Quick answer: Iliotibial band syndrome (ITBS) is an overuse injury that causes pain on the outside of the knee, most often in runners. In one large study it was the second most common running injury, after pain around the kneecap. Most people get better without surgery by easing back on running, strengthening the hip muscles and returning gradually, and about 50 to 90% improve within 4 to 8 weeks.
What is the IT band?
The iliotibial (IT) band is a thick band of connective tissue that runs down the outside of your thigh, from the hip to just below the knee. In ITBS, the area where the band crosses the bony bump on the outside of the knee becomes painful.
Symptoms
- pain on the outside of the knee, sometimes spreading up the outside of the thigh
- at first, pain after exercise; later, pain during runs; and if it gets worse, pain at rest
- pain that is worse running downhill
- tenderness when you press on the outside of the knee
Pain at the front of the knee, around the kneecap, is more likely to be runner’s knee.
What causes ITBS?
It is an overuse injury, usually after a sudden increase in running, especially downhill. It was long thought to come from the band rubbing over the knee, but the cause is debated. Research suggests it may be more about pressure on a sensitive layer of fat beneath the band than friction.
Risk factors include:
- sudden jumps in distance: in a study of more than 5,200 runners, a single run more than 10% longer than their longest run in the previous 30 days was linked to a higher risk of an overuse injury
- a lot of downhill running
- weak hip muscles, especially those that move the leg outwards, which may play a part, although the evidence is mixed
Treatment
Ease back on running
Many people need to cut back or pause running until the pain settles. Avoid downhill running at first. Swimming can keep you fit in the meantime.
Strengthen your hips
Strengthening the hip muscles, especially those that move your leg out to the side, is the most common approach in the research. Examples include side lying leg raises, side steps with a resistance band and single leg exercises such as step ups. Stretching does not build strength, and the IT band itself is not a muscle you can strengthen.
Other treatments
- Ice: wrap an ice pack in a towel and hold it on the sore area for up to 20 minutes to ease pain.
- Hands on treatment and shockwave: may help alongside exercise.
- Foam rolling: its effects are small and it hasn’t been studied well for ITBS. Use it if it feels good, but don’t rely on it.
- Injection: a steroid injection may help in some cases.
- Surgery: rarely needed.
Changing running technique (gait retraining) is being studied, but more research is needed before it can be recommended for ITBS.
Returning to running
Return in stages once everyday activities are pain free. Start with short, flat, easy runs, then build up distance before adding hills and speed. Avoid any run more than 10% longer than your longest run in the past 30 days, and keep up your hip exercises.
How long does ITBS take to heal?
With non surgical treatment, about 50 to 90% of people improve within 4 to 8 weeks.
When to see a doctor or physiotherapist
See a doctor the same day or go to A&E if the knee is very painful, badly swollen or has changed shape, locks or gives way, can’t take your weight, or is red and hot and you have a high temperature.
See a physiotherapist if the pain isn’t improving within a few weeks, or keeps coming back when you run.
Frequently asked questions
Can I keep running with IT band syndrome?
Many people need to cut back or pause until the pain settles. Avoid downhill running at first, as it is a common trigger.
How long does IT band syndrome take to heal?
About 50 to 90% of people improve within 4 to 8 weeks of non surgical treatment.
What are the best exercises for IT band syndrome?
Hip strengthening, especially the muscles that move your leg out to the side. Hands on treatment or shockwave may help alongside it.
Does foam rolling fix IT band syndrome?
Probably not on its own. Foam rolling has small effects in research, and strengthening has more support.
Will I need an injection or surgery?
Surgery is rare. A steroid injection may help in some cases, but most people get better with exercise and changes to their running.
Sources
- Cleveland Clinic: Iliotibial band syndrome
- Taunton et al. 2002, BJSM: a retrospective case-control analysis of 2002 running injuries
- Fairclough et al. 2006, Journal of Anatomy: the functional anatomy of the IT band
- Sanchez-Alvarado et al. 2024, Frontiers in Sports and Active Living: treatment of IT band syndrome in runners
- Foch et al. 2023, Gait & Posture: running mechanics and hip strength in IT band syndrome
- Wiewelhove et al. 2019, Frontiers in Physiology: foam rolling meta-analysis
- Frandsen et al. 2025, BJSM: how much running is too much?
- NHS: Knee pain
Need help with this? Our knee pain physiotherapy team at Total Health by Hong Kong Sports Clinic can assess you and start treatment in your first session, in Central, Kai Tak or Tin Hau. Message us on WhatsApp to book.
