Iliotibial Band Syndrome

The iliotibial (IT) band is a thick rope of connective tissue that runs from your hip down the outside of your thigh to just below your knee. IT band syndrome happens when this band rubs back and forth against the bony bump on the outside of the knee (or the bony bump on the outside of the hip) every time you bend and straighten your leg, usually from running or cycling. The result is pain on the outside of the knee or hip that builds up over miles.

IT band syndrome is one of the most common overuse injuries in runners, accounting for up to 12 percent of running injuries. The classic triggers: ramping up training mileage too fast, lots of downhill running, or shoes that have worn out their support.

The signature pattern is a sharp or burning pain on the outside of your knee that starts at a predictable point during a run, often the same mileage every time, and forces you to stop. The pain eases within minutes of walking, then returns if you try to run again. Some runners feel the pain at the outer hip instead of (or in addition to) the knee, depending on where the band is tightest.

Between runs, going down stairs or downhill tends to be worse than going up, because the band snaps over the bony bump on the outside of the knee each time it bends past about 30 degrees. Sitting with the knee bent for a long time can produce an ache at the outer knee. You may notice tightness or a snapping sensation on the outside of the thigh, and pressing directly on the bony prominence at the outer knee reproduces the pain precisely.

The classic story is pain on the outside of the knee (or hip) that starts at a predictable distance into a run and eases with rest. A focused physical exam of the hip and knee checks how tight the IT band is and reproduces your pain by pressing on the outer knee. Imaging is usually not needed; MRI is added when the diagnosis isn't clear-cut or when symptoms are severe.

Almost everyone with IT band syndrome gets better without surgery. The treatments below are listed in the order we usually introduce them, and each one is added on top of the steps before it rather than instead of them. The first three are the backbone of care; the rest are added when the pain is slow to settle.

First-line care

If the pain is slow to settle

1. NSAIDs

   NSAIDs like ibuprofen for short courses to calm acute inflammation.

2. Corticosteroid injection

   A corticosteroid injection at the painful spot (outer knee or outer hip) can relieve cases that haven't responded to the steps above.

Surgery is rarely needed. When symptoms persist despite a sustained course of consistent non-operative treatment, a small procedure can release the back portion of the IT band where it rubs against the bone.

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language