The iliotibial band (IT band) is also known as the iliotibial tract or Maissiat’s band. It’s a long piece of connective tissue, or fascia, that runs along the outside of your leg from the hip to the knee and shinbone. The IT band helps to extend, abduct, and rotate your hip. It also helps to stabilize and move the side of your knee while protecting the outer thigh.

IT band syndrome (ITBS) is a common lateral knee injury. Overuse and repetitive flexion and extension of the knees usually cause this type of injury. It occurs when the IT band becomes tight, irritated, or inflamed. This tightness causes friction on the outside of the knee when bending, which is painful. Sometimes it causes referred hip pain.

ITBS is caused by excessive friction from the IT band being overly tight and rubbing against bone. It’s primarily an overuse injury from repetitive movements. ITBS causes friction, irritation, and pain when moving the knee. It seems to happen only in some people, though the reasons for this are unclear.

It’s especially common for cyclists and runners. It can even develop from repetitively walking up and down stairs, wearing high heels, or sitting for long periods with bent knees.

Risk factors for developing ITBS include:

  • preexisting iliotibial band tightness or prior injury
  • weak hip, gluteal, and abdominal muscles
  • walking or running on a track or uphill
  • weakness or lack of flexibility
  • excessive sitting
  • weak knee extensor, knee flexors, and hip abductors
  • repetitive activities such as running and cycling
  • knee arthritis
  • unbalanced leg lengths
  • bowlegs
  • flat feet

Who gets IT band syndrome?

ITBS can affect anyone. It’s especially common among runners, cyclists, and hikers. Athletes who use their knees such as basketball players, soccer players, and weightlifters are more likely to develop ITBS.

Usually people who get IT band syndrome are younger athletes or people who exercise regularly. Often, it’s due to mistakes in training that can usually be corrected.

Training mistakes include:

  • not warming up or cooling down properly
  • pushing yourself past your limits
  • straining your body
  • not resting enough between workouts
  • wearing improper shoes
  • training on the wrong surfaces
  • incorrect bicycle fitting
  • increasing training too quickly
  • using poor form

Your doctor can check to see if you have IT band syndrome by considering your history, looking at your symptoms, and performing a physical exam. This may involve some type of body assessment such as performing certain exercises to demonstrate movement patterns, strength, and stability. Your doctor may assess the alignment of your pelvis and tightness of the IT band. Some cases may require an ultrasound, X-ray, or an MRI scan.

If you think you have IT band syndrome or an IT band issue, see a doctor to be diagnosed. They may find that your IT band is unaffected, making different treatment and exercises more appropriate.

ITBS is usually effectively healed and managed through conservative treatments.

Conservative treatments include:

  • taking nonsteroidal anti-inflammatory drugs (NSAIDs)
  • icing and resting the affected area during the first week after symptoms start
  • stretching daily
  • strengthening muscles, like the hip muscles

For very severe, chronic cases, corticosteroid injections or surgery may be an option. But you should start with conservative treatments and be consistent.

Usually IT band issues can be relieved by performing exercises and stretches to relieve tightness and promote flexibility and strength. You can also focus on bringing your knees, hips, and shoulders into alignment. Here are five stretches that focus on the IT band and supporting muscle groups.

Standing IT band stretch

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  1. While standing, cross your right leg in front of your left and press firmly into both feet. Try to have your feet about shoulder width apart.
  2. Lean to the right side as far as your body will allow, feeling the stretch in your knee and outer hip.
  3. To deepen the stretch, you can reach your left arm overhead.
  4. Press your left hand into a wall for added resistance or stability.
  5. Hold the stretch for 30 seconds.
  6. Do this stretch 3 times on each side.

Standing forward bend variation

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  1. While standing, cross your right ankle in front of your left.
  2. Slightly bend your knees as you fold forward, placing your hands on the floor, on a block, or another stable surface.
  3. Press your legs into each other for added resistance.
  4. Hold this position for up to 1 minute.
  5. Then do the opposite side.
  6. Do each side 2 to 3 times.

Wide-legged standing forward bend

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  1. From a standing position, jump or step your feet so they’re wider than your shoulders.
  2. Turn your toes in slightly and put a slight bend in your knees.
  3. Slowly hinge at the hips to fold forward, dropping your hands down to the floor.
  4. Use a block or chair for support if your hands don’t reach the floor.
  5. Press into the outer edges of your legs and feet, feeling the stretch along the outside of your lower body.
  6. Walk your hands to the right and turn your upper body to the right, placing your hands on the outside of your right leg.
  7. Hold this position for 15 seconds.
  8. Then repeat on the left side.
  9. Do each side 2 to 3 times.

Low lunge variation

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  1. Come into a low lunge with your right foot in front and your left knee on the floor directly under your hips.
  2. Place your right hand on your right thigh and then stretch your left arm over to the right.
  3. Keep your hips square and don’t allow them to stretch forward.
  4. Feel the stretch in the outer left hip.
  5. Hold for 30 seconds.
  6. Repeat on the opposite side.
  7. Do each side 2 to 3 times.

Glute stretch

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  1. Lie on your back with your right leg extended on the floor.
  2. Draw your left knee into your chest.
  3. Then pull it across your body, feeling a stretch in the buttocks and outer hip.
  4. Hold for 30 seconds.
  5. Then do the opposite side.
  6. Do each side 2 to 3 times.

It’s vital that you do exercises to strengthen the IT band, gluteal muscles, and hip abductors. Here are a few exercises that will help you build strength in these areas.

Hip hikes

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  1. Stand sideways on a step so that your left leg hangs off the edge.
  2. Keep your hips and shoulders squared forward.
  3. Keep your right leg straight as you lift your left hip up.
  4. Then drop the left leg back down again.
  5. Continue this subtle movement for 12 to 15 repetitions.
  6. Then do the opposite side.
  7. Do 2 to 3 sets on each side.

Focus on pulling from your hip and waist rather than lifting your leg with your knee or from your foot.

Heel drops

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  1. Stand on a step with one foot and extend the opposite foot in front of you.
  2. Slowly squat down as though you are going to step forward.
  3. Return to the starting position.
  4. Keep your pelvis square throughout the movement.
  5. Do 2 to 3 sets of 15 to 20 repetitions.

Side plank pose

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  1. Come into plank pose.
  2. Then press into your left arm as you roll your right. Your right hip should point up toward the ceiling. Square up your hips.
  3. Stack your ankles or drop your left shin to the floor for support.
  4. Place your right hand on your right hip or extend your arm up toward the ceiling.
  5. Then lift your right leg as high as you can.
  6. Hold this position as long as you can, up to one minute.
  7. Then do the opposite side.
  8. Do each side 2 to 3 times.

Side leg abduction

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  1. Lie on your side with your affected leg on top.
  2. Straighten your top leg and draw your toes toward you as if they’re trying to touch the front of your leg. Do this as you press out through your heel.
  3. Engage your abdominals, stack your hips, and keep your bottom leg slightly bent for balance.
  4. Slowly lift your top leg up and slightly back.
  5. Return to the starting position.
  6. Do 2 to 3 sets of 10 repetitions.
  7. Repeat on the opposite side.

Clamshell exercise

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  1. Lie on your side with bent knees and your affected leg on top.
  2. Extend your lower arm under your head, or bend your arm to make a pillow for your head to rest on.
  3. Place your top hand on your top your hip for support.
  4. Engage your abdominals and keep your hips facing downward throughout the exercise.
  5. Slowly lift your top leg as high up as you can, keeping your feet together.
  6. Return to the starting position.
  7. Do 2 to 3 sets of 10 repetitions.
  8. Repeat on the other side.

IT band tightness may also lead to patellofemoral syndrome, which is known as runner’s knee. It can also occur in people experiencing osteoarthritis of the knee, greater trochanteric pain syndrome, or anterior cruciate ligament injuries.

These connective tissue injuries should be treated by reducing inflammation through ice therapy, NSAIDs, and corticosteroids. Take adequate time to rest before beginning a treatment program that includes strengthening and stretching, and before resuming normal activities.

Complementary and alternative treatments for IT band issues include:

  • acupuncture
  • kinesio tape techniques
  • myofascial release
  • sports massage
  • yin or restorative yoga

To prevent IT band issues from occurring, it’s important that you take care of your body while working out. Practice good form and don’t exert yourself beyond your limits. Always stretch, warm up, and cool down when working out. You may wish to use a foam roller to loosen up your IT band.

Continue doing exercises to strengthen and stretch your body. This will also help to balance out your body if you’re often doing the same type of repetitive activity. Do the exercises at least three times per week. Take at least one full day of rest per week to allow yourself time to recover between workouts.

See a medical professional at any point if you feel pain, tightness, or discomfort in your leg, especially if it’s happened suddenly or is persistent.

If you’ve taken steps to treat your IT band issues and it doesn’t seem to be healing, you may want to see a medical professional. You might see a physical therapist, occupational therapist, or osteopath. You can also seek treatment from a chiropractor or a podiatrist.

Usually you can heal your IT band by taking time to rest and heal. Then work to build up strength and flexibility to avoid future recurrences. Make sure you’re able to do the exercises without pain. Once you feel that balance has been restored you can slowly return to your usual fitness program.

It’s important that you gradually build up your activity over time. Take extra care to ensure your form and technique are correct. Improvements and a return to normal activity should be made over a period of three to six weeks. Speak to a doctor about any routines and changes you’re trying.

If you don’t see improvements after taking conservative steps on your own, definitely talk to your doctor. They may be able to provide other treatment methods. They can diagnose if it’s in fact an IT band issue, and together you can come up with the right treatment plan for you.