What is IT Band Syndrome?

What is IT Band Syndrome

IT Band Syndrome (ITBS) is a common injury that predominantly affects long-distance runners although it can also strike cyclists, hikers, and weightlifters. Most people first experience IT Band Syndrome during the early part of a run or jog, often described as an intense, shooting pain that starts on the outside of the leg near the knee with pain radiating upward into the outer thigh. While the pain experienced during onset of IT Band Syndrome is initially very intense, it usually quickly subsides a few minutes after the individual stops running and allows the muscles to relax.

IT Band Syndrome, or Iliotibial Band Syndrome, refers to an injury of a ligament that connects the tibia (shin) to the knee. The IT Band is critical for maintaining stability in the knee during activity, especially running and other long-distance physical exertions. As athletes run, cycle, or hike, the IT band is designed to flex around and over the knee. If the IT band gets overextended it start to develop an interior area of irritation known as a bursa, or small sack of fluid. This is what causes the pain of IT Band Syndrome. Some individuals suffering from IT Band Syndrome will also notice swelling of the knee as well as acute pain during physical activity.

Diagnosing IT Band Syndrome

Only a doctor can properly diagnose IT Band Syndrome, as a number of other knee complaints can present quite similarly. When you come into the clinic, an X-ray or MRI will be performed. If a bursa, or swollen sac of fluid caused by irritation from the IT band rubbing across the knee, is identified, this is usually a clear indication of IT Band Syndrome. After carefully examining the area, as well as taking a complete history of the individual’s physical activity and exercise regimen, it will be possible to diagnose a case of IT Band Syndrome.

Treating IT Band Syndrome

If you experience any of the symptoms of IT Band Syndrome, immediately cease all physical activity and allow the ligaments to rest. Do not engage in strenuous exercise like running, cycling, or hiking for a few days to give the IT band a chance to heal. When at home, elevate the affected leg above your waistline and apply ice to any swollen areas.

If conditions improve, you may be able to resume normal activities at a reduced pace. Run, cycle, or hike shorter distances and begin every intense workout with a lengthy warm-up period at a slow pace.

Should the symptoms of IT Band Syndrome continue for several weeks, medical intervention may be necessary. An injection of cortisone into the bursa can help speed the healing process and shrink the bursa. Your doctor can work with you to help determine a healthier exercise regimen to avoid irritating or exacerbating the problem. In severe cases, surgery may be necessary to relax the IT band and allow it to once again move freely.

Symptoms of IT Band Syndrome

  • Swelling of the knee.
  • A shooting, stabbing pain in the knee radiating up to the thigh when running, cycling, weight lifting, or hiking.
  • Pain when running or cycling up or down hills.
  • Sharp pinpricks of pain in the hip area.
  • Acute pain when flexing the knee during weightlifting exercises like squats.
  • Pain that rapidly disappears with rest.

The History of IT Band Syndrome

Ever since long-distance running and cycling became popular sports more than a century ago, many athletes were crippled from pain and swelling caused by IT Band Syndrome. For many decades, it was believed that little could be done to address IT Band Syndrome other than lengthy bed rest and withdrawing from competition.

In the 1990s, researchers at Stanford University began examining athletes who suffered from IT Band Syndrome to better understand what was causing the pain and swelling associated with these types of injuries. Dr. Michael Fredericson, then the team doctor for Stanford University, developed special protocols for diagnosing and treating IT Band Syndrome. Today, doctors around the world use Dr. Fredrickson’s protocols to identify and provide lasting relief to the pain and swelling caused by IT Band Syndrome.

Preventing IT Band Syndrome

IT Band Syndrome is always the result of overextension of the IT ligament. By taking appropriate measures, it is possible to prevent the onset of IT Band Syndrome, including:

  • Perform stretching exercises before any intense workout.
  • Walk between a quarter-mile and half-mile before beginning a run.
  • Wear appropriate footwear with a balanced, supporting sole.
  • Run or hike in the middle of the road or on the flattest part of the trail.
  • Avoid concrete and very hard surfaces.
  • Cross-train whenever possible.
  • If running on a track or oval, switch directions repeatedly.
  • Take advantage of deep tissue massages to help stretch and loosen the IT ligament band.

A strengthening program can help athletes recover from the effects of IT Band Syndrome and prevent future injuries and pain. Doctors now believe that one of the primary causes of IT Band Syndrome is insufficient strength in the glutes and hip muscle groups. Weakness in these muscle groups can lead to excessive strain on the IT Band and the eventual development of IT Band Syndrome.

Exercises which help strengthen and tone your hip and glutes can be very useful in preventing the onset of IT Band Syndrome. Your doctor will work with you to develop a strengthening exercise regime suitable for your needs, which may include exercises like horizontal leg lifts, clamshells, squates, bridges, and single-leg step downs. These strengthening exercises are also important to help individuals rehabilitate from the damage caused by IT Band Syndrome.

It’s also important to understand that speed is a factor in IT Band Syndrome. By running, cycling, hiking or performing strenuous repetitive exercise more slowly, the IT band spends less time flexing over the edge of the knee and thus minimizes inflammation in the area. For committed athletes, a regimen of short bursts of intense activity can be designed to accompany longer periods of less strenuous activity to give the IT band a chance to heal and strengthen.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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