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IT Band Pain - Overview

by Jaydee Vykoukal, PT, DPT October 12, 2020 0 Comments

IT Band Pain

IT band syndrome is an overuse injury that results in mild to intense lateral leg pain. Thankfully, IT band pain is surprisingly easy to treat with simple corrections to your exercise routine, daily lifestyle, footwear, and the right perspective. This guide contains everything you’ll need to know on the causes, symptoms, and treatments available for IT band syndrome.

What is IT Band Syndrome?

IT band syndrome, or ITB syndrome, is a tightness of the iliotibial (IT) band. Commonly diagnosed as an overuse injury, ITB syndrome is felt on the outside of the leg between or near the hip and knee where a tight IT band rubs aside prominent bony landmarks. IT band syndrome can cause conditions like runner's knee, in which the IT band painfully rubs over bony areas in the leg. Repetitive activities like cycling, walking, or climbing stairs may cause IT band syndrome.

IT Band Syndrome Causes

The cause of IT band syndrome varies depending on lifestyle. Whether ITB syndrome is mild or chronic, three common causes include improper gait, weak hip muscles, and poor orthotics.

  • Improper Gait

    ITB syndrome is often caused by improper form when walking or running. A person's gait can place the IT band in a compromised position, causing the ligament to rub or snap over bony landmarks in the leg.

    Excessive internal rotation or valgus (where the knee collapses inward) of the thigh while walking or running, sometimes known as knock knees can be an issue. This places stress on the IT band near the knee, causing the tendon to rub over the lateral epicondyle (outside edge of the knee) of the femur. Additionally, not keeping the pelvis level while running or walking can lead to the same problem.

  • Weak Hip Muscles

    Weak hips can cause IT band syndrome and chronic IT band syndrome. Weak hip muscles strain the ligaments in the lower body due to coordination and joint alignment imbalances, especially the large IT band. This ultimately can lead to inflammation and IT band tightness. 

    The IT band connects into the tiny hip flexor muscle known as the tensor fascia latae. This muscle is meant to provide stability to the hips and IT band but can quickly be overused and strain surrounding tissues when surrounding muscles are weak, particularly the hip abductors. Poor movement patterns, prolonged sitting and excessive flexion can weaken hip muscles.

  • Poor Orthotics

    While not everyone needs orthotics, issues like flat feet can warrant investing in them to prevent issues like IT band syndrome. However quality counts, as wearing poor orthotics that do not support the arch or ankle can cause the knees to internally rotate and the legs to cross over during gait. This internal rotation and cross-over gait causes the IT band to move over the lateral condyle of the femur, resulting in inflammation and tightness.

IT Band Syndrome Symptoms

IT band syndrome symptoms are apparent at the knee and hip. If you have any of the following symptoms, consult your doctor for a professional diagnosis.

  • Tightness or Loss of Flexibility

    A common symptom is tightness and loss of flexibility on the outside of the leg. Adduction movements of the leg (moving across the body) become more difficult and painful. The TFL muscle (tensor fasciae latae), which attaches to the IT band near the hip, often becomes tight, resulting in poor knee and hip flexibility. This makes the knee and hip feel stiff and out of sync with normal movement. 

  • Tenderness and Pain

    Most commonly found on the outside of the upper knee, a stabbing or throbbing feeling while running, walking, or cycling is a key symptom of IT band syndrome. Although, there can be tenderness and extreme sensitivity anywhere along the side of the thigh all the way up to the hip.

    More specifically, if pain is felt in the knee when the joint is flexed 30 degrees, IT band syndrome is likely the cause. Standing or sitting with legs crossed can cause tenderness on the outside of the leg. Running with IT band syndrome will worsen the pain.

IT Band Syndrome Test

Understanding IT band syndrome and whether these tissues are affected is important to creating the proper treatment plan for your injury. Test for IT band syndrome using one of the three following methods.

Always consult your doctor for a professional diagnosis and treatment plan, especially if symptoms are moderate to severe and affecting your quality of life. These tests should be completed by a medical professional. 

Ober’s Test

  • Lie on the non-affected side with your hip and knee flexed at 90-degree angles.
  • Supporting the hip, raise the affected leg until it is in line with the hip.
  • While keeping the knee bent bring the thigh behind you (extended), and slowly lower your hip down toward the floor.
  • If your leg remains elevated, you have IT band tightness. 
  • If your leg can comfortably move down toward the floor without straightening the knee or rotating the hip, then the IT band is flexible and not the primary issue. 

Renne Test

  • Stand up straight with your legs shoulder-width apart.
  • Stand on the affected leg.
  • Have someone place a hand around your knee, with the thumb at the lateral epicondyle of the femur.
  • Squat 30 degrees on the affected leg.
  • If you feel pain underneath examiner's thumb, you have IT band tightness.

Noble’s Test

  • Lie flat on your back.
  • Flex your knee to 90 degrees.
  • Have someone place firm pressure on or near the lateral femoral condyle (outside edge of your knee) and gently extend the knee.
  • If you feel pain at roughly 30 degrees of flexion, you have IT band tightness.

Long-Term Chronic ITBS Solution

Depending upon the severity of tightness and inflammation, IT band syndrome can subside in a few weeks or months. Recovery time hinges on proper rest and implementation of exercises and stretches for IT band syndrome.

Simple movement and lifestyle adjustments can prevent and ease pain associated with IT band syndrome. Adopt a new approach to daily movement and body posture, and maintain good body awareness to prevent injury. Of course, stay active to keep your lower body strong and functioning properly, and consult your doctor or physical therapist for further treatment options.


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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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