How to Recognize, Fix, and Prevent ITB Syndrome

What Is IT Band Syndrome?

ITB (Intervertebral Disc) syndrome is a common injury among athletes. It occurs when there are tears or other damage to the ligaments that attach one side of your spine to another. These tendons connect two bones in your lower back, called vertebrae. When these ligaments become inflamed or damaged, they no longer support the weight of your body properly and may cause pain and weakness in certain areas of your back.

The most common location for ITBS is the front of your hips. However, it can occur anywhere along the length of your lower back. Some cases are more severe than others, but all cases result in some degree of disability if not treated promptly.

The symptoms vary widely depending on where you have it and how bad it is.

Symptoms of ITB Syndrome

Pain in one or both sides of your lower back. This pain may radiate up through your chest and into your neck. You might feel a sharp stabbing sensation in the area around the base of your neck, which could be accompanied by nausea and vomiting.

Your heart rate will increase and you’ll begin to sweat. If left untreated, this condition can lead to: Weakness or numbness in one or both legs.

Difficulty walking or standing.

Hip pain that worsens with running and climbing stairs.

ITBS can be caused by several things, but an overuse injury is the most common. This is when your leg muscles become so fatigued that they begin to vibrate abnormally, which in turn puts extra tension on the ITB. In most cases, ITBS is the result of a previous injury or past activity in which you pushed yourself too hard.

It can also be caused by a combination of anatomical and biomechanical factors, such as having a very high or low arch, having very straight calves or ankles, or perhaps having one leg slightly longer than another.

Treating ITBS

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Most cases of ITBS clear up within six weeks with appropriate treatment. Non-surgical treatment methods usually involve the use of anti-inflammatory medication and physical therapy. Your physician may advise you to rest your legs completely for a few weeks.

He may also suggest that you apply ice and take over-the-counter pain medication for a few days. After the acute phase, you’ll begin to do stretches and strengthening exercises to help alleviate any long-term issues with your IT band and hip flexors.

Surgical Treatment

In rare cases, an invasive procedure may be required. In this procedure, an incision is made into the back of the hip and the inflamed tissue is removed. The patient will experience some degree of post-operative pain that will last for a few weeks.

With rest and proper healing, most patients are able to resume their normal activities within a month after the operation.


The best way to avoid ITBS is to take a step back when you begin to feel pain. This means that if you’re feeling any pain while running, you need to stop and rest until the pain subsides completely before continuing. It’s also important to stretch your legs and warm up before engaging in any rigorous physical activity.

Avoiding hills, especially when you’re first getting used to running on them, is a good idea as well. It’s also wise to begin any exercise programme slowly and gently to allow your muscles to get accustomed to the new activity.


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If you’re experiencing pain in both legs, you should seek medical attention immediately as this may be a sign of a more serious condition. Severe pain in your side could mean that you’ve pulled a muscle in your abdomen, which would also require immediate medical attention.

by Bok Hea (S’porean Physiotherapist)


Burning knees (Patellofemeral Pain Syndrome)

Total Knee Replacement

Osteoarthritis of the knee

Meniscus Tear

Painful Foot

Plantar fasciitis

Shin splints

Anterior knee pain

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IT Band Syndrome

Iliotibial band (ITB) syndrome is an overuse injury of the iliotibial (or IT) band, a thick strip of fibrous tissue that runs from the outside of your pelvis, down the outside of your thigh and past your knee. The IT band attaches to your knee just below the joint and then continues down to the top of your foot where it attaches to the outside of the bone.

The IT band has a number of important functions but is probably best known for its role in running, as it acts as a supporting structure for the knee, helping to stabilize the joint and allowing for movement when you run.

Anatomy: The key to understanding how ITBS develops is to understand a little about the anatomy of your knee and the function of your IT band. The knee is a complex joint consisting of four bones; the thighbone (femur), the large bone in the center of your leg, the shinbone (tibia), the bone in your lower leg, and the kneecap (patella), the small ligament-bound bone that protects your knee joint and allows it to move freely.

The knee is a modified hinge joint, designed to allow movement in one direction only, but a very versatile one. The type of movement possible at the knee joint is most easily explained by comparing it to a common door. Just as you can swing a door in and out, front to back or side to side, your knee allows for similar movement.

With every step you take while running, your knee is bending and straightening as your foot hits the ground, just like a swinging door. However, while the door only moves in one direction, your knee allows for a little movement in two other directions as well. This extra movement is what stabilizes your knee and stops it from wobbling all over the place while you’re running.

On the inside, or medial side of your knee, where your thigh and shin bones meet, are a pair of bones called the tibia (inner) and fibula (outer). These are connected to the knee joint with strong bands of ligament, keeping them in place while allowing a little give in certain directions. The outside, or lateral side, of your knee is a little different; here part of your femur connects to your kneecap and the rest of your femur connects to the rest of your leg.

Here, the only strong ligaments that keep things stable are on the medial side, so there needs to be another way of keeping the bones in place.

Enter the iliotibial (IT) band. The IT band is a thick strip of fibrous tissue that begins somewhere near your hips and runs down the outside of your thigh, over the side of your knee and down part of your lower leg. In general, it’s position is from your hip to a little below your knee.

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It is very important for stabilizing the side of your knee and keeping your leg from twisting too much on the outside.

Signs and symptoms: ITBS Symptoms are typically a sharp pain on the outside of the knee that gets worse with running, especially downhill. It generally won’t trouble you too much when walking or going up hills, but as you speed up, particularly downhill, the pain can get very bad. Any kind of sudden twisting motion, such as turning a doorknob after rushing through a door, can cause a lot of pain very quickly.

ITBS is generally classified as either beginner’s ITBS, or intermediate ITBS.

It’s fairly common for people new to running to feel a sharp twinge in the outside of the knee after running downhill for the first time. This is usually no cause for alarm and will generally go away in a couple days with rest.

The more serious and far less common, but far more debilitating, form of ITBS is intermediate ITBS. This form generally occurs in people who have been running for a few months to a year and develops suddenly. There is severe pain on the outside of the knee that is made much worse by running.

This pain will generally keep you from running and remain constant, though it will decrease a little bit after a few days of resting. This form of the injury can take a long time to heal and in rare cases surgery is required.

IF you feel any pain when you run, especially downhill, see a doctor to confirm or rule out ITBS.


There are several things you can do to recover from ITBS, most of which involve resting, icing and anti-inflammatory medication. Most doctors will tell you to ice your knee for a few days and take ibuprofen (advil, motrin, etc…) to combat the swelling.

Rest is important and it is usually advised that you don’t run at all until the pain has completely gone away. A lot of people tend to be impatient with this, but it’s very important that you don’t run until the pain is gone otherwise you will very likely just make it worse.

In general, your knee will start feeling better in about a week, though it can take up to a month for the pain to go away completely. It is very important that you do not run at all during this time. Light biking and swimming can be done if needed, but no running.

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Once the pain has started to go away, you can start running again, but it is very important that you start out slowly. Usually just a mile or two the first time and working your way up slowly from there. You should also remember to ice after your runs for a couple days and keep the anti-inflammatory medication handy for a while since your body is going to be under a lot more stress than it is used to.

If you’ve had intermediate ITBS, the first few runs back are going to hurt, but it’s very important that you don’t give up. Keep running and the pain will go away again.


There are several things you can do to decrease your chances of getting ITBS. Start by making sure that your stride is as efficient as possible. When you run, your foot should be directly over your knee when your heel touches the ground.

Sources & references used in this article:

The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome by J Fairclough, K Hayashi, H Toumi, K Lyons… – Journal of …, 2006 – Wiley Online Library

Iliotibial band syndrome in cyclists by JC Holmes, AL Pruitt… – The American journal of …, 1993 –

Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment by RL Baker, RB Souza, M Fredericson – PM&R, 2011 – Elsevier

Runner’s Knee–How To Diagnose, Treat and Prevent by J Davis –

How Long Until I See Results from my Strength Training? by J Davis –


Step width alters iliotibial band strain during running by SA Meardon, S Campbell, TR Derrick – Sports Biomechanics, 2012 – Taylor & Francis

The surprising iliotibial band by CM Kline – Journal of the American Chiropractic Association, 2011 –