IT Band Pain: Complete Guide
Understanding your Iliotibial Band (ITB) Pain as a Runner
Have you ever experienced a sharp, stabbing, ice-pick sensation on the outside of one of your knees while running? You might notice stiffness and tightness a few hours later or even a sharp twinge just from standing up. If so, there is a good chance that you might be dealing with iliotibial band (ITB) syndrome or pain. ITB pain is one of the most common running related injuries and can plague runners for a long time if not managed appropriately. In this blog post, I will provide an overview of what causes ITB pain, review common myths, explain how to treat it, and outline a simple return to running guide.
What is the ITB and What Does it Do?
ITB pain is the second most common running related injury behind runner’s knee or PFPS (check out our blog page if you want to learn more about PFPS). It has been cited to be the cause of about 15% of all lower extremity overuse injuries. Further, it is most commonly seen in recreational distance runners, such as someone training for their first marathon, and is more common in females.
While ITB pain causes frustration for many runners, what does the IT band actually do? The ITB can be described as a spring on the side of your leg. It is a dense piece of connective tissue that starts at the TFL and glute max, goes along the side of your thigh and inserts on the lateral aspect of your knee. While running, it can store and release about 14% of the energy that your Achilles tendon does or 5% of total work while running. This might not sound like much, but a 3 hour marathon could turn into a 3 hour and 9 minute marathon just from your ITB!
Common Myths About ITB Pain
With this improved understanding of the IT band function, there are still myths that remain around treatment and the cause of pain. A couple of common myths include:
“Your ITB rubs across your knee bone which causes pain”
“You need to stretch and roll your ITB to fix the pain”
“You have weak hips, that is why you have ITB pain”
“You have a high arch and pronate too much which is what caused your ITB pain”
All of these myths share one common assumption: the ITB pain is due to a specific mechanical issue like rubbing, tightness, or weakness. In reality, this injury is much more complex as it is typically related to a combination of tissue overload, training error, and reduced muscle capacity. In a future blog post, we will break down each of these myths in more detail and examine what current research actually says.
A Modern Rehab Approach
In order to rehab back from ITB pain, a proper rehab plan should focus on the previously stated errors. Smart load management is the key to starting this process as the goal should be to keep symptoms below 3/10 to reduce knee sensitivity. A review of current training load is required as well. In some cases, there should be a reduction in running volume, intensity, and downhill runs should be avoided as this increases knee stress. Once tissue overload is managed, rehab should progress into building tissue capacity of the glute, hip, and knee complexes. These exercises can vary from table level like bridges to more intense activities like Bulgarian split squats. A final modification to training can be made related to gait. Research shows that increasing running cadence by 5-10% or increasing step width to reduce crossover gait can alleviate ITB pain and improve running tolerance.
As one of the most common running related injuries, ITB pain can be frustrating and difficult to overcome. However, by improving load management, avoiding training spikes, and improving tissue tolerance, returning to running is possible. In our next post we will further break down the anatomy, biomechanics, and function of the ITB as it relates to running.
Tired of trying to figure out how to treat your ITB pain by yourself? If you live in the CSRA, set up an appointment with us today! We will create a personalized treatment plan and get you back to running ASAP!
Disclaimer: This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or health-related goals.
References
Abubakar, A., Anwar, M., Sameen, H., Saher, U., Abid, H., Rafi, S., Ali, I., Fatima, W., Zubair, A., & Rafique, H. (2024). Prevalence and association of iliotibial band tightness with daily sitting hours and type of sitting surface among tailors of Sahiwal, Pakistan. Journal of Health and Rehabilitation Research, 4(3), 1–6.
Buckthorpe, M., Stride, M., & Della Villa, F. (2019). Assessing and treating gluteus maximus weakness – A clinical commentary. International Journal of Sports Physical Therapy, 14(4), 655–669. https://doi.org/10.26603/ijspt20190655
Charles, D., & Rodgers, C. (2020). A literature review and clinical commentary on the development of iliotibial band syndrome in runners. International Journal of Sports Physical Therapy, 15(3), 460–470. https://doi.org/10.26603/ijspt20200460
Ebaugh, D., Gard, K., Maschi, R., & Milner, C. (2016, February 20). Anatomy and biomechanics of running injury: From cadaver dissection to practical interventions [Presentation]. APTA Combined Sections Meeting, Anaheim, CA, United States.
Eng, C. M., Arnold, A. S., Lieberman, D. E., & Biewener, A. A. (2015). The capacity of the human iliotibial band to store elastic energy during running. Journal of Biomechanics, 48(12), 3341–3348. https://doi.org/10.1016/j.jbiomech.2015.06.017
Kashyap, R., Goyal, M., Bhowmik, S., Nagpal, A., Chhaya, Bathla, M., Saha, J., & Goyal, K. (2026). Development and content validation of a novel Iliotibial Band Friction Syndrome Index questionnaire: A cross-sectional study. Journal of Clinical and Diagnostic Research, 20(7), YC06–YC09. https://doi.org/10.7860/JCDR/2026/87821.23695
Lenhart, R., Thelen, D., & Heiderscheit, B. (2014). Hip muscle loads during running at various step rates. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 766–774. https://doi.org/10.2519/jospt.2014.5575
Nielsen, R. Ø., Sørensen, H., Parner, E. T., Lind, M., Nohr, E. A., & Rasmussen, S. (2014). Excessive progression in weekly running distance and risk of running-related injuries: An association which varies according to type of injury. Journal of Orthopaedic & Sports Physical Therapy, 44(10), 739–747. https://doi.org/10.2519/jospt.2014.5164
