What is iliotibial band syndrome?
Iliotibial band syndrome (ITBS) — also called IT band syndrome or iliotibial band friction syndrome — is an overuse injury that causes pain on the outside of the knee. It is one of the most common injuries in runners, cyclists, and other endurance athletes, but can also affect non-athletes.
The iliotibial band (IT band) is a thick band of connective tissue that runs from the hip, down the outer thigh, and attaches just below the knee at the lateral aspect of the tibia. In ITBS, the IT band repeatedly rubs against the bony prominence on the outside of the knee (the lateral femoral epicondyle) as the knee bends and straightens during movement, causing inflammation and pain.
Who gets ITBS?
ITBS is particularly common in:
- Runners — especially those who increase their mileage too quickly or run on cambered roads
- Cyclists — especially those with poor bike fit or high saddle positions
- Hikers and hill walkers — particularly on descents
- Military personnel with high-volume marching
Risk factors include weak hip abductor muscles (particularly gluteus medius), excessive foot pronation, leg length discrepancy, and sudden increases in training volume.
Symptoms of ITBS
The classic presentation is:
- Sharp or burning pain on the outer side of the knee
- Pain that typically comes on at a predictable point during a run (often 10–20 minutes in) and may force you to stop
- Pain that eases at rest but returns immediately on resuming activity
- Tenderness to touch over the lateral femoral epicondyle
- No swelling or instability — the knee itself is structurally sound
Pain may also be felt at the outer hip (where the IT band originates) in some patients.
How is ITBS diagnosed?
Diagnosis is typically clinical, based on the characteristic history and a positive Noble compression test (pain reproduced by pressing over the lateral epicondyle with the knee at 30 degrees of flexion). Ultrasound imaging can confirm IT band thickening and fluid accumulation beneath it, and helps rule out other lateral knee pathology.
ITBS treatment at Alton Pain Clinic — what actually works?
Cortisone injection for ITBS
A corticosteroid injection into the IT band bursa (the fluid-filled sac beneath the IT band at the level of the lateral epicondyle) can rapidly reduce inflammation and pain, allowing rehabilitation to progress. It is most effective when performed under ultrasound guidance and combined with a structured rehabilitation programme.
At Alton Pain Clinic, we use real-time ultrasound to place the injection precisely into the bursa, maximising effectiveness and minimising discomfort.
How long does ITBS take to resolve?
ITBS can be frustrating to treat because recovery requires a reduction in the very activity that many athletes are reluctant to give up. With appropriate management — load modification, rehabilitation, and injection if indicated — most patients see significant improvement within six to twelve weeks.
Returning to full training too quickly is the most common reason for prolonged recovery.
This article is intended for informational purposes only and should not replace professional medical advice. If you are experiencing persistent symptoms, please consult a qualified clinician.
Frequently Asked Questions
Can I run with IT band syndrome?
In the acute phase, running through pain is likely to prolong recovery. A period of relative rest — reducing or pausing running — is usually recommended initially.
How many cortisone injections can I have for ITBS?
We would generally recommend one or two injections at most, with at least six weeks between them. Injections are most effective when used as part of a broader rehabilitation plan, not as a standalone treatment.
Does stretching help IT band syndrome?
Stretching the IT band itself is difficult and has limited evidence. More beneficial is addressing the hip and glute weakness that contributes to IT band tension.