Iliotibial Band Syndrome: What It Is, Why It Happens, and How to Fix It
- Ryan Lauderdale
- Apr 6
- 4 min read
If you’ve ever felt a nagging pain on the outside of your knee—especially during running, squatting, or cycling—you may have experienced Iliotibial Band Syndrome (ITBS). This condition is one of the most common causes of lateral knee pain in athletes and active individuals. Yet, despite its prevalence, there’s still a lot of misunderstanding about what ITBS actually is, why it happens, and how to treat it.
Let’s break it all down from a performance and rehabilitation perspective.
What Is IT Band Syndrome?
The iliotibial (IT) band is a thick, fibrous band of fascia that runs along the outside of your thigh, from the hip to just below the knee. It plays a crucial role in stabilizing the knee joint during movement, especially during running, jumping, and squatting.
IT Band Syndrome (ITBS) occurs when this band becomes irritated and inflamed, leading to pain along the outer knee, typically where it rubs against the femur (thigh bone). Contrary to popular belief, ITBS is not caused by a "tight" IT band that needs to be stretched—instead, it’s often the result of excessive friction, poor biomechanics, and overuse.
How Do People Get IT Band Syndrome?
1. Overuse & High-Volume Training
ITBS is common in runners, cyclists, and athletes who engage in repetitive knee flexion and extension (Schwidder et al., 2021).
A sudden increase in training volume (e.g., ramping up mileage too fast, adding too many squats) without proper adaptation can overload the IT band.
2. Poor Hip and Glute Strength
Weakness in the gluteus medius and gluteus maximus leads to poor hip stability, causing the knee to drift inward (dynamic knee valgus), which increases friction on the IT band (Fredericson et al., 2000).
Many athletes neglect single-leg strength work, which is crucial for knee stability.
3. Biomechanical Imbalances
Leg length discrepancies, foot pronation, and poor running mechanics contribute to ITBS (Noehren et al., 2007).
If the tensor fasciae latae (TFL) is overactive, it pulls excessively on the IT band, increasing tension and irritation.
4. Poor Recovery & Mobility
Tightness in surrounding muscles (e.g., quadriceps, hamstrings, TFL) increases stress on the IT band.
Lack of soft tissue work, poor hydration, and insufficient cool-down routines contribute to IT band dysfunction.
How IT Band Syndrome Affects Training
1. Pain During Squats, Lunges, and Running
ITBS often worsens with deep squats, lunges, and prolonged running, making it a major issue for strength athletes and runners.
Athletes may compensate with poor movement patterns, leading to knee valgus, hip shifts, and increased injury risk elsewhere.
2. Decreased Power & Stability
Since the IT band assists in knee stabilization, inflammation and pain reduce an athlete’s ability to generate power efficiently.
Weak glutes and hip instability can result in a weaker squat, slower sprint speed, and less efficient cutting movements in sports.
3. Chronic Compensation Patterns
If left untreated, ITBS forces the body into compensatory movement patterns (e.g., shifting weight away from the painful leg).
This can lead to hip pain, low back pain, and even issues in the opposite leg.
How to Fix & Prevent IT Band Syndrome
1. Strengthen the Glutes & Hips
Glute medius activation: Clamshells, lateral band walks, and single-leg glute bridges.
Hip stability work: Bulgarian split squats, step-ups, and single-leg Romanian deadlifts (RDLs).
Force absorption drills: Eccentric control exercises (e.g., slow step-downs) to improve knee stability.
2. Improve Running & Squatting Mechanics
Ensure proper knee alignment during squats and lunges (knee tracking over the toes, not caving inward).
Avoid excessive heel striking when running—focus on a midfoot strike for better shock absorption.
3. Soft Tissue & Mobility Work
Foam rolling: Target the quads, hamstrings, and TFL (not the IT band itself—it’s too dense to “release”).
Hip flexor & TFL stretching: Loosening these muscles reduces IT band tension.
Myofascial release: Deep tissue work with a lacrosse ball can help break up adhesions in the TFL.
4. Modify Training Load
Reduce running volume or adjust training intensity until symptoms subside.
Avoid deep knee flexion if it aggravates symptoms—opt for box squats or split squats instead.
5. Address Foot & Ankle Mechanics
Athletes with flat feet or excessive pronation should consider proper footwear or orthotics if needed.
Strengthening the intrinsic foot muscles and improving ankle dorsiflexion can help redistribute forces properly.
Conclusion: Train Smart, Stay Pain-Free
Iliotibial Band Syndrome is more than just an annoying knee pain—it’s a sign of underlying weakness, mobility restrictions, and poor movement mechanics. Addressing these issues not only eliminates ITBS but also enhances overall athletic performance.
By building strong glutes, improving knee stability, and correcting movement patterns, you can prevent ITBS from derailing your training and keep progressing toward your goals.
If you’re dealing with IT band pain, don’t just foam roll and hope for the best—fix the root cause, and you’ll be back to training pain-free in no time.
References
Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine, 10(3), 169-175.
Noehren, B., Davis, I., & Hamill, J. (2007). Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clinical Biomechanics, 22(9), 951-956.
Schwidder, A., Stoll, J., Stukenborg-Colsman, C., & Windhagen, H. (2021). Iliotibial band syndrome: Diagnosis, treatment, and prevention strategies. Orthopedic Reviews, 13(1), 21-28.
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