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Iliotibial Band Syndrome


What is iliotibial band syndrome (ITBS)?

ITBS, also known as runner's knee, happens when your iliotibial band becomes injured and causes pain. The iliotibial band is a long band of tissue. It extends from the outside of your pelvis (hip bone) to the outside of your tibia (shin bone). It helps keeps the knee in the correct position when you stand or move. ITBS occurs most often in long distance runners and cyclists.

Iliotibial Band Syndrome

What causes ITBS?

  • Weak hip muscles
  • Tight hip muscles
  • Swelling caused by rubbing of the iliotibial band against the bursa (sac of fluid between bones and tissues)
  • Too much turning of your hip outward and knee inward when you exercise
  • Differences in the length of your legs

What increases my risk for ITBS?

Long distance, or downhill running may increase your risk for ITBS. Cycling or other repetitive exercises with your lower body may also increase your risk.

What are the signs and symptoms of ITBS?

  • Pain or swelling in your hip, knee, thigh, or buttock
  • Pain when you touch your hip, outer thigh, or outer part of your knee
  • Pain that gets worse during running or repetitive exercises and gets better when you rest

How is ITBS diagnosed?

Your healthcare provider will ask you about when and where your pain occurs. Tell him about the type of exercise that you do. Your healthcare provider may test the strength and flexibility of your hip. He may move your hip in different positions and ask if you have pain. He will look for swelling or push on parts of your leg and ask if you have pain. You may also need the following tests:

  • An x-ray, ultrasound, or MRI may show injury to your iliotibial band. You may be given contrast liquid to help the iliotibial band show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.

How is ITBS treated?

Symptoms of ITBS may improve after 6 weeks of minor treatments. You may need any of the following:

  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Medicine to decrease pain and swelling can be applied to your skin over sore areas as directed.
  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely.
  • Steroid injections may be given to decrease swelling.
  • Surgery may be needed if other treatments do not work. Surgery may include knee arthroscopy or an open procedure to remove part of the injured iliotibial band.

What can I do to manage my symptoms?

  • Rest. Do not do exercises that cause pain. You may need to rest for several weeks. Ask your healthcare provider when you can resume your normal exercises.
  • Apply ice on your hip, knee or thigh for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel. Ice helps prevent tissue damage and decreases swelling and pain.
  • Apply heat on the area in pain for 20 to 30 minutes before your stretch or exercise. Use a heat pack or wet a washcloth and heat it for 15 seconds in the microwave. Heat helps decrease pain and makes it easier to stretch your muscles.
  • Massage painful areas as directed. Use a foam roller to gently massage your painful areas. Place the foam roller on a flat surface. Lie on your side with the foam roller against your painful leg. Move so that it rolls up and down from your hip to above your knee. Do not lie with it against the outside of your knee cap.
  • Stretch as directed. Stand and wrap your painful leg behind and to the side of your other leg. Reach your arm to the outside of the ankle of your painful leg. Hold for 15 seconds Return to the starting position. Do this 10 times. Repeat this exercise 3 to 5 times per day. Ask your healthcare provider or physical therapist for other ways to stretch.
  • Go to physical therapy as directed. Your physical therapist will teach you how to do exercises that will strengthen your hip muscles and improve your flexibility.

How can I help prevent ITBS?

  • Slowly increase the time and distance that you run or bike. Start with short runs or cycle rides. Ask your healthcare provider how and when to increase your distance and time that you exercise.
  • Do not run down hills or stairs. When your healthcare provider says it is okay to exercise, run on flat surfaces only. Hills and stairs may cause pain and make your condition worse.
  • Warm up and stretch before vigorous exercise or sports.
  • Change the seat height or foot position of your bicycle. Ask your physical therapist what the correct height and foot position of your bicycle should be. Make these changes to decrease the stress on your iliotibial band.
  • Use correct body position when you exercise. Ask your healthcare provider or physical therapist how to move your legs and feet when running or cycling. This may decrease the stress on your iliotibial band.
  • Wear supportive shoes or orthotics. Orthotics are cushions that are placed inside of your shoes or sneakers. You may need orthotics in your running shoes if the bottom of your feet do not curve or arch enough off of the floor. Ask your healthcare provider if you need orthotics.

When should I contact my healthcare provider?

  • You have a fever or chills.
  • You have redness, warmth, or severe swelling.
  • Your pain does not improve or gets worse after treatments.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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