ITB Syndrome: 10 Key Symptoms You Shouldn’t Ignore

Knee pain can be frustrating, especially when it stops you from doing the things you love, like running, cycling, or even taking long walks.

If you’re feeling a sharp or nagging pain on the outer side of your knee, you might be dealing with something called Iliotibial Band Syndrome (ITB Syndrome). It’s a common issue for people who stay active, affecting about 1 in 8 runners at some point in their lives¹.

The iliotibial band is a thick strip of tissue on the outer side of your thigh that helps stabilize your knee when you move. When it’s overused or irritated, it can cause pain that’s hard to ignore.

The good news? ITB Syndrome doesn’t have to hold you back. With the right care and some simple changes, you can heal, strengthen your body, and get back to doing what you enjoy most. Let’s explore what’s going on and how to fix it.

What is Iliotibial Band Syndrome?

Iliotibial Band Syndrome (ITB Syndrome) is a condition that causes pain on the outer side of the knee. It happens when the iliotibial band (IT band), a thick band of tissue running from your hip to your shin, becomes tight or irritated.

This irritation usually occurs where the band crosses the outside of the knee, making it one of the most common causes of pain in this area².

Who Does ITBS Affect the Most?

ITB Syndrome is particularly common among runners, cyclists, and other people who perform repetitive knee-bending activities.

Studies show that up to 14% of runners experience ITB Syndrome at some point³. It’s also seen in hikers, walkers, and even military recruits—anyone who puts regular stress on their knees.

Women tend to be slightly more at risk due to natural differences in hip and knee alignment, which can cause more strain on the IT band⁴.

People who suddenly increase their activity levels or fail to stretch properly before and after exercise are also more likely to experience this condition.

How Common Is ITB Syndrome?

ITBS is the second most common running injury, just behind knee pain from patellofemoral syndrome¹. It’s the leading cause of outer knee pain in athletes, making it a familiar foe for anyone who loves staying active.

While it’s more common in younger, active people, anyone can develop ITBS if they overwork their knees or use improper form during exercise.

Common Symptoms of ITB Syndrome

If you’re dealing with ITB Syndrome, these are some of the most common symptoms you might notice:

• Pain on the Outer Side of the Knee: A sharp or burning pain is felt on the outside of your knee, especially during activities like running or walking downhill.
• Tenderness When Pressing the Outer Knee: Pressing on the outer part of your knee (near the bony bump) may feel sore or tender.
• Pain That Worsens with Activity: The pain usually starts during activity, gets worse as you continue, and might linger afterward.
• Tightness in the Outer Thigh: Your outer thigh may feel tight or as if it’s being pulled, especially after exercising or sitting for a long time.
• Pain During Repetitive Knee Movements: Activities like running, cycling, hiking, or climbing stairs can trigger or worsen the pain.
• Difficulty with Knee Bending: You may notice discomfort or stiffness when bending or straightening your knee, making everyday movements harder.
• Worse Pain Going Downhill or Downstairs: Moving downhill or downstairs often puts more strain on the IT band, leading to increased pain.
• Swelling or a Snapping Sensation: Some people notice mild swelling on the outer side of the knee or feel a snapping sensation as the IT band moves over the knee joint.
• Morning Stiffness: The knee or outer thigh may feel stiff or achy when you first wake up, especially after intense activity the day before.
• Weakness in the Affected Leg: Over time, the pain may cause you to subconsciously avoid using the leg, leading to weakness or instability.

Why Does ITB Syndrome Happen?

ITB Syndrome happens when the iliotibial band, a thick strip of tissue on the outside of your leg, gets irritated from overuse. This band helps keep your knee stable during movement, but when it’s overworked or under strain, it can cause pain and swelling.

What Is the Iliotibial Band?

The iliotibial band (IT band) runs from your hip to your shin, along the outside of your thigh. It works to keep your knee steady as you walk, run, or cycle. Normally, it moves smoothly over the outside of your knee.

But when it becomes tight or irritated, it can rub against the bones on the outer knee, causing pain and inflammation².

Why Does It Become Irritated?

The irritation happens because of repeated bending and straightening of the knee. This movement causes the IT band to rub against the outer knee.

Over time, this rubbing can lead to inflammation and pain. Activities like running, cycling, or hiking are common triggers, especially if you’re doing too much too soon³.

What Causes the Band to Tighten?

The IT band can tighten for a few reasons: weak hip muscles, poor stretching, or simply overdoing your workouts without giving your body enough rest.

When the band tightens, it pulls harder on the outside of your knee, which makes the rubbing worse. Tight muscles in your hips or thighs can also add to the problem⁴.

How Does This Cause Pain?

The pain comes from two things: rubbing and pressure. When the IT band rubs too much against the bones, it causes irritation and swelling.

This creates a painful cycle where the more you move, the more irritated it gets. The tension in the band can also squeeze nearby tissues, adding to the discomfort³.

What Other Conditions Could It Be?

Sometimes, pain on the outer side of the knee can be confused with other conditions. Here are five common conditions that can be mistaken for ITB Syndrome and how they differ:

Patellofemoral Pain Syndrome (Runner’s Knee)

Patellofemoral pain syndrome causes pain at the front of the knee, around or behind the kneecap, instead of the outer knee as seen in ITB Syndrome.

The pain is often worse when climbing stairs, squatting, or sitting for long periods with bent knees. Unlike ITB Syndrome, it doesn’t typically involve tightness in the outer thigh or pain that worsens during downhill activities⁵.

Lateral Meniscus Tear

A tear in the lateral meniscus, the cartilage cushioning the outer part of the knee, can mimic ITB Syndrome pain. However, a meniscus tear often comes with a popping sensation or locking of the knee.

Swelling is also more common with a meniscus tear than with ITB Syndrome, which typically doesn’t cause significant swelling⁶.

Bursitis (Lateral Knee)

Bursitis refers to inflammation of the small fluid-filled sacs near the outer knee joint. Bursitis pain is more localized and can cause noticeable swelling, which is less common in ITB Syndrome. Pressing on the swollen area usually triggers sharp pain⁷.

Hamstring Tendinopathy

Hamstring tendinopathy causes pain near the back of the knee and sometimes the thigh, unlike the sharp, outer-knee pain associated with ITB Syndrome. Pain from hamstring tendinopathy is often worse during stretching or sprinting motions, which don’t typically affect ITB Syndrome as much⁸.

Tibial Stress Fracture

A stress fracture in the shinbone can sometimes cause pain mistaken for ITB Syndrome. Unlike ITB Syndrome, this condition causes pain that worsens with weight-bearing activities and persists even at rest. Stress fractures are also associated with pinpoint tenderness over the fracture site⁶.

Types of Scans for ITB Syndrome

Ultrasound

An ultrasound is quick and painless. It shows real-time images of the tissues around the knee, including the IT band. We look for signs of swelling, thickening, or fluid buildup that suggest irritation⁷.

MRI (Magnetic Resonance Imaging)

An MRI provides detailed images of the soft tissues, including the IT band, muscles, and tendons. This helps us identify inflammation, tissue damage, or other conditions like meniscus tears⁶.

X-Ray

While X-rays don’t show soft tissues, they can rule out bone-related issues like structural abnormalities or bone spurs that might be contributing to your pain⁹.

Is Surgery Needed?

Surgery is rarely needed for ITB Syndrome and is typically considered only after several months of failed non-surgical treatments. The most common surgical option is IT band release, which involves cutting a small section of the IT band to reduce tension and friction. In some cases, inflamed tissue or bursa near the knee is also removed⁶.

How Physiotherapy Helps After Surgery

After surgery, physiotherapy is essential for recovery. It reduces swelling, restores knee movement, and strengthens the muscles around the hip and thigh to stabilize the joint. Physiotherapy also focuses on correcting movement patterns to prevent future irritation and help you return to pain-free activity⁷.

Treatment Options For ITB Syndrome

As a physiotherapist, I can offer several treatments to manage ITB Syndrome, relieve pain, and improve mobility.

Exercise Therapy

Targeted exercises improve hip and thigh strength, which reduces strain on the IT band. Stretching routines focus on loosening the IT band and surrounding muscles for better flexibility⁸.

Myofascial Release

This hands-on therapy applies sustained pressure to release tension in the IT band and surrounding muscles. Foam rolling is another option to complement manual therapy⁵.

Orthopedic Manual Therapy

Gentle mobilization techniques improve joint movement in the knee and hip to reduce stress on the IT band⁴.

Laser Therapy

Low-level laser therapy reduces inflammation and promotes tissue healing. It’s a painless treatment often combined with exercises⁷.

Dry Needling

Dry needling releases tight spots in the hip and thigh muscles, relieving IT band tension. It improves blood flow and eases muscle tightness⁸.

Strapping and Taping

Taping provides temporary support for the IT band, reducing strain during movement. This can be helpful as you build strength and flexibility³.

Conclusion

Iliotibial Band Syndrome doesn’t have to stop you from enjoying the activities you love. With the right treatment plan, including exercises, manual therapy, and techniques like dry needling, you can reduce pain, regain strength, and prevent ITB Syndrome from coming back.

Recovery takes patience and consistency—every small step forward brings you closer to living pain-free.

If you need guidance or have questions along the way, I’m here to help.

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References

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6. Strauss, E. J., Kim, S., Calcei, J. G., & Park, D. (2011). Iliotibial band syndrome: evaluation and management. The Journal of the American Academy of Orthopaedic Surgeons, 19(12), 728–736. https://doi.org/10.5435/00124635-201112000-00003
7. Pawlina, M., Pawełczak, N., Oskroba, A., Orzechowska, A., Ziętara, K., Stawikowski, C., … Raksa, K. (2023). Development of diagnosis and treatment in the iliotibial band syndrome. Journal of Education, Health and Sport, 13(3), 153–158. https://doi.org/10.12775/JEHS.2023.13.03.022
8. Baker, R. L., & Fredericson, M. (2016). Iliotibial Band Syndrome in Runners: Biomechanical Implications and Exercise Interventions. Physical medicine and rehabilitation clinics of North America, 27(1), 53–77. https://doi.org/10.1016/j.pmr.2015.08.001