Knee

What It Is

Line drawing of the outer thigh, showing the IT band running from the hip and glutes down the side of the thigh, over the outer quadriceps, to just below the knee. — The IT band is fascia rather than muscle, which is why the work goes into the muscles that pull on it and the tissue around it.

Iliotibial band (ITB) syndrome is one of the most common overuse injuries in runners (Fairclough et al., 2006), and it also affects cyclists (MedlinePlus, 2025). The iliotibial band is a tough band of tissue that runs down the outer part of the thigh, from the top of the pelvic bone to just below the knee (MedlinePlus, 2025). It helps to stabilise the outside of the knee. In ITB syndrome, the tissues at the outside of the knee become irritated and painful, and running can become painful. The pain can become so severe that runners are sidelined for weeks, if not longer.

You may hear ITB syndrome called "runner's knee", but that name is usually used for a different problem, patellofemoral pain syndrome, which causes pain at the front of the knee around the kneecap (AAOS, n.d.). ITB syndrome is usually diagnosed from your description of the symptoms and an examination, including pressing along the band to find the most tender area (MedlinePlus, 2025). The pain is on the lateral (outside) part of the knee. At first it may come on when you start exercising and ease as you warm up; over time it can get worse and not go away during exercise. Running downhill, or sitting for a long time with your knee bent, may make it worse (MedlinePlus, 2025).

Iliotibial Band Friction Syndrome Anatomy

ITB syndrome is one of the main causes of pain on the outside of the knee in runners (Fairclough et al., 2006). The ITB is a thick band of fascia (connective tissue) that runs from the outer part of the pelvis, down the outside of the thigh and over the outside of the knee, and attaches to a small bump on the shin bone just below the knee (Fairclough et al., 2006).

For many years the pain was thought to come from the band rubbing ("friction") over a bony bump on the outside of the thigh bone (the lateral femoral epicondyle) as the knee bends and straightens repeatedly during running (MedlinePlus, 2025). More recent research suggests the band is firmly anchored to the thigh bone and does not actually slide back and forth; instead, the pain may come from the band compressing a sensitive layer of fatty tissue underneath it (Fairclough et al., 2006).

The ITB wraps around a muscle called the tensor fasciae latae (TFL), which attaches to the pelvis, and it also receives fibres from the gluteus maximus (buttock muscle) (Fairclough et al., 2006). This has led some to feel that a tight gluteus maximus can contribute to ITB syndrome.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Iliotibial Band Friction Syndrome

A physical therapist can give you exercises to strengthen your core and hip muscles and stretch the tissues, and once you can do them without pain you can gradually return to running, slowly building up distance and speed (MedlinePlus, 2025). I can help with hands-on work for the band and the hip and thigh muscles around it, a stretching and strengthening programme, and a gradual return to running. See the My Approach tab for how I work.

1. Cross-Training

While you are cutting back your mileage, you might consider other exercise that does not irritate the ITB, such as swimming (MedlinePlus, 2025) or pool running. Activities that involve bending the knee over and over, such as cycling, can also irritate the band (MedlinePlus, 2025).

2. Ice

Apply ice to the painful area for 15 minutes every 2 to 3 hours. Wrap the ice in a clean cloth first; never put ice directly on your skin (MedlinePlus, 2025). Mild heat before stretching or strengthening exercises may also help (MedlinePlus, 2025).

3. Rest

Once you notice pain in the area, try running shorter distances than usual. If you still have pain, stop running completely for a while (MedlinePlus, 2025). If you do not give yourself a break from running, the problem can become long-lasting.

4. Pain Relief

MedlinePlus (2025) suggests that over-the-counter painkillers such as ibuprofen, naproxen or paracetamol (called acetaminophen in the US) can be used for pain. It advises talking to your provider first if you have heart disease, high blood pressure or kidney disease, or have had stomach ulcers or internal bleeding, and not taking more than the recommended amount. (This medicine information comes from MedlinePlus, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

5. Arch Supports

Changes to how you exercise or arch supports for your shoes may help (MedlinePlus, 2025). I can help you work out whether an arch support might help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Cortisone injection: an injection of a steroid medicine into the painful area to relieve pain and swelling (MedlinePlus, 2025).
Surgery: most people do not need it, but if other treatments do not work, an operation to remove part of the band or the bursa, or to lengthen the band, may be recommended (MedlinePlus, 2025).

How I can help (see the My Approach tab)

Hands-on work for the outer thigh and hip muscles

A hip and core strengthening and stretching programme

Training advice and a gradual return to running

Tips

Decrease the number of miles you run, or take a couple of days off, whenever you feel pain along the outside of the knee.
Make sure your shoes are in good condition. If they are worn along the outside of the soles, replace them.
Warm up before you run.
Contact your doctor if the pain gets worse or does not get better in a few weeks (MedlinePlus, 2025).

Treatment

My Approach

ITB syndrome is an overuse injury, and it tends to flare with running, especially downhill. The band gets much of its tension from the muscles that attach to it at the hip, a small muscle at the front of the hip and the big buttock muscle, so much of my work goes there, not just to the sore spot at the knee. My aim is to settle the irritation, then build strength and control around your hip so you can run without the pain coming back.

I start by assessing where it's tender, how your hip, knee and foot move, the strength of your hip and core muscles, and how you walk, squat and balance on one leg. I'll also ask about your training, your shoes and any recent changes, since these often explain why it started.

When It's Sore

Cutting back your running rather than stopping everything, with swimming or pool running to keep fit
Hands-on work higher up the leg and around the hip, leaving the sore spot near the knee alone
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Gentle stretches for the outer hip and thigh, such as crossing the sore leg behind the other and leaning away

As It Settles

Myofascial work, skin rolling and trigger point work through the low back, hip and outer thigh, lying on your side with pillows so the band is relaxed
Contract-relax stretching for the hip muscles that feed into the band
Strengthening for the hip and core, starting with side-lying and bridging work and building to step-downs, single-leg squats and gym-based work if you lift
A home programme between visits, including self-massage with a foam roller or ball
A gradual return to running on level ground, building distance before speed and adding hills last

Work on the buttock muscles is only with your informed consent and a written consent form, and you can say no at any time. I'll also look at your shoes and training, and help you work out whether an arch support would help and how to get one. At night, sleeping on the other side with a pillow supporting the sore leg can ease aching.

If the pain gets worse or isn't improving after a few weeks, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, with a reassessment at about 6 weeks, then less often as you build your running back up. Most people notice the pain settling within a few weeks, and getting back to full running usually takes around 6 to 8 weeks, sometimes longer if it has been going on for a while.

What I Focus On

Assessment

Hip Muscle Release

Hip & Core Strength

Settling Irritation

Gradual Return to Running

Sources

References

MedlinePlus (2025) Iliotibial band syndrome - aftercare. National Library of Medicine. Available at: https://medlineplus.gov/ency/patientinstructions/000683.htm (Accessed: 7 October 2026).
Fairclough, J., Hayashi, K., Toumi, H. et al. (2006) 'The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome', Journal of Anatomy, 208(3), pp. 309–316. doi: 10.1111/j.1469-7580.2006.00531.x. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC2100245/ (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Patellofemoral pain syndrome. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooIliotibial Band Friction Syndrome

What It Is

Iliotibial Band Friction Syndrome Anatomy

Self-Care & Treatment

How to Treat Iliotibial Band Friction Syndrome

1. Cross-Training

2. Ice

3. Rest

4. Pain Relief

5. Arch Supports

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooIliotibial Band Friction Syndrome

What It Is

Iliotibial Band Friction Syndrome Anatomy

Self-Care & Treatment

How to Treat Iliotibial Band Friction Syndrome

1. Cross-Training

2. Ice

3. Rest

4. Pain Relief

5. Arch Supports

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

As It Settles

Typical Course

References

Related Conditions

Patellofemoral Pain Syndrome

Greater Trochanteric Bursitis

Hyperlordosis

Sports Massage

Book a session