Ilio-tibial band (ITB) syndrome

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due December 2023

Ilio-tibial band (ITB) syndrome – also known as ITB friction syndrome – is an injury to a part of your knee. Your IT band is a thickened band of tissue that runs all the way down the length of the outside of your thigh. ITB syndrome is the most common cause of pain on the outside of the knee in runners, cyclists and other sports people.

About Ilio-tibial band (ITB) syndrome

Your IT band works with your knee ligaments to help stabilise your knee joint. ITB syndrome happens when your IT band rubs repeatedly against the lower end of your thigh bone as it joins your knee. This friction causes inflammation and pain.

ITB injuries are given different grades depending on how severe they are.

Causes of iliotibial band (ITB) syndrome

You usually get ITB syndrome if you run or cycle, but you can get it from other sports too, such as tennis or football. ITB syndrome is an overuse injury – it tends to get worse with repeated movement. You’re more likely to get it the more you do over the course of a week.

There are certain things to do with how you run or exercise that can put you at greater risk of developing ITB syndrome. These include if you:

• run for long distances or for a long time
• are new to running or you suddenly increase how far or how often you run
• wear worn-out running shoes
• run on slippery or uneven ground
• have sudden changes to the surface you run on, for example you go from soft to hard or flat to uneven ground
• overpronate (your foot rolls inwards when you run)

There are some things in your body that can make you more susceptible to developing ITB syndrome too. These include having weak muscles in your hips or knees, tightness in your TB band, and having slight differences in the length of your legs.

Symptoms of iliotibial band (ITB) syndrome

The main symptom of ITB syndrome is a sharp pain or ache on the outside of your knee, which may spread up or down your leg, and occasionally up towards your hip. The outside of your knee may be tender to the touch and you may have some swelling. The pain may be worse when you run downhill, or if you run or cycle for longer than normal. You may find that the pain starts at a similar point in your run, and goes when you stop.

Usually, you’ll only feel pain when you do activities such as running or cycling. But if the problem gets worse, it can start to affect you even when you just go for a walk or sit with your knee bent.

Self-help for iliotibial band (ITB) syndrome

It’s important that you stop doing the activity that brings on your pain. If you’re only getting mild pain, you may just be able to do less of your activity. For instance, stop running before the time or distance when you normally get the pain. If your pain is more severe, you should stop altogether. You can keep active by doing exercise which doesn’t bring on pain, such as swimming.

When you first develop ITB syndrome, it can help to put ice or a cold compress on the painful area. Apply it for 15–20 minutes at a time, every two to three hours. Don’t put ice directly on your skin as it can give you an ‘ice burn’ – place a cloth between the ice and your skin.

Treatment for iliotibial band (ITB) syndrome

The initial treatment for ITB syndrome aims to reduce your pain and inflammation. You can do this with rest and ice (see above) and medicines. Further treatment includes physiotherapy to gradually get you back to your usual activities. Most people recover and can go back to sports or running within four to six weeks.

You may find it helpful to see a sports medicine professional, such as a physiotherapist or a sports doctor who can diagnose and treat ITB syndrome. Your GP may refer you, or you can book an appointment with a physiotherapist directly.

Physiotherapy for ITB syndrome

Your physiotherapist will carefully assess your knee and plan an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles gradually.

Treatment usually involves manual techniques and stretching exercises at first. Your physiotherapist may suggest you try using a foam roll as part of a home exercise programme to help reduce your pain. You’ll then usually need to follow some specific strengthening exercises to help you recover. Finally, your physiotherapist will advise you on how you can gradually get back to your normal activities. Make sure you do the exercises as this is an important part of your recovery.

Your physiotherapist may give you some advice on how to try to prevent the problem coming back. For example, you may need to change your running shoes to correct problems with your foot movement or look at your running gait on a treadmill.

Medicines for ITB syndrome

You can take over-the-counter painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen, to help ease your pain and reduce inflammation and swelling. Your doctor may also be able to prescribe stronger NSAIDs if your pain is really bad. Always read the patient information that comes with your medicine, and if you have questions ask your pharmacist or GP for advice.

Your GP may recommend that you have a corticosteroid injection into the inflamed area if you have severe pain or swelling. This is unlikely to take away the pain completely, but may give you enough pain relief to be able to continue with physiotherapy and rehabilitation.

Surgery for ITB syndrome

Surgery isn’t usually used to treat ITB syndrome. Your doctor will only suggest you have an operation if other treatments have failed. Ask your doctor for more information on the best treatment for you.