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Iliotibial Band (IT Band) Syndrome: Part 1 - What is it?

Updated: May 10, 2022

Written by: Dr. Lisa Bodratti

Anatomy and why it matters:

The ITB is a fibrous, thick band of fascia that begins at the outside of your hip and runs all the way down to the outside of your knee. Fascia is relatively inflexible, very strong connective tissue that covers all of your muscles and joints (kind of like casing on sausage). In the case of the ITB, it is its own entity and adds stability to the outer hip/thigh. At the hip, the ITB arises from fibers of the tensor fascia lata (TFL) muscle, gluteus maximus and gluteus medius muscles. It is key to understand our anatomy in order to understand how weakness or lack of flexibility through certain muscle groups leads to troubles with our ITB. Because of its attachment sites, we know the ITB is meant to help support hip extension (leg going behind our body), hip abduction (bringing our leg outwards, further from our body), hip external rotation (rotating your knee outward), and knee flexion (bending our knee). If any muscles that are meant to help us perform these functions (insert: hip extension, hip abduction, hip external rotation, knee flexion), excessive force gets placed on the ITB which can manifest as pain at the top of the outer hip or the outer knee.

How does this happen?

ITBS is classified as an overuse injury, meaning that the volume or type of exercise has caused the issue. As you learned in Dr. Ashley’s running injury prevention and recovery blog here overuse injuries are generally caused by doing too much too soon. These injuries may not be apparent at first, but come to light once you have been doing the activity for some time. Lack of gluteal or hip rotator strength and flexibility also plays a major role in the development (or lack of development!) of ITBS. Some types of exercise that are generally associated with a higher rate of ITBS are

  • Long distance running - an estimated 5-14% of runners will experience ITBS

    • Running on the same banked or slanted surface without changing directions increases the chance of developing ITBS

  • Rowing

  • Cycling

What do all of these sports have in common? Repetitive hip and knee flexion with a requirement for high hip strength!

What does it feel like?

ITBS pain typically manifests as:

  • Sharp pain at the outer knee with:

    • Heel strike or weight bearing on the affected leg

    • Descending stairs, running down hill

    • Knee flexion around 30degrees

  • Tenderness at the upper/outer hip

  • Tenderness at the outer knee and sometimes the kneecap

What can you do about it?

See Part 2 of this series, coming next week, for treatment recommendations and ideas! If you would like to talk to any of our Doctors about your IT band issues, schedule a free in-person or phone consultation by clicking this link here

In good health,

Dr. Lisa Bodratti of The Green Room Physical Therapy

Clifton Park & Troy

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