Iliotibial Band Syndrome

The iliotibial (IT) band is a thick rope of connective tissue that runs from your hip down the outside of your thigh to just below your knee. IT band syndrome happens when this band rubs back and forth against the bony bump on the outside of the knee (or the bony bump on the outside of the hip) every time you bend and straighten your leg — usually from running or cycling. The result is pain on the outside of the knee or hip that builds up over miles.

IT band syndrome is one of the most common overuse injuries in runners — accounting for up to 12 percent of running injuries. The classic triggers: ramping up training mileage too fast, lots of downhill running, or shoes that have worn out their support.

The signature pattern is a sharp or burning pain on the outside of your knee that starts at a predictable point during a run — often the same mileage every time — and forces you to stop. The pain eases within minutes of walking, then returns if you try to run again. Some runners feel the pain at the outer hip instead of (or in addition to) the knee, depending on where the band is tightest.

Between runs, going down stairs or downhill tends to be worse than going up, because the band snaps over the bony bump on the outside of the knee each time it bends past about 30 degrees. Sitting with the knee bent for a long time can produce an ache at the outer knee. You may notice tightness or a snapping sensation on the outside of the thigh, and pressing directly on the bony prominence at the outer knee reproduces the pain precisely.

The classic story is pain on the outside of the knee (or hip) that starts at a predictable distance into a run and eases with rest. Your surgeon will use the Ober test to measure how tight the IT band is, and the Noble compression test (direct pressure on the outside of the knee with the leg slightly bent) to reproduce your pain. Imaging is usually not needed; MRI is added when the diagnosis isn't clear-cut or when symptoms are severe.

1. NSAIDs

   NSAIDs like ibuprofen for short courses to calm acute inflammation.

2. Corticosteroid injection

   An corticosteroid injection at the painful spot (outer knee or outer hip) can relieve cases that haven't responded to the steps above.

Surgery is rarely needed. When symptoms persist despite at least 6 months of consistent non-operative treatment, a small procedure can release the back portion of the IT band where it rubs against the bone.

External patient-education references and related OSI pages for additional background:

• Britannica — Hip (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language