Overcoming Persistent IT Band Pain

IT BAND SYNDROME (ITBS) is a common diagnosis seen in the PT clinic. Typically, clients present with a primary complaint of pain, tightness and/or clicking at the outside of the knee. These symptoms may worsen with activities such as running, cycling, walking hills/hiking or repetitive squatting. Rest may help for a period, but symptoms will often resume when activities ramp back up, creating a frustrating cycle of inconsistent activity levels. Fortunately, ITBS responds well to non-surgical and non-pharmacological management through physical therapy and activity modification.

What is the IT Band?

The IT Band (iliotibial band) is a long fascial continuation of the tensor fascia lata (TFL) and gluteus maximus. It travels along the outside of the thigh to attach to the outside aspect of your tibia (below the joint line of the knee). The IT Band spans multiple joints and experiences forces in multiple directions due to it’s multiple muscle attachments.

Iliotibial Band (ITB) Diagram
There are multiple theories as to what the mechanism is that causes the pain. Historically, it was thought of as friction across the outside end of the femur, or thigh bone, but more recent research points to multiple sources. Additionally, what actually leads to this is varied when we look at the literature. Muscle strength, muscle length, anatomical differences, movement control deficits are often argued. Poor load management such as fast increases in activity or training volume/type can also be a factor. Does this make ITBS a mystery? No, certainly not. But what it does mean is that it’s best to have a thorough history and exam performed by your physical therapist who can identify the factors that contribute to your symptoms and provide a customized plan.

Effective ITBS Treatments & Rationales

Treatment for ITBS, like its causes and contributors is often complex and multifactorial. Read on for six of the more common treatments and their rationales.

“I had been dealing with this leg injury since last year. Howard figured it out in the first session. At the end of that day, I was 90% better. I got my life back in just 2-3 weeks.” -Nicole DeShone


Muscles that are short can alter movement patterns and contribute to increased stress in specific areas. You can find lots of methods for “stretching the ITB” online, but truthfully, we aren’t going to successfully stretch it, as it is a very tough, inelastic tissue. Instead, we target stretching muscles around the ITB that do lengthen and may be contributing to the symptoms.


Your physical therapist will be able to determine if you have some areas of muscle weakness that may be slowing down your progress.   These may be muscles of the back/pelvis (ie “core”), hips, thigh and even the calf/foot.   That’s because the ITB spans multiple joints and strain is placed on it in multiple directions.   


Soft tissue techniques such as massage, trigger point dry needling, foam rolling or cupping can loosen up tight muscles. Muscles that are “tight” fail to relax sufficiently when at a state of rest and can be a source of pain. This also impacts their ability to contract. Your PT may also utilize the Neubie Estim device to identify specific areas where the nervous system is contributing to increased tightness or impaired muscle function.


Certain movement patterns can cause increased stress at the lateral (outside aspect) knee and contribute to ITBS in many people.   Your PT can determine what movement patterns are contributing to your symptoms and work with you to restore normal movement patterns and resolve excessive stress. 

“AFTER MANY MONTHS OF PAIN in my left gluteus which left me unable to walk well and serious pain when I sat for a period of time or when I drove, Physical Therapy was recommended and I chose Cioffredi… I graduated from Cioffredi after eight sessions with pain almost completely dissipated, and tendons and muscles less tight. I was again able to walk and sit and drive without pain. I am so thankful for Joe for all his attention, abilities, and professionalism which helped me back to a pain-free life.”
-Linda Timbrell


The “knee bone’s connected to the…. ankle bone.” Your footwear can play a role in your symptoms, whether it is that your shoes contributed to the initial onset, or we need to make some modifications to help move you forward more quickly. Your PT may make specific footwear recommendations, modify your footbedsor orthotics, or even suggest an OTC or custom orthotic.


IT Band Syndrome may become evident when you’re training for your next race, hiking downhill, or working hard on your Peloton. This information, your activity goals and current level of function will help your PT to guide you back to your desired activities.

Are you a CYCLIST? 

The repetitive nature of cycling can increase compression across the lateral (outside) aspect of the knee. Poor bike fit and increasing volume too quickly can both contribute to symptoms. Often times the saddle may be too high or far forward, or cleat positioning may increase compression across the lateral knee. A skilled physical therapist can make activity modifications and bike fit suggestions to improve your current training schedule.

Are you a RUNNER? 

Increasing volume too quickly or changing terrain drastically can both contribute to lateral knee symptoms.   Modification of training variables and relatively minor adjustments to running form can often keep you running, or get you back there more quickly. 

“With a few adjustments to my run and added strength exercises I am not only experiencing less knee pain but I am also running faster. I think a lot of athletes may think they need to wait until they have 5/10 or higher pain to go see a physical therapist. But the opposite is actually true! The team at Cioffredi wants your mobility and performance to be your best. So if you go in with minor pain they can really help you reach the next level. Thank you Cioffredi!” -Caroline Borger

If you are reaching a roadblock in your recovery, reach out to set up an evaluation to determine the factors that are holding you back.

ITB Pain not going away? Here are three overlooked components.

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This article first appeared in the September 2023 Cioffredi & Associates Newsletter. Read more here:

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