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Knee Pain

IT Band Syndrome

Iliotibial (IT) band syndrome is an overuse problem that is often seen in bicyclists, runners, and long-distance walkers. It causes pain on the outside of the knee just above the joint.

The IT band is a long tendon that runs down the side of the thigh and connects to the outside edge of the tibia (shinbone) just below the middle of the knee joint. The IT band crosses over the side of the knee joint, giving added stability to the knee.

The lower end of the IT band passes over the outer edge of the lateral femoral condyle, the area where the lower part of the femur (thighbone) bulges out above the knee joint. When the knee is bent and straightened, the tendon glides across the edge of the femoral condyle.

A bursa is a fluid-filled sac that cushions body tissues from friction. A bursa rests between the femoral condyle and the IT band. Normally, this bursa lets the tendon glide smoothly back and forth over the edge of the femoral condyle as the knee bends and straightens.

This bursa can become irritated and inflamed if the IT band starts to snap over the condyle with repeated knee motions such as those from walking, running, or biking. This is known as IT band syndrome.

  • Overuse and overtraining: When people increase the intensity of their training too quickly, the strain may cause the bursa on the side of the knee to become inflamed.

  • Knee bowing outward: This may happen in runners when their shoes are worn on the outside edge or they run on slanted terrain. It may also happen with foot abnormalities like pronation, where the arch flattens.

  • Bowed legs: The outward angle of the bowed knee makes the lateral femoral condyle more prominent and can make the snapping worse.

  • Weakened or fatigued gluteus medius: The gluteus medius muscle in the hip controls outward movements of the hip. If it is weakened, the thigh tends to turn inward, making the knee angle into a knock-kneed position. This tightens the IT band against the bursa on the side of the knee.

  • Pain located on the outside of the knee that increases as a person runs, cycles or performs other exercises that involve repetitive bending and straightening of the knee.

  • One may also experience a feeling of clicking, popping or snapping on the outside of the knee.


The diagnosis of IT band syndrome can usually be made without any complicated tests. Your doctor will take a history of the problem and ask about any other injuries that may have occurred in the past. X-rays may be taken to make sure that there are no other injuries that could be adding to the problem. Generally, no swelling is visible. The snapping sensation usually cannot be heard.

Pain on the outside of the knee can be caused from conditions other than IT band syndrome. Your doctor will perform an examination of the knee and will look at your entire leg. You may want to take the shoes that you use to run or walk with you to your appointment.

If there is doubt about the diagnosis, or you are still having problems after reasonable attempts have been made to decrease the symptoms, a magnetic resonance imaging (MRI) scan may be suggested by your doctor. An MRI scan is a special test that uses magnetic waves to create images of the soft tissues inside and around the knee. Regular X-rays only show the bones around the knee. The MRI can show if there are problems with the soft tissues such as the cartilage and ligaments.

Non-surgical treatments
  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Wearing a knee brace / kneecap taping / shoe inserts: Your provider may have you wear any of these to improve muscle balance and joint alignment of the hip and lower limb.

  • Doing physical therapy: Your provider will most likely have you do physical therapy exercises to improve your strength and range of motion in your knee. Exercises may involve strengthening your thigh muscles, cycling and doing resistance exercises. If you have IT band syndrome and play a sport, your physical therapist will probably ask you about your sport activities and may give you tips on your warm up and training schedule, footwear, and choices of terrain.

  • Cortisone injection:  If your symptoms continue, your doctor may suggest an injection of cortisone, a powerful anti-inflammatory medication that may help reduce the inflammation and pain.