IT Band Syndrome: Why Runners Get It and How to Fix It

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre 

One of the most common causes of pain on the outside of the knee is Iliotibial Band Syndrome (ITBS). ITBS is an overuse injury frequently seen in runners, cyclists, and other active individuals. The good news is that with appropriate treatment and rehabilitation, most people can make a full recovery and return to their sport. 

What Is IT Band Syndrome? 

The iliotibial (IT) band is a thick band of connective tissue that runs along the outside of the thigh from the hip to the knee. IT Band Syndrome occurs when the tissue becomes irritated around the outer portion of the knee, leading to pain and inflammation during repetitive activities such as running.

Why Do Runners Get IT Band Syndrome? 

ITBS develops when repetitive stress exceeds the body's ability to recover. 

• Sudden increases in running distance, speed, or frequency 

• Running on sloped or uneven surfaces 

• Downhill running 

• Hip muscle weakness, particularly in the gluteal muscles 

• Poor lower-limb biomechanics 

• Inadequate recovery between training sessions  

Common Symptoms 

Symptoms typically develop gradually and may include: 

• Pain on the outside of the knee during running 

• Pain that worsens with longer distances 

• Tenderness along the outer knee 

• Discomfort when running downhill 

• Symptoms that improve with rest but return when activity resumes 

Who Is at Risk? 

• Marathon and long-distance running 

• Rapid changes in training volume 

• Muscle weakness around the hips and pelvis 

• Previous history of ITBS 

• Poor movement control during running 

• Limited flexibility or mobility in surrounding tissues 

  
  

How Can Physiotherapy Help? 

Physiotherapy is often the most effective treatment for IT Band Syndrome because it addresses the underlying causes of the condition rather than simply treating symptoms. 

• Reducing pain and irritation 

• Assessing running mechanics and training habits 

• Strengthening the gluteal, hip, and core muscles 

• Improving lower-extremity movement patterns 

• Addressing mobility restrictions 

• Developing a gradual return-to-running plan 

At Waterloo Sports Medicine Centre, rehabilitation programs are tailored to the individual and may include gait analysis, strength training, education, and progressive exercise to help runners return to training safely.