Iliotibial Band Syndrome

Iliotibial band syndrome is an overuse injury that causes knee pain or, less often, hip pain. It occurs when the iliotibial band (IT band) becomes overly tight and irritated, often from activities like running that involve repetitive bending of the knee.

The IT band is a tendon that runs along the outside of the leg from the hip to the top of the shinbone and stabilizes the outside of the knee. Pain from iliotibial band syndrome occurs on the outside of the knee or hip, away from the midline of the body.

In most cases, iliotibial band syndrome does not require surgery. Treatment typically includes rest and targeted stretching and strengthening exercises.

Some sports have a higher risk of iliotibial band syndrome:

• Running
• Cycling
• Hockey
• Basketball
• Skiing
• Soccer
• Weightlifting

Certain training behaviors can also increase an athlete’s risk:

• Sudden increase in running distance (rather than adding distance in stages over time)
• Running on a sideways-sloping surface
• Running long distances downhill
• Not spending enough time warming up or cooling down

Some physical characteristics can also increase the chance of iliotibial band syndrome:

• Naturally tight IT bands
• Weak hip abductors, the muscles that move the leg away from the body
• Leg-length discrepancy
• High foot arches or flat feet

An athlete may first notice knee or hip pain after exercising. If they continue exercising, the pain may start earlier, last longer, and become more severe over time.

• Knee pain or hip pain on the outside of the leg
• Snapping or clicking noises when bending or unbending the leg
• Pain that increases when running or walking downhill

Normally, the IT band glides over the knee and hip bones. If the IT band becomes tight, through overtraining or a sudden increase in training, the IT band may start to rub against the bones, causing friction and becoming inflamed and painful.

Your child’s doctor will ask about your child’s symptoms, when they started feeling pain, and what activities seem to trigger the pain. If your child is involved in sports, the doctor may ask about their training regimen and whether they recently increased the duration or intensity of their training. The doctor will do a physical exam and may order an X-ray or sports ultrasound to rule out other possible causes of knee or hip pain.

Most cases of iliotibial band syndrome heal on their own without surgery. An athlete may need to take time off from sports to give their leg time to recover. The amount of time depends in part on the extent of the injury.

Treatment may include:

• Rest and ice
• Anti-inflammatory medication to reduce pain and swelling
• Physical therapy to stretch the IT band and strengthen the surrounding muscles
• In very rare cases, when no progress has been made and symptoms are significant, surgery or cortisone injections may be considered

Working with an athletic trainer who can analyze your child’s movement patterns and help them adjust their form can reduce your child’s risk of future injuries.

As the largest and most experienced pediatric and young adult sports medicine practice in the country, the Sports Medicine Division at Boston Children's combines personalized care with innovative treatment for each athlete we treat.

Our Sports Medicine team consists of sports medicine physicians, orthopedic surgeons, physical therapists, podiatrists, athletic trainers, sports psychologists, dietitians, and many others who collaborate in every aspect of our patients’ care and their recovery.

Our Injured Runners Clinic is a partnership between Boston Children’s Sports Medicine Division and The Micheli Center for Sports Injury Prevention devoted to the diagnosis, treatment, and prevention of running-related injuries in runners of all ages and ability levels.