Preventing and treating iliotibial (IT) band syndrome: Tips for pain-free movement

The iliotibial band (also known as the IT band) is a thick stretch of tissue on the outside of your upper leg that runs from your hip to your knee.

When your IT bands are healthy, they help you bend and straighten your knees. But when they get inflamed or irritated — often from activities that require a lot of knee bending like running, cycling, and skiing — you can end up with pain that keeps you from your favorite activities.

What is iliotibial band syndrome?

IT band syndrome can cause pain and discomfort. Symptoms of this condition may include:

• pain along the IT band, from the hip to below the knee
• pain, swelling, warmth, or redness in the outer part of the knee
• pain on the outside of the hip that is worsened by pressure, such as when lying on the affected side
• pain when you start to exercise, but that improves as you warm up (eventually you may have pain even while at rest)
• pain that gets worse when you run down hills or stairs, lengthen your stride, or sit for long periods of time with your knees bent.

What causes IT band syndrome?

IT band syndrome is likely caused by a number of factors. It was once thought to be due to friction as the band of tissue rubbed against bone in the knee. But studies don’t support this theory.

Today, experts believe IT band syndrome is largely due to overuse, particularly during activities that require you to repeatedly bend your knee.

The pain doesn’t typically occur after a specific injury, says Dr. Robert H. Shmerling, senior faculty editor at Harvard Health Publishing and former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center. Rather, “it develops after intense use or overuse, and sometimes due to poor form.”

Other risk factors include:

• changing your activity level, especially quickly
• skipping a warmup before exercise
• having bowed legs.

Preventing IT band syndrome

The following steps can help you ward off IT band pain:

• Warm up for at least five to 10 minutes before starting athletic activity.
• Increase the amount and intensity of your training gradually over time.
• Wear supportive, comfortable shoes when you exercise.
• Include at least one full day off from exercise every seven to 10 days. Listen to your body and take more rest days as needed.
• Run on level surfaces whenever possible.
• Vary the types of activity you do.
• Stretch your lower body regularly.

Treating IT band syndrome

Treatment for IT band syndrome usually involves:

• rest
• ice
• physical therapy, including foam rolling, stretching the IT band, and strengthening the surrounding muscles
• nonsteroidal anti-inflammatory drugs like ibuprofen (Advil) or injected corticosteroids.

If you’re a cyclist, you may want to adjust the seat of your bicycle to make sure it’s not contributing to poor form and pain, Dr. Shmerling says. If you’re a runner, treating your discomfort might involve investing in new running sneakers, he adds.

Following these steps usually allows people with IT band syndrome to return to their activity of choice in about six weeks. In rare cases where these treatment tactics don’t help, your doctor may recommend a surgical treatment.

IT band stretches

IT band stretches can help to both prevent IT band syndrome and relieve symptoms. A physical therapist can help recommend the best IT band stretches to relieve your symptoms, but these classic movements may help.

Note: For the following exercises, a repetition (or rep) counts as each time you complete the full movement. One set is a specific number of repetitions.

Standing IT band stretch

Hold: 20 seconds
Reps: 3–4

• Stand with your right side closest to a wall.
• Place your right arm on the wall for support.
• Cross your right foot behind your left foot.
• With both feet on the floor, slowly lean your right hip toward the wall.
• Hold for 20 seconds.
• Return to standing, then repeat on the opposite side. This is one rep.
• Continue alternating sides for your desired number of reps.

Figure 4 stretch

Hold: 20 seconds
Reps: 3–4

• Lie on your back with your right knee bent and your right foot on the floor. Rest your left ankle on your right thigh just above your knee. Your left knee should point out to the side.
• Keep your head on the floor, your neck relaxed, and your shoulders back and down.
• Grasp the back of your right thigh with both hands and slowly lift your right foot up off the floor, pulling your legs toward your chest, until you feel a stretch in your left hip and buttock.
• Hold for 20 seconds.
• Return to the starting position, then repeat on the opposite side. This is one rep.
• Continue alternating sides for your desired number of reps.

Exercises to strengthen muscles around the IT band

The IT band is fibrous tissue, not a muscle, so you technically can’t strengthen the IT band itself, Dr, Shmerling says. But surrounding the IT band are muscles in your hips and thighs that allow you to bend and straighten your knees. Strengthening those muscles may help prevent and treat IT band syndrome.

Once again, a physical therapist may be best suited to recommending the ideal IT band strengthening exercises for you to try. But these tried-and-true knee and hip exercises are a good place to start.

Wall squat

Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

• Start standing up straight and place your back against a wall.
• Walk your feet out about 18 to 24 inches. Place your hands on your hips.
• Slowly bend your knees and hips, sliding your back down the wall. Stop before your buttocks reach knee level. Your knees should be aligned over your ankles in the squat position. Hold.
• Slowly straighten your legs as you return to the starting position. This is one rep.

Standing side leg lift

Reps: 10 per leg
Sets: 1–3
Rest: 30–90 seconds between sets

• Start standing up straight with your feet together and your hands on your hips.
• Keeping your shoulders back and down and your core engaged, shift your weight onto your right leg and slowly lift your left leg straight out to the side with your foot flexed.
• Pause briefly, then slowly lower your leg. Keep your hips even and your knees and toes pointing forward throughout.
• Finish all your reps, then repeat with the right leg. This completes one set.