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What is IT Band Syndrome?

Running Man Anatomy

If you’ve experienced lateral knee pain, you may have been told that you have Iliotibial (IT) Band Syndrome, or a “tight IT band.”  Although commonly associated with runners and cyclists, IT Band Syndrome is an overuse injury that can affect athletes of many sports, including soccer, rowing, and weightlifting.

The IT band is a long, fibrous band of fascia that originates in the hip and pelvis and attaches just below the outside of the knee. While commonly thought to be caused by the friction of repeatedly bending and straightening the knee, some studies suggest that IT band pain is actually the result of compressive forces below the IT band1. Here are some individual and training factors that may predispose and contribute to IT Band Syndrome:

Individual Factors


  • Variations in anatomy (such as hip and knee alignment, and foot and ankle range of motion) can make people more prone to internal rotation and adduction at the knee during dynamic activity.


  • The lack of flexibility in different muscle groups can affect the way the foot, ankle, knee, and hip joints move, causing compensations.

Muscle strength

  • Muscle strength imbalances in the pelvis, hip, knees, foot, and ankle can cause the body to rely on compensatory movement strategies to achieve sport-specific tasks.

Muscle control

  • Someone can have full range of motion and strength throughout their lower leg, but lack muscle coordination. This can lead to issues in alignment, such as over-pronation in the foot and ankle (rotating your foot and ankle too far inward).

Training factors

Training surface

  • Training on uneven surfaces can alter your mechanics, and cause repetitive stress on the IT band.

Shoe wear

  • The recommended shoe wear for runners ranges from 300 to 500 miles. Training in shoes that are too worn can alter the mechanics in the foot, ankle, knees, hip, and pelvis, leading to IT Band Syndrome.

Training dosage

  • Over training without adequate rest or recovery time can overload the system causing you to rely on faulty movement patterns.


Prevention of IT Band Syndrome is geared toward correcting any training or individual factors that can contribute to faulty biomechanics. A comprehensive program includes adequate flexibility, strength, and control in the pelvis, hips, knees, foot, and ankle as well as ensuring that the training environment is appropriate to reduce the amount of stress experienced at the knee. Be sure to consult a health and fitness professional before participating in a new training or rehabilitation program.

  1. Fairclough J. Hayashi K. ToumiH. Is iliotibial syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-6

Curtis Wu is a Doctor of Physical Therapy with HSS Rehabilitation. He is a Strength and Conditioning Specialist and Level 1 Track and Field Coach certified by the US Track and Field Association.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.