IT Band Syndrome: 10 Best Exercises & Stretches for Knee Pain Relief

What is the IT Band?

The IT Band, formally known as the Iliotibial Band, is a thick band of fascia (connective tissue) that runs from the outside aspect of the pelvic crest bone, down the outer thigh, past the knee, and finally inserts into the tibia bone (shin bone). The IT Band helps to stabilize the pelvis as well as extend and rotate the hip.

What is IT Band Syndrome (ITBS)?

IT Band Syndrome, or ITB Syndrome, is a group of symptoms (typically outer knee pain) that occur as the result of a friction syndrome involving the IT Band and other structures surrounding it. This condition is very commonly seen in runners and cyclists due to the repetitive nature of the movements. Although, it does affect non-athletes as well.

The IT Band is a very strong and flat band of fascia. Since it helps to stabilize the pelvis, sometimes our body begins to rely too much on it. This is especially amplified if the hip muscles are weak.

Under normal circumstances, every time that we bend and straighten the knee, the IT Band flawlessly glides over the side of the upper shinbone (tibia). However, as added stresses are repetitively placed through the IT Band with activities such as running, cycling, or walking up/down stairs, increased tightness will occur in the tissue.

The increased tightness of the IT Band will eventually lead to excessive rubbing of the tissue on the shinbone. This repetitive rubbing will cause aggravation and inflammation in the band itself. Once the onset of inflammation occurs, pain is produced in the outer (or lateral) knee area.

Causes of IT Band Syndrome

There are several causes of IT Band Syndrome.

These include:

1. Knee Structure Deformities

   • Increased tension and stress in the IT Band can be caused by being knock-kneed or bow-legged.

2. Hip Weakness

   • Weakness in the glute complex (gluteus maximum, gluteus medius, gluteus minimus) and the hip external/internal rotators cause the body to rely more on the IT Band for support.

3. Repetitive Motion Sports

   • Participation in sports like cycling and running increases the likelihood of getting IT Band Syndrome. IT Band Syndrome is sometimes referred to as “runner’s knee.“

4. Being Overweight

   • A combination of a sedentary lifestyle and carrying excessive weight causes increased stress through both the soft tissues (IT Band, etc.) and joints.

5. Wearing High Heels

   • Wearing high heels changes the forces on the knee joint leading to increased activation of the IT Band.

IT Band Syndrome Symptoms

In general, IT Band Syndrome causes pain that will follow the path of the IT Band down the outer thigh to the outside of the knee. In addition, it typically presents with:

• Outer knee pain

• Increased pain with repetitive movement sports

  • Cycling, running, etc.

• Increased pain with stair climbing, repetitive squatting, walking

• Increased tightness and tenderness along the IT Band

• Swelling near the outer knee

How is IT Band Syndrome Diagnosed?

IT Band Syndrome is fairly easy to diagnose as the patient will report that his/her primary pain complaint is originating at the IT Band as it passes by the knee. There will be a replication of pain when you simultaneously push on the IT Band and bend/extend the knee joint. In the later stages of this condition, there typically is a small pocket of swelling at the outside of the knee.

Ultrasound Imaging would be able to display the inflamed IT Band tissue, which would confirm the presence of IT Band Syndrome.

Do I need an MRI?

Typically no, an MRI (Magnetic Resonance Imaging) is reserved for those that have met one or more of the following criteria:

1. Continued knee pain after a full trial of conservative treatment

   • Physical therapy exercises

2. Traumatic onset was the initial cause of the knee pain

   • Knee pain caused by a car or bike wreck, etc.

3. Knee pain or leg weakness begins to increase progressively

4. Progression of difficulty with walking

   • If you notice increased trouble with walking or standing activities

Alternative Treatment Options

Cryotherapy (ice/cold pack) can be placed over the outside of the knee to promote decreased knee pain and decreased inflammation. This can be used multiple times per day, but especially after periods of increased activity that may have caused increased tissue irritation.

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Diclofenac sodium (brand name: Voltaren Gel) is an over-the-counter anti-inflammatory topical gel that may also be considered for use with IT Band Syndrome. This gel will be rubbed over the painful area several times a day. It soaks through the skin and works to decrease the inflammation in the irritated soft tissue underneath. Remember to talk to your doctor or physical therapist before using any topical creams to ensure that it is safe for you to try.

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A non-hinged knee brace could be helpful in that it would help provide support to the knee during activities where you will be walking or up on your feet.

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If the knee pain is moderate to severe, or if the pain is not drastically improving with physical therapy exercises, the individual would likely benefit from a corticosteroid injection into the area of the IT Band. The injection acts as an anti-inflammatory and should have an immediate effect of decreasing the pain and reducing the inflammation.

However, don’t be fooled that you should stop doing your physical therapy exercises just because you get an injection. Just because the pain may be reduced, the initial cause of the irritation has not been addressed, so continue to follow the guidance in my knee and hip exercises and stretches found below.

Does Stretching the IT Band Help?

The IT Band is a thick, broad band of fascia. It is NOT a muscle. In fact, the IT Band is so strong that a research study has indicated that it would require over 2,000 lbs. of force to deform it. THAT’S A LOT OF FORCE!

There is a current discussion in the medical field with ongoing research as to what actually occurs when the IT Band tightens up. Is it really possible to stretch it? Probably not for the reason mentioned before.

Either way, we still need to mobilize it (get it moving). The IT Band stiffens up and needs to be relaxed so that there is less friction between it and the shin bone underneath whenever the knee bends and straightens.

My favorite way to mobilize the IT Band is to use a foam roller, which you will see included below as one of the 10 BEST IT Band Syndrome Exercises.

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Should I Stop Running?

Since IT Band Syndrome is caused by excessive friction of the IT Band on the shin bone, I would highly recommend temporarily stopping any activity that requires repetitive motion of the knee. Yes, this would include running.

However, let’s say that your knee pain does not start until after the 3rd mile into your runs each time. Then, in this case, I would tell you that you can run 2.5 miles or maybe even 2.75 miles each time. That way you could finish each run before feeling the onset of any knee pain.

As long as you are concurrently treating the condition by following my steps for the 10 Best IT Band Syndrome Exercises & Stretches located below, you should be able to slowly increase the distance of your runs over time as the knee pain symptoms gradually decrease.

How Long Does it Take for IT Band Syndrome to Heal?

This all depends on how quickly you begin to address the issue. If you have been having a gradual increase in IT Band Syndrome symptoms over the past 3-months before you finally decided to address it, then it wouldn’t be surprising for the condition to take 6 to 8 weeks to heal.

However, if you take charge quickly and follow my guidance, your knee pain should respond within 2-4 weeks allowing you to return to normal activity with minimal knee pain.

How to Prevent IT Band Syndrome in the Future?

The biggest take-home idea that I want you to understand is that IT Band Syndrome is fully preventable. Regardless of whether you’re an endurance athlete running 50k races or you were just helping your friend move into the 3rd-floor apartment where you had to go up and down several flights of stairs.

Performing basic hip and knee strengthening exercises and stretches to maintain normal flexibility and proper support of the surrounding structures will absolutely be able to help you live a much more pain-free lifestyle.

If you happen to “fall off the wagon” and not perform your basic exercises, then at least have the awareness of the signs and symptoms of IT Band Syndrome that I have mentioned previously so that you can intervene quickly before this friction syndrome gets out of control.