Iliotibial Band Syndrome

Sports and Activity-Related Conditions· Also known as: ITB syndrome, IT band syndrome, ITBS, iliotibial band friction syndromeUpdated Nov 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, November 2026

At a Glance

Iliotibial band syndrome (ITBS) is an overuse injury that causes pain on the outer side of the knee and lower thigh. It is one of the most common running injuries, making up roughly 1 in 10 of them. The pain is usually sharp or burning, comes on gradually during activity such as running or cycling, and settles with rest. Treatment starts without surgery and centres on changing activity and a rehabilitation programme that builds strength and flexibility in the hip and knee. Pain and function improved over a few weeks in runners who were treated this way.

What is it?

Iliotibial band syndrome is an overuse injury that causes pain on the outer side of the knee and lower thigh. The iliotibial band is a thick band of tissue that runs down the outside of your thigh and ends near your knee. You may hear the condition called ITB syndrome or IT band syndrome.

It is one of the most common running injuries. It makes up roughly 1 in 10 running injuries, and some estimates go up to 16 per cent, depending on the group studied and how the condition is defined.

Exactly how it happens isn't settled. Older explanations describe the band rubbing over the bony bump on the outer side of the thigh bone at the knee. More recent explanations favour the band being pinched or squashed against that bump when the knee is bent about 20° to 30°. Other ideas include pressure on the fat and soft tissue under the band, or irritation of the fluid-filled sac (bursa) beneath it.

Who does it affect?

Most of what is known comes from adult runners. Female runners are about twice as likely as male runners to be affected. It isn't yet clear why.

People who cycle can also get it, because the pain tends to build up during long stretches of activity such as running or cycling. How common it is in people who don't run, and in children, isn't yet known.

Signs and symptoms

The typical pain is sharp or burning and sits on the outer side of the knee. It often shows up when the knee is bent about 20° to 30°, and it tends to get worse during running. It usually comes on gradually as an activity goes on, and it settles with rest. Some people also notice swelling at the sore spot.

Some signs point away from this condition and towards something more serious. A hot, red, swollen, painful knee, especially with a fever or feeling unwell, can mean a joint infection (septic arthritis). A knee that has slipped out of position, looks a different shape or sits at an odd angle can mean a significant injury. Tingling or numbness in the knee, leg or toes can mean a nerve problem or a significant injury.

Pain that starts suddenly after a fall, twist or high-impact injury, especially with severe pain or marked swelling, is more likely to be a ligament or cartilage (meniscus) injury than an overuse problem. Not being able to move the knee or put weight on it also points away from ITBS. So does a knee that locks, gives way or clicks painfully (clicking without pain is normal), which can mean an internal injury such as a meniscal tear.

Night pain, or constant severe pain that is worse on weight bearing with little or no injury, can be a sign of a rare bone problem called spontaneous osteonecrosis of the knee. Pain that is getting worse, keeps coming back, or hasn't improved after three to four weeks of self-help can also mean the cause is something other than ITBS.

What causes it?

ITBS is thought to have more than one cause. Things inside your body, such as how your joints move, seem to play a part. So do outside factors such as training errors, a jump in running distance, hill running and unsuitable footwear. How much a rise in distance, time or intensity raises the risk of ITBS in particular isn't clear yet.

Runners with ITBS have been found to move a little differently, for example with slightly more inward turning of the knee. These differences are small. It isn't clear whether they cause the problem or are a result of it, so they can't yet be used to say who will get it.

Other things can cause pain on the outer side of the knee, including a torn lateral meniscus (the cartilage cushion on the outer side of the knee), problems with the ligaments on the outer side of the knee, damage to the joint's cartilage, bruising inside the bone, an irritated tendon at the back of the outer thigh (biceps femoris), or pain referred from somewhere else. Ligament injuries, such as to the ACL, can also look similar after an injury.

How is it diagnosed?

ITBS is mostly diagnosed from your story and a physical examination. Your podiatrist will ask about your pain and your activity, and examine your knee. They may also watch how you move and look at your footwear.

No single test settles the diagnosis. For knee problems in general, single physical tests rarely rule a condition in or out, so the whole picture matters. Scans such as MRI aren't usually needed. They are kept for pain that doesn't settle, or for checking whether something else is going on.

Knee pain has many possible causes, so it is hard to be sure of the cause without an examination.

Treatment

Treatment begins without surgery. The mainstay is changing your activity and following a rehabilitation programme. Most of the research on treatment is small, short and of limited quality, so firm recommendations aren't yet possible.

Looking after it at home

Avoid running while it hurts.
Stop any exercise that causes pain.
Initial care may include a break from the activity that brings it on, changes to equipment, and anti-inflammatory tablets.

How much to cut back running, and for how long, isn't clear yet.

Treatment from your podiatrist

The main treatment is changing your activity and a rehabilitation programme, which your podiatrist may guide or share with a physiotherapist. A programme usually includes stretches, correcting muscle imbalances, and strengthening and load management (gradually building up what you do).

Once the sharp pain has settled, the focus moves to making the hip and knee more flexible and stronger. Strengthening the hip muscles that lift your leg out to the side is the best-supported part of care. It reduced pain and improved function in runners, especially when combined with shockwave therapy (pulses of sound waves) or hands-on therapy.

Other options

Gait retraining (changing the way you run) stopped pain during running in one study. It looks promising, but more high-quality research is needed.

It isn't yet known whether shoe inserts (orthoses) or changing your footwear help once you have ITBS.

Surgery

Surgery is kept for long-lasting cases that haven't responded to treatment without surgery. A keyhole (arthroscopic) option has been described. It avoids the complications of open surgery and lets the surgeon examine the whole knee. How well surgery works isn't clear yet.

Recovery

In runners with ITBS treated without surgery, pain eased by 27 to 100 per cent and function improved by 10 to 57 per cent over 2 to 8 weeks. That is a wide range, so how quickly you improve can differ a lot from person to person.

What happens over the longer term, and how often ITBS returns, isn't clear yet. Among recreational runners with running-related knee injuries more generally (not ITBS only), about one-third had not recovered at follow-up. If pain keeps getting worse, keeps coming back, or hasn't improved after three to four weeks of self-help, the diagnosis may need another look.

Preventing it

No approach has yet been shown to stop ITBS from coming back. Building flexibility and strength in the hip and knee once the pain has settled is the main recovery advice. Injury prevention programmes for runners are encouraged more generally.

Frequently asked questions

Can cyclists get iliotibial band syndrome?

Yes. The pain typically builds up during long periods of activity such as running or cycling. Most of what is known comes from runners, so it isn't clear how common ITBS is in cyclists.

Why do women get it more often?

Female runners are about twice as likely as male runners to have ITBS, but the reason isn't clear yet. Some differences in how female runners move have been noted, but they are small and not conclusive.

Does stretching help?

Stretching and correcting muscle imbalances are part of usual rehabilitation, though the evidence for them is limited. Strengthening the hip muscles is the best-supported part of care. If any exercise causes pain, it should be stopped.