Conditions We Treat
IT Band Syndrome
At a glance
IT band syndrome, or iliotibial band syndrome, causes sharp pain on the outside of the knee where the iliotibial band crosses the end of the thigh bone. It accounts for around one in ten running injuries and affects cyclists too, often switching on at a predictable point in a run or ride. Treatment built around hip strengthening, with manual therapy, shockwave therapy or dry needling added where they suit you, can ease pain and get you back to training.
You set off feeling good. Then, at almost the same point every time, a sharp pain switches on at the outside of your knee. It gets worse with every stride until you have to stop and walk, eases off, then comes straight back the moment you start running again. On the bike it bites at the same spot in every pedal stroke.
The iliotibial band, or IT band, is a thick strip of connective tissue running down the outside of the thigh from the hip to just below the knee. The pain is thought to come from tension in the band compressing the sensitive tissue lying beneath it near the knee, which becomes irritated and inflamed (Friede et al., 2022). The same review points out that stretching on its own is unlikely to change the band's length, which is why treatment looks at how the whole leg is loaded rather than trying to lengthen the band itself.
IT band syndrome accounts for roughly one in ten running injuries (Sanchez-Alvarado et al., 2024). It is about twice as likely to affect female runners as male runners, and a meta-analysis found that female runners with current IT band syndrome had weaker hip abductors, the muscles on the side of the hip that steady the pelvis and thigh, than runners without it (Foch et al., 2023). That is one reason we test hip strength in every assessment.
Cyclists get it too. A review of lower limb cycling injuries lists IT band syndrome among the common overuse problems on the bike, puts these injuries down to a combination of preparation, equipment, technique and overuse. It also highlights bike fit and alignment as a focus for prevention (Wanich et al., 2007). We see more of it through the spring riding season as training builds towards the 947 Ride Joburg each November. We look at your riding history and training load as part of the assessment, and if your position on the bike may be playing a part, a professional bike fit can be worth considering.
The treatment evidence supports an active, combined approach. A 2024 systematic review of conservative treatment in runners found hip abductor strengthening came up repeatedly across the studies, and concluded that treatment built on it, possibly augmented by shockwave or manual therapy, is effective for reducing pain and improving function (Sanchez-Alvarado et al., 2024). In a randomised trial of 24 runners, shockwave and manual therapy, each given alongside an exercise programme, reduced pain during treadmill running by a similar amount (Weckström and Söderström, 2016). A second randomised trial of 40 patients found that both dry needling and shockwave improved pain and function (Maghroori et al., 2021).
At our Sandton practice we start by finding out what changed: distance, hills, shoes, bike set-up or a race build-up. We assess the hip, knee, foot and lower back, check hip strength and watch how you run or squat on one leg. Treatment combines soft tissue work and fascial release around the outside of the thigh and hip, joint mobilisation, shockwave or dry needling where they suit you and a graded hip strengthening programme. We also plan your training with you, so you can keep moving while it settles rather than guessing when it is safe to push again.
You can book directly without a referral. Pain on the outside of the knee is not always the IT band. After an injury, severe pain, swelling, a knee that feels unstable or one that will not take your weight should be seen promptly, as should a swollen, red knee with a fever or loss of movement (Bunt et al., 2018). In those cases we look for other causes and can refer you directly for an X-ray, ultrasound or specialist opinion. Pain on the outside of the hip is often a separate problem, covered on our hip pain page, and our knee pain page covers other common causes of knee pain.
In pain now? Same-day appointments available at our Sandton rooms.
Book OnlineCommon symptoms of IT band syndrome
- Sharp pain on the outside of the knee while running or cycling
- Pain that starts at a predictable distance or time into a session
- Pain that builds until you have to stop
- Pain that eases with rest and returns when you start again
- Tenderness over the bony point on the outside of the knee
- Pain at the same point in every pedal stroke
- Walking with a stiff, straight leg to avoid the pain
- Tightness or aching along the outside of the thigh
If the outside of your knee hurts at the same point in every run or ride, getting assessed early helps you start the right treatment sooner and keep more of your training.
Located on Rivonia Road in Morningside, we treat patients from Sandton, Bryanston, Rivonia, Fourways and across Johannesburg.
Book an appointment at our Sandton practice and let us help you get back on the road.
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Same-day appointments available at our Sandton rooms.
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Frequently Asked Questions
A sharp pain on the outside of the knee that tends to switch on at a predictable point in a run or ride, then builds until you have to stop. It usually eases with rest and comes back when you start again. The bony point on the outside of the knee is often tender to press.
Yes. We assess the hip, knee, foot and lower back, then combine soft tissue work, joint mobilisation and a hip strengthening programme, with shockwave therapy or dry needling where they suit you. A 2024 systematic review concluded that treatment built on hip abductor strengthening, possibly augmented by shockwave or manual therapy, is effective for reducing pain and improving function in runners with IT band syndrome.
It can. In a randomised trial of 24 runners, shockwave and manual therapy, each given alongside an exercise programme, reduced pain during running by a similar amount. A separate trial of 40 patients found that both shockwave and dry needling improved pain and function. We use it as part of a rehabilitation plan rather than on its own.
Usually you can keep some training going. We look to keep sessions below the point where the pain switches on, rather than stopping completely, and build back as your strength improves. Your assessment helps decide what to keep, what to change and how quickly to progress.
Stretching on its own is unlikely to change the length or mechanical properties of the IT band, which is a thick band of connective tissue. That is why treatment focuses on hip strength, how you load the leg and your training, with hands-on soft tissue work around the thigh and hip to help ease pain while you rebuild.
IT band syndrome is one of the recognised overuse injuries in cycling. Reviews of cycling injuries point to a combination of preparation, equipment, technique and overuse, so we look at how your training has built up as well as the knee itself. If your position on the bike may be playing a part, a professional bike fit can be worth considering.
References
- Sanchez-Alvarado A, Bokil C, Cassel M, Engel T. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Frontiers in Sports and Active Living. 2024;6:1386456.
- Weckström K, Söderström J. Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome. Journal of Back and Musculoskeletal Rehabilitation. 2016;29(1):161-170.
- Maghroori R, Karshenas L, Khosrawi S. Shockwave therapy versus dry needling for the management of iliotibial band syndrome: a randomized clinical trial. Galen Medical Journal. 2021;10:e2174.
- Foch E, Brindle RA, Pohl MB. Lower extremity kinematics during running and hip abductor strength in iliotibial band syndrome: a systematic review and meta-analysis. Gait and Posture. 2023;101:73-81.
- Friede MC, Innerhofer G, Fink C, Alegre LM, Csapo R. Conservative treatment of iliotibial band syndrome in runners: are we targeting the right goals? Physical Therapy in Sport. 2022;54:44-52.
- Wanich T, Hodgkins C, Columbier JA, Muraski E, Kennedy JG. Cycling injuries of the lower extremity. Journal of the American Academy of Orthopaedic Surgeons. 2007;15(12):748-756.
- Bunt CW, Jonas CE, Chang JG. Knee pain in adults and adolescents: the initial evaluation. American Family Physician. 2018;98(9):576-585.