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Q&A: Dealing with ITB Syndrome

I’ve developed pain on the outside of my thigh/knee. My friend says it’s ITB syndrome. What’s that, and what should I do?


ITB stands for iliotibial band. It’s a strong, thick strip of connective tissue that runs along the outside of your hip down your thigh to your knee. Muscles of the hip and pelvis attach to the ITB, which attaches into your kneecap and to your shinbone on the outside of your leg close to your knee.

Strain on the ITB increases when the hip is adducted (thigh moves inward) and/or when the knee turns in. Increased strain on the ITB can cause it to rub at your hip or just above where your knee bends, leading to pain.

ITB syndrome can occur for several reasons:

  • Training factors: sudden and rapid changes in mileage and/or speed, running on  embankments, or running downhill
  • Muscle imbalances: tightness in hip or calf muscles and/or weakness of pelvic, gluteal, or quadriceps muscles
  • Structure: how you’re built, including hip/pelvis, foot/ankle, and leg-length discrepancies

Modify your activity so it isn’t painful. If it hurts when you run a certain distance, stay below that distance.

Apply cold therapy over the area where it hurts to help control pain and inflammation. (Place a thin layer of towel between the cold pack and your skin.)

Look at your training routine to see if the factors mentioned above are present. Can you stand on one foot without your opposite hip dropping and without leaning? If not, begin regular hip-strengthening exercises (bridging, side planks, side-lying leg lifts, standing on one leg) and flexibility exercises. “Get in shape to run,” instead of “running to get in shape.”

Seek professional help from a physical therapist who can not only identify the cause of your pain, but can make recommendations for treatment whether it is related to your training, muscular balance or the way you are built. 


Theresa Chiaia

Theresa Chiaia, PT, DPT, is the section manager of the Sports Rehabilitation and Performance Center at Hospital for Special Surgery (HSS). She has been part of the HSS Women’s Sports Medicine Center since its inception and has consulted with and performed pre-season screening examinations of the New York Power and NY/NJ Metrostars soccer teams, the New York Liberty basketball team, and college soccer programs. 

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