Iliotibial Band Syndrome Treatment
Iliotibial band syndrome — commonly known as IT band syndrome or ITBS — is one of the leading causes of lateral (outer) knee pain in runners, cyclists, and endurance athletes. The iliotibial band is a thick strip of connective tissue that runs from the hip along the outside of the thigh to the top of the tibia, stabilizing the lateral knee and assisting with hip movement and rotation during every stride. When repetitive bending and straightening of the knee causes the IT band to repeatedly slide over the bony prominence on the outer side of the femur, friction and irritation develop — producing the characteristic burning pain on the outside of the knee that worsens with continued activity. IT band syndrome is one of the most common overuse injuries in distance running and can also affect hikers, basketball and soccer players, and anyone who suddenly increases their training volume or intensity.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon, sports medicine specialist, and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with over 30 years of experience diagnosing and treating overuse knee conditions in athletes at every level of competition. A member of the Society for Tennis Medicine and the Medical Advisory Board of Sports Lab NYC, he has a deep understanding of the biomechanical factors — including hip weakness, training errors, and gait imbalances — that contribute to IT band syndrome and related lateral knee pain. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, Dr. Glashow manages overuse and repetitive-stress injuries in professional athletes who need a precise diagnosis and a targeted treatment plan that returns them to performance as quickly as possible. Named a Castle Connolly Top Doctor every year since 2000, he evaluates and treats IT band syndrome at his Upper East Side practice in New York City.
Causes and Symptoms of IT Band Syndrome
The IT band slips over the bottom outside of the femur, or thigh bone, when you bend or extend your leg. For runners, especially long distance or marathon runners, this continuous movement of the IT band over the femur can cause friction and irritation. The IT band can become irritated, or other tissues under the IT band may be affected. Irritation or inflammation in nearby bursae, tendons or other tissues can result in pain. Symptoms can include:
- Pain on the outside of the knee
- A burning pain spreading from the knee up the thigh
- Pain may worsen when running or exercising
- Pain may worsen when climbing stairs
For mild cases of IT band syndrome, rest, NSAIDs and ice can relieve symptoms. For more severe IT band syndrome cases, treatment may be necessary. Interventional treatments like corticosteroid injections may offer relief, and physical therapy can help restore function. In some cases, surgery may be recommended when less invasive treatments are not effective at relieving pain or inflammation.
If IT band syndrome pain is keeping you from training or enjoying your daily run, Dr. Glashow and his sports medicine team can identify the specific factors driving your symptoms and develop a targeted treatment plan to get you back to activity. Contact our Upper East Side practice to schedule an evaluation.
Frequently Asked Questions About Iliotibial Band Syndrome
What does IT band syndrome feel like?
The hallmark symptom is a sharp or burning pain on the outside of the knee that typically begins during a run or workout and worsens with continued activity — particularly on downhill running, stair descent, or any movement that involves repetitive knee bending. In early stages, the pain may appear only toward the end of a run and subside with rest. As the condition progresses, it can begin earlier in activity, persist after exercise, and eventually interfere with walking. Some patients also experience a snapping or clicking sensation as the IT band slides over the femoral condyle during knee bending.
What causes IT band syndrome?
IT band syndrome is fundamentally an overuse condition caused by excessive friction between the iliotibial band and the lateral femoral condyle — the bony prominence on the outer side of the knee. Contributing factors include sudden increases in running mileage or intensity, downhill running, hip abductor weakness that allows the pelvis to drop during the stance phase of running, tightness in the IT band or surrounding muscles, poor running form, worn-out footwear, and training on cambered or uneven surfaces. Identifying and correcting these contributing factors is just as important as treating the symptoms.
Is IT band syndrome the same as runner’s knee?
No. Despite being commonly confused, these are two different conditions. IT band syndrome produces pain on the outer side of the knee and involves irritation of the iliotibial band where it crosses the lateral femoral condyle. Runner’s knee — also known as patellofemoral pain syndrome or chondromalacia patella — produces pain at the front of the knee, around and behind the kneecap. The location of the pain is the primary distinguishing factor, and Dr. Glashow differentiates between the two through clinical examination and, when needed, imaging.
Can IT band syndrome be treated without surgery?
Yes — and the vast majority of cases respond well to non-surgical treatment. Dr. Glashow typically recommends a structured approach that includes rest and temporary activity modification, targeted physical therapy focused on hip strengthening and IT band flexibility, foam rolling and soft tissue mobilization, correction of training errors and biomechanical factors, and in some cases corticosteroid or PRP injections to reduce persistent inflammation. Most patients experience significant improvement within several weeks to a few months of consistent therapy.
When is surgery considered for IT band syndrome?
Surgery is rarely necessary and is considered only after a thorough course of conservative treatment — typically six months or more — has failed to provide adequate relief. When surgery is indicated, the most common procedure involves arthroscopic release or excision of the portion of the IT band that is creating friction against the lateral femoral condyle. This is a minimally invasive, outpatient procedure with a relatively rapid recovery. Dr. Glashow exhausts all non-operative options before recommending surgical intervention.
How can I prevent IT band syndrome from coming back?
Recurrence is common if the underlying biomechanical and training factors are not addressed. The most effective prevention strategies include maintaining consistent hip abductor and gluteal strengthening — particularly the gluteus medius — progressive increases in training volume and intensity rather than sudden jumps, regular IT band and hip flexor stretching, proper running shoe fit and replacement, varying running surfaces and avoiding excessive cambered roads, and incorporating cross-training to reduce repetitive load on the IT band. Dr. Glashow works with each patient to develop a maintenance program tailored to their sport and training schedule.
