What is Iliotibial Band Syndrome (ITBS)

Iliotibial band syndrome is a condition that often causes knee pain. It can also cause pain in the outside of your hip, thigh, and knee. The iliotibial band is a strip of tissue that runs from the outside of your hip and down your thigh to the outside of your knee.

Repeatedly bending and straightening your knee can irritate the iliotibial band.

What are the causes?

This condition is caused by inflammation and irritation from the friction of the iliotibial band moving over the thigh bone (femur) when you repeatedly bend and straighten your knee.

What increases the risk?

This condition is more likely to develop in people who:

• Frequently change elevation during their workouts.
• Run very long distances.
• Recently increased the length or intensity of their workouts.
• Run downhill often, or just started running downhill.
• Ride a bike very far or often.

You may also be at greater risk if you start a new workout routine without first warming up or if you have a job that requires you to bend, squat, or climb frequently.

What are the signs or symptoms?

Symptoms of this condition include:

• Pain along the outside of your knee that may be worse with activity, especially running or going up and down stairs.
• A “snapping” sensation over your knee.
• Swelling on the outside of your knee.
• Pain or a feeling of tightness in your hip.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and physical exam. You may also see a health care provider who specializes in reducing pain and increasing mobility (physical therapist). A physical therapist may do an exam to check your balance, movement, and way of walking or running (gait) to see whether the way you move could contribute to your injury. You may also have tests to measure your strength, flexibility, and range of motion.

How is this treated?

Treatment for this condition includes:

• Resting and limiting exercise.
• Returning to activities gradually.
• Doing range-of-motion and strengthening exercises (physical therapy) as told by your health care provider.
• Including low-impact activities, such as swimming, in your exercise routine.

Follow these instructions at home:

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times per day.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Keep all follow-up visits with your health care provider. This is important.

Contact a health care provider if:

• Your pain does not improve or gets worse despite treatment.

Iliotibial Band Syndrome Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your hip and pelvis.

Exercise A: Quadriceps, prone

1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Iliotibial band

1. Lie on your side with your left / right leg in the top position.
2. Bend both of your knees and grab your left / right ankle. Stretch out your bottom arm to help you balance.
3. Slowly bring your top knee back so your thigh goes behind your trunk.
4. Slowly lower your top leg toward the floor until you feel a gentle stretch on the outside of your left / right hip and thigh. If you do not feel a stretch and your knee will not fall farther, place the heel of your other foot on top of your knee and pull your knee down toward the floor with your foot.
5. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your hip and pelvis. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Straight leg raises (hip abductors)

1. Lie on your side with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your bottom knee to help you balance.
2. Roll your hips slightly forward so your hips are stacked directly over each other and your left / right knee is facing forward.
3. Tense the muscles in your outer thigh and lift your top leg 4–6 inches (10–15 cm).
4. Hold this position for __________ seconds.
5. Slowly return to the starting position. Let your muscles relax completely before doing another repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Straight leg raises (hip extensors)

1. Lie on your abdomen on your bed or a firm surface. You can put a pillow under your hips if that is more comfortable.
2. Bend your left / right knee so your foot is straight up in the air.
3. Squeeze your buttock muscles and lift your left / right thigh off the bed. Do not let your back arch.
4. Tense this muscle as hard as you can without increasing any knee pain.
5. Hold this position for __________ seconds.
6. Slowly lower your leg to the starting position and allow it to relax completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Hip hike

1. Stand sideways on a bottom step. Stand on your left / right leg with your other foot unsupported next to the step. You can hold onto the railing or wall if needed for balance.
2. Keep your knees straight and your torso square. Then, lift your left / right hip up toward the ceiling.
3. Slowly let your left / right hip lower toward the floor, past the starting position. Your foot should get closer to the floor. Do not lean or bend your knees.

Repeat __________ times. Complete this exercise __________ times a day.