October 12, 2022

A Physical Therapy Guide to Iliotibial Band Syndrome

If you are a runner, cyclist, or other long distance athlete, you may have heard of Iliotibial band syndrome (IT band syndrome). In fact, IT band syndrome is the second most common cause of lateral (outside) knee pain in runners and other long distance athletes.1

IT band syndrome is an overuse injury and usually caused by an increase in exercise intensity.2 Pain or discomfort from IT band syndrome may come on at the start of a run or activity, and last for the duration of that exercise. The pain can be enough to limit your activity levels.

If you think that you may suffer from this condition, no need to fear; IT band syndrome is very treatable. In this guide, we will cover causes, symptoms, and treatment options.

Table of Contents

Understanding IT Band Syndrome

Your IT band is a band of connective tissue that runs down the outside of your leg. The job of the IT band is to provide stability to your knees. The IT band itself is not considered a muscle; however, its fibers come from a muscle in your hip known as the tensor fasciae latae (TFL). While the IT band is not a muscle, it can assist the muscles in your leg to help move your hips.

Repeated movements with poor mechanics can lead to irritation of the IT band near the knee. In the past, many clinicians theorized that friction led to this irritation. However, recent studies suggest that the IT band compresses a fat pad near the knee. It is this compression that irritates the area and leads to pain.3

What are the Symptoms of IT Band Syndrome?

Since the IT band covers a large area of your leg, the symptoms of IT band syndrome can vary. Common symptoms include: 4

  • Pain in the outside of the knee
  • Snapping or cracking at the knee
  • Pain or tightness along the outer edge of the leg

What are the Common Causes of IT Band Syndrome?

A dramatic increase in exercise intensity or frequency is the most common cause of IT band syndrome.5 For example, IT band syndrome is likely to occur in a runner who increases their mileage as they train for their first marathon. Plus, athletes who do a lot of running, cutting, squatting and cycling are particularly susceptible to IT band syndrome.

Movements done with poor mechanics can lead to friction and compression between your IT band and some of the other structures in your leg. Some of these poor movement patterns can include:

  • Increased foot pronation
  • Decreased hip abduction (ability to move your leg out to the side)
  • Running in a bent over position
  • Letting your hip drop down
  • Too much hip internal rotation with certain movements

How is IT Band Syndrome Diagnosed?

Syndromes in general can be difficult to diagnose. There is no one test which can lead to a diagnosis. Instead, syndromes are identified through a number of symptoms which happen together. A CityPT physical therapist can make a diagnosis of IT band syndrome after performing the following:

  • A patient/client interview: The provider may ask when your pain started. What makes your pain worse, and what makes your pain better.
  • Analysis of movement: The provider may ask you to perform tasks such as walking, running, and jumping.
  • Clinical tests: The provider may perform tests to assess your flexibility, and strength. They can also use special tests to rule out other possible knee injuries.

What to Expect from Physical Therapy for IT Band Syndrome

Many of those who suffer from IT band syndrome get better with conservative care. Working with a physical therapist is a good place to start as they can help to identify whether or not you have IT band syndrome, and what the underlying cause may be.

When you see a CityPT physical therapist for IT band syndrome, you can expect the following:

  • A subjective evaluation and comprehensive interview
  • An in-depth discussion of your goals and activities that you would like to return to
  • A physical examination done over video telehealth, or in person
  • Assessment of your movement patterns
  • A treatment plan to reach your goals — to include options like exercise prescription, education, manual therapy, biomechanics training, etc.

What If Conservative Treatment Doesn't Work?

If you have been working with a physical therapist for IT band syndrome and are not satisfied with the results, there are still other forms of treatment which may be beneficial for you. Most invasive treatments will require you to work with a medical doctor. These treatments can include:2

  • Prescription medications
  • Injections
  • Surgery

How Do I Prevent IT Band Syndrome?

Are you concerned that you may be susceptible to IT band syndrome? While there are plenty of treatment options, preventing IT band syndrome from happening in the first place is preferable.

Some things that you can do to prevent IT band syndrome include:

  • Increasing your activity level at a reasonable rate
  • Maintaining adequate flexibility at your hip, knee, and ankle
  • Working with a coach, trainer, or CityPT physical therapist to identify and fix movement patterns which may put you at greater risk of developing IT band syndrome

Is It Time to Seek Treatment?

Have you started to notice pain or tightness into your outer knee when you are active? Are you starting up a training routine and wanting to stay injury free?

If you are already experiencing symptoms of IT band syndrome, a CityPT physical therapist can help to identify the cause of those symptoms and guide you towards pain free movement. Additionally, they can also assist you with injury prevention. CityPT therapists can work with you to improve your movement patterns and training to help you achieve your goals while staying pain-free.

Book an appointment today

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.



  1. Almeida SA, WIlliams KM, Shaffer RA, et al. Epidemiological patterns of musculoskeletal injuries and physical training. Med. Sci. Sports Exerc. 1999 August; 31(8): 1176-1182.

  2. Louw M, Deary C. The biomechanics variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature. Physical Therapy in Sport. 2014 February; 15(1): 64-75. 2

  3. Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of Anatomy. 2006 March; 208(3): 309-316.

  4. Beals C, Flanigan D. A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population. Journal of Sports Medicine 2013; 2013. https://doi.org/10.1155/2013/367169.

  5. Charles D, Rodgers C. A Literature Review and Clinical Commentary on the Development of Iliotibial Band Syndrome in Runners. Int J Sports Phys Ther. 2020 May; 15(3): 460-470.

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