfort. There are various reasons why the IT band might become overly tight.

Tendons are strong, flexible, and elastic-like tissues that connect muscles to bones. When you contract a muscle, the tendon pulls on the bone, which creates movement.

ITBS can occur in one leg or both legs. When it occurs in both legs it is called Bilateral Iliotibial Band Syndrome.

Who does ITBS affect?

You're more likely to develop iliotibial band syndrome if you're young and regularly active. Athletes who are especially prone to ITBS include:

• Basketball players

• Cyclists

• Hockey players

• Runners

• Skiers

• Soccer players

But you don’t have to be an athlete to be at risk. Certain physical traits or conditions can also slightly increase your chances, such as:

• Bowed legs

• One leg being longer than the other

• Arthritis in the knee

• Inward rotation of the ankle, leg, or foot during movement

• Weakness in the hips, glutes, or core muscles

How common is ITBS?

Frequent runners, particularly those who run long distances, are especially susceptible to iliotibial band syndrome. In fact, ITBS makes up roughly 12% of all running-related injuries. It's also more common in females than in males.

Knee pain — which can have many different causes, including ITBS — affects up to 25% of adults.

What causes ITBS?

The iliotibial (IT) band can become irritated and inflamed when it gets too tight and starts rubbing against nearby bones. Several factors can contribute to this tightness, including:

• Excessive foot pronation: When your foot rolls outward more than usual, it can stretch the IT band and bring it closer to the bone.

• Weak hip abductors: If the muscles responsible for moving your hip away from your body are weak, the IT band can become tense.

• Internal tibial torsion: This condition, where the shinbone (tibia) twists inward, pulls the IT band closer to the bone, increasing friction.

• Medial compartment arthritis and genu varum: Arthritis in the inner knee and bowlegged posture (genu varum) can both lead to increased tension in the IT band.

• Naturally tight IT band: Some people may simply be born with a tighter-than-average IT band.

Other factors that might cause or worsen rubbing of the IT band against bone include:

• Cooling down too quickly after workouts

• Insufficient rest between exercises

• Skipping pre-exercise stretching

• Overexertion during workouts

• Running on sloped or uneven surfaces

• Running downhill frequently

• Rushing your warm-up

• Wearing worn-out or unsupportive shoes

Symptoms of ITBS

A tight iliotibial (IT) band can lead to a range of symptoms, including:

• Hip pain: The IT band may rub repeatedly against the greater trochanter — the bony area near the top of your femur (thigh bone). This friction can lead to inflammation and pain in the hip, sometimes accompanied by a snapping sound.

• Clicking sensations: You might notice a snapping, popping, or clicking feeling on the outside of your knee.

• Knee pain: The IT band can also rub against the lateral epicondyle, the outer part of the lower femur near the knee. This repeated friction causes irritation and pain, especially when bending and straightening the knee.

• Warmth and redness: The outer side of your knee may appear red and feel warm, which are signs of inflammation

How is ITBS treated?

There are some treatments for ITBS that you can do at home, while others require a healthcare provider. Common treatments include:

• Rest: Some experts recommend that you not exercise your hurt leg until your pain is gone and your iliotibial band syndrome has healed. Talk to your healthcare provider about how much rest and activity you should get.

• Pain medications: Examples of non-steroidal anti-inflammatory drugs (NSAIDs) include Ibuprofen (Advil®, Motrin®) and Naproxen (Aleve®). Talk with your healthcare provider about correct dosages.

• Manual therapy: A physical therapist might teach you to use a foam roller to massage your body.

• Physical therapy: A physical therapist can teach you stretches, strengthening exercises and other treatments to help relieve your hip and knee pain. These treatments might help you lengthen your Iliotibial Band, decreasing the tension. A physical therapist can also show you how to best warm up before exercise and cool down afterward.

• Posture training: The way you hold your body when you go about your daily activities, playing sports or otherwise, might influence your iliotibial band syndrome.

• Steroid injections: Corticosteroids might reduce the inflammation in your iliotibial band.

• Surgery: Surgery for iliotibial band syndrome is rare. Your healthcare provider might recommend it if medications and physical therapy don’t work.

How can I lower my chances of developing ITBS?

While it can be challenging to fully prevent ITBS—especially if you're an athlete like a skier, cyclist, or long-distance runner—you can reduce your risk by making a few adjustments to your routine and technique. Consider the following tips:

• Avoid running on hills or sloped surfaces, which increase strain on the IT band.

• Focus on proper form and technique in all physical activities.

• Gradually increase the intensity of your training. For example, ease into faster cycling speeds rather than making sudden shifts.

• Take time to warm up before workouts and cool down afterward.

• Wear well-cushioned, supportive footwear to reduce impact and improve alignment.