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IT Band Syndrome: What it is and how to avoid it

Spring is in the air, and so is the desire to get outside and run. Whether it’s just a run, it’s soccer, cycling, or other sports that require running, this is the time that we see more people come in with IT Band Syndrome. The winter has been long, and I’m sure many of you were eager to get outside and take in the sun and the fresh air, but don’t get over zealous!

Without adequate precautions, you run the risk of injuring yourself.

Who Do We See IT Band Syndrome The Most In?

People who engage in activities that involve repetitive motion, like running, triathletes, hiking, cycling etc are the most prone, particularly when there is a rapid increase in distance. Other sports that involve lateral movements like tennis, squash, and skiing are also susceptible to IT Band Syndrome.

Those with poor connective tissue quality (like what we see in those with autoimmune disease) and hypermobile joints fall under this category, as do those who are biomechanically hypermobile – like gymnasts, yogi’s, dancers, and ice skaters. Something like an overstretched hamstring can lead to the IT Band pulling across the knee.

So What Is The IT Band?

It’s a thick band of fascia that runs down the outside of the thigh from the illiac crest (hip bone) to just below the knee on the lateral tibia (shin) bone at the Gerdy’s Tubercle. It actually starts as a muscle at the top of the hip, and turns into a thick connective tissue band.

What is The Function of The IT Band?

The IT Band is what extend, abducts, and externally rotates the hip with the foot off the ground. During knee extensions, the IT Band moves anterior to the lateral condyle of the femur. While in -30 degree knee flexion, the IT Band moves posterior to the lateral condyle.

When the foot is on the ground, it slows down the lateral hip shift. The IT Band stabilizes the knee both in extension and in partial flexion. What this means is – it is constantly used during walking and running.

What Causes IT Band Syndrome?

There are a number of causes, but here is a list of the 8 most common:

  1. Overuse, specifically in sports that require repetitive motion.
  2. Training too fast- increased mileage of more than 10% a week can result in injury.
  3. Crossing your legs at work, while seated for many hours a day.
  4. Weak hamstrings- if your hamstrings are weak the IT Band will overwork to stabilize your knee.
  5. Hypermobile knees when in extension, will cause too much internal rotation – and the IT Band will pull.
  6. Bunions will cause feet to roll in (over pronate). This will cause your hips to internally rotate too much and will pull on your IT Band.
  7. Old ankle sprains can also be a cause. When an old ankle injury isn’t healed correctly, it can cause further injury somewhere else up the kinetic chain. This often can result in IT Band Syndrome.
  8. High arches can cause the feet to oversupinate. This can lead to the IT Band trying to stabilize the outside of the leg and result in injury.

Symptoms may include;

  • Swelling around outside of knee.
  • Lateral knee pain.
  • Pain with bending and extending the knee.
  • A clicking on the outside of the knee.
  • It will feel worse going up or down stairs or hills.
  • It will feel worse at beginning of exercise, then calms down.
  • Pain will become worse midway into exercise when the fatigue hits, and form falters.
  • Redness on the outside of knee that travels up the lateral thigh.

What About Treatment?

Treatment for IT Band Syndrome is more than just ICE and soft tissue manipulation on the IT Band. The complete treatment should include repatterning the old bad gait patterns. This in addition to:

  1. ICE – but only in the acute phase. It will not speed up the healing process.
  2. A change of gait mechanics, typically we look for a Pose Method Coach for patients to work with. Pose Method encourages a more efficient gait pattern striking more mid foot, underneath the body, and pulling more with a higher cadence with the hamstrings.
  3. Foam roll or stretching the IT Band. The IT Band is very thick, and really strong. This being said, we do find foam rolling or stretching the IT Band to be beneficial if followed immediately afterwards with strengthening exercises for the glutes, hamstrings, and lateral hips.
  4. Strengthening the hamstrings in those who are hypermobile or biomechanically hypermobile. Overstretched hamstrings will allow the knees to hyperextend and the hips to turn inward or into internal rotation. This will pull on the IT Bands. Strengthening the hamstrings will prevent this compensation, and the strength exercises we love for this are thrusters, deadlifts, kettlebell swings, and lunges – all of course, with amazing form.
  5. Replace old footwear
  6. For the cyclists – check your bike set up, if you clip in your shoes and your feet are too internally rotated, your knees and IT Bands could suffer.
  7. Graston Technique is used to treat the soft tissue down by the knee, and is great for tendon injuries and breaking up tight fascia.
  8. Active Release Technique (ART) is used to work the muscles around the IT Band and the IT Band itself.
  9. Correcting gait patterns with anatomy in motion is a vitally important step. Especially if there are old foot injuries, high arches, and existing bunions. This will help the body find it’s center and learn to load and shift into each leg properly.

The bottom line is, IT Band Syndrome can be painful, and time consuming particularly if you are training for an event or sport. The main goal at Urban Wellness Clinic is to help you understand the nature of your injury, and to heal it completely and holistically.

Much like other injuries, if left untreated it can lead to further injuries. Finding to root cause of your injury and taking the steps to repair it will ensure that you can get back to your regular activities stronger, more stable, and better prepared. Want to jump start  your healing process now? Shoot us an email at or call 212-355-0445 for an appointment.

In good health,

Dr Emily Kiberd