IT Band Syndrome
Iliotibial band (IT band or ITB) syndrome is a common overuse injury causing sharp or burning pain on the outside of the knee. It’s the most common running injury involving the knee, and also affects cyclists. The good news: with the right approach, it typically responds very well to physiotherapy.
What Is the IT Band?
The iliotibial band is a thick band of connective tissue running along the outside of the thigh from the hip to the knee. The lateral knee pain in ITB syndrome isn’t from the band “rubbing” over the knee as was once thought — it’s from compression of a fat pad under the ITB at the lateral knee. Regardless, the driver is usually hip weakness and running mechanics.
Why It Happens
- Hip abductor weakness: Allows the hip to drop and the knee to drift inward, increasing ITB tension
- Rapid increase in running volume: The classic story — increasing too much, too soon
- Narrow running stride: Crossing the foot over the midline increases lateral knee load
- Running on cambered surfaces or downhill
- Fatigued training in the late stages of long runs
Symptoms
- Sharp or burning pain on the outside of the knee, typically at the 2 km mark in a run
- May ease when you slow down or stop, then returns quickly when you resume
- Tender spot just above the lateral knee joint
- Rarely present at rest
- Stiffness when walking down stairs
Treatment
Hip Strengthening — The Key
Gluteus medius weakness is the most common driver. We prescribe progressive hip abductor and external rotator exercises, building from side-lying to single-leg loading.
Running Analysis and Retraining
We assess your running cadence, stride width and hip drop. Simple cues and adjustments — like slightly widening the stride or cueing better hip control — can dramatically reduce lateral knee loading.
Load Management
A structured return-to-run program that keeps you active without provoking the compressed fat pad.
Manual Therapy and Dry Needling
Soft tissue work to the TFL, gluteals and lateral thigh reduces tension and pain to allow better engagement with exercise. Foam rolling alone is insufficient.
