Running Injury Spotlight: IT Band Syndrome
If you’ve ever had a dull, nagging ache on the outside of your knee while running — especially downhill — chances are you’ve dealt with IT Band Syndrome (ITBS).
Most runners have heard of IT Band Syndrome, but it’s often misunderstood, misnamed, and mistreated. And despite the scary word “syndrome,” ITBS isn’t a mysterious illness — it’s mechanical overload of tissue that’s sensitive but very treatable.
What Is the IT Band?
The iliotibial band (ITB) is a thick, dense strip of connective tissue that runs down the outside of your thigh.
It transmits force from the glute max and tensor fasciae latae (TFL) down to the knee.
It attaches at Gerdy’s tubercle on the tibia.
It also helps stabilize the kneecap through the lateral retinaculum.
👉 Because of this stabilizing role, we don’t recommend surgical “IT band release” procedures for pain.
Why Does the IT Band Hurt When I Run?
Old theory: ITBS was caused by friction of the IT band rubbing over bone with running and repetitive movement.
New research: ITBS is more likely compression of a sensitive fat pad between the IT band and femur.
This compression is strongest at 20–30° of knee bend, which is exactly when your body is absorbing the most force during running why makes it common in runners.
Typical IT Band Symptoms:
Sharp, pinpoint pain just above the outside of the knee (not directly on the joint line)
Pain that begins after running a certain distance (often suddenly)
Worsens with downhill running, training spikes, or poor recovery
Who Gets IT Band Syndrome?
~12% of running-related injuries are ITBS
More common in newer runners
Slightly more common in men
Common triggers:
Sudden mileage increases
More downhill running
Hip weakness (glutes not pulling their weight → IT band overcompensates)
How Do You Treat IT Band Syndrome?
At The Run Rx in Boston, here’s how we guide runners back to pain-free training:
Let it calm down
Scale back from painful runs, but keep moving in ways that don’t flare symptoms.
You don’t need to stop running completely — just adjust load and intensity.
Don’t stretch or foam roll the IT band itself!
The IT band can’t truly be stretched - it is a dense and thickened portion of fascia
Give the compression cause - stretching and foam rolling only further compress!
Instead, work on hip and ankle mobility to reduce strain.
Skip the classic side-leaning IT band stretch — it often worsens compression.
Strengthen the hips
Target the glute max and external rotators.
The goal is to resist hip drop and knee collapse during stance phase.
Reframe the injury
IT Band Syndrome is not forever. With the right strength, mobility, and training adjustments, most runners return to full mileage.
Get Evaluated by a Running Physical Therapist
Every injury is unique to the runner.
The above guidance is a solid starting point, but true long-term relief comes from finding and addressing your root cause.
A professional evaluation — including a running gait analysis — ensures you don’t just treat symptoms, but fix the underlying problem.
Stretching and foam rolling the IT band endlessly isn’t the solution. In fact - given the compression mechanism it’s probably worsening it. IT band pain is your body’s way of saying: your training, strength, or recovery needs attention.
At The Run Rx, we treat the whole runner, not just the sore tissue. With smart load management, strength work, and coaching, you can run stronger and avoid chronic flare-ups.
📞 Ready to put IT band pain behind you?
Book a free discovery call with our Boston-based physical therapy team today.
Somerville, MA
