Ilio-Tibial Band Syndrome: A Common Cause of Lateral Knee Pain

The most common cause of lateral knee pain:

If you’re a runner or an active walker, you may already know the frustration of pain along the outside of your knee. One of the most common causes of this discomfort is Ilio-Tibial Band Syndrome (ITBS), an overuse injury that can sideline even the most dedicated athletes.

What Is the IT Band?

The iliotibial band (IT band) is a thick band of fascia that runs along the outside of the thigh. It connects muscles of the hip (including the gluteus maximus and tensor fasciae latae) to the tibia, just below the knee. Because of its length and attachments, the IT band plays an important role in stabilizing both the hip and knee during movement.

What Causes IT Band Syndrome?

ITBS develops when the IT band becomes irritated from repetitive stress, most often due to:

• Weak hip abductors (gluteus medius and gluteus maximus)

• Over-pronation of the foot

• Repetitive impact from running, hiking, or cycling

• Training errors, such as sudden increases in mileage or intensity

When the IT band rubs against the lateral femoral condyle (the bony part of the thigh near the knee), friction and inflammation occur, leading to pain.

Symptoms of ITBS

The hallmark symptom of ITBS is sharp or burning pain on the outside of the knee. Other possible symptoms include:

• Pain that worsens with running or repetitive knee flexion

• Tenderness along the outer thigh or full length of the IT band

• Discomfort during everyday walking if left untreated

• Relief with rest, but recurrence with activity

Treatment and Recovery

Early management can prevent ITBS from becoming chronic. Strategies may include:

Self-care:

• Apply ice to reduce inflammation.

• Gentle stretching of the hip and IT band.

• Foam rolling to release tightness and trigger points.

Correcting the root cause:

• Strengthening hip abductors is critical. Without addressing weak glutes, symptoms often return.

• Gait assessment and correction of foot mechanics may be recommended.

Professional care:

• Chiropractors and physical therapists can provide adjustments, soft tissue therapy, and a personalized rehab plan.

• Targeted exercises ensure muscles are activated and retrained for long-term stability.

Example Exercises for Hip Strengthening

Clamshell with resistance band

Photo Source: Thera-bandacademy.com

• Lie on your side with knees bent and feet together.

• Place a resistance band around your thighs.

• Keep your heels together and lift the top knee.

• Repeat 10–15 times per side.

• Focus on keeping your torso stable (don’t roll forward or backward).

Hip hikes

Photo Source: rehabexercise.org

• Stand on one leg on a step or even surface.

• Slowly drop and lift the opposite hip, focusing on engaging the glute medius.

• This can be modified by standing against a wall with a stability ball pressed into your hip for support.

These exercises help retrain the hip muscles to support the IT band and relieve strain on the knee.

The Takeaway

Ilio-Tibial Band Syndrome is common but highly treatable. Addressing muscle imbalances — especially weak glutes — is the key to recovery and prevention. With proper care and guided rehab, you can return to running, walking, or cycling without nagging knee pain.

References

1. Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007;10(2):74–76. https://doi.org/10.1016/j.jsams.2006.05.017

2. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005;35(5):451–459. https://doi.org/10.2165/00007256-200535050-00006