by Smith CM

Iliotibial Band Syndrome

(IT Band Friction Syndrome; ITBFS; ITBS)


Iliotibial band syndrome (ITBS) is an overuse injury. The iliotibial band (ITB) is a thick band of fibrous tissue. It runs from the hip down the outside of the thigh and attaches to the tibia. The tibia is the large bone of the lower leg.
Tendons of the Lateral Knee
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ITBS is caused by repetitive friction or rubbing of the iliotibial band against the bone on the outer side of the knee. This excessive rubbing can irritate the ITB and/or the tissue underneath.
Causes of the excessive friction include:
  • Structural abnormalities, such as a short, tight IT band
  • Problems related to the foot, ankle, or hip
  • Opposing muscle imbalances, such as the quadriceps stronger than hamstrings
  • A prominent lateral femoral epicondyle, the bony structure on the outer side of the knee
  • Inward rotation of the leg
  • Angle where knee flexes
  • Legs of different lengths
  • Bowlegs

Risk Factors

Factors that increase your risk of getting ITBS include:
  • Certain sports with repetitive motions, such as running and cycling
  • Incorrect training technique
  • Increasing cycling or running mileage too quickly
  • Running up and down hills
  • Overtraining
  • Using damaged or worn out equipment or footwear
  • Wearing improper shoes for a sport or athletic activity
  • Athletic equipment that is not properly fit to the user, such as a bicycle


Symptoms of ITBS include:
  • Dull aching or burning sensation on the outside of the knee during or after activity
  • Sharp stabbing pain on the outside of the knee during or after activity
  • Pain that shows up in the hip, known as referred pain
  • Progressive, worsening pain
  • Snapping, creaking, or popping when the knee is bent and then straightened


You will be asked about your symptoms and medical history. In most cases, diagnosis can be made with a physical exam.
Your ITB function may be tested. This can be done with:
  • Obers test—determines the tightness of the ITB
  • Rennes test—specifies the area of pain while full weight is placed on the bent leg
  • Nobles test—determines the area of pain while the leg is flexed at a certain angle
Images may be needed of your leg. This can be done with an MRI scan .


Talk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:

Supportive Care

The IT band will need time to heal. Supportive care may include:
  • Rest—Activities may need to be restricted. Normal activities will be gradually reintroduced as the injury heals.
  • Ice—Ice therapy may help relieve swelling. Heat therapy may be advised when normal activities are reintroduced.
  • An orthotic device may be advised to help control rotation of the foot and stabilize the knee.
Prescription or over-the-counter medications may be advised to reduce pain. Corticosteroid injections may also be advised in some cases.

Physical Therapy

A physical therapist will assess the IT band. An exercise program will be created to help recovery and to stretch and strengthen the muscles.


Surgery may be needed in cases when other treatments are not effective.


To reduce your chances of ITBS, take these steps:
  • Learning proper training techniques
  • Increasing mileage run gradually
  • Wearing appropriate shoes for each sport
  • Replacing athletic shoes as they show signs of wear
  • Being aware of running surfaces
  • Using properly fitted equipment
  • Strengthening quadriceps, hamstrings, and gluteal muscles


American College of Sports Medicine
OrthoInfo—American Academy of Orthopaedic Surgeons


Canadian Orthopaedic Association
Department of Orthopaedics—The University of British Columbia


Baker RL, Souza RB, et al. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PMR. 2011;3(6):550-561.
Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451-459.
Iliotibial band (ITB) syndrome. Updated July 10, 2013. Accessed March 4, 2015.
Strauss EJ, et al. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec;19(12):728-36.

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