Iliotibial band syndrome (ITBS) is an overuse condition that causes pain on the outside of the knee, where the iliotibial band passes over the end of the thigh bone. It is the most common cause of outer knee pain in runners and is also seen in cyclists. Most people improve with a period of reduced load, hip strengthening and gradual return to activity.
Also known as ITB syndrome, ITBS, IT band syndrome, iliotibial band friction syndrome
Symptoms
- Sharp or burning pain on the outside of the knee
- Pain that comes on at a predictable time or distance into a run or ride
- Pain that is worse running downhill or down stairs
- Tenderness over the bony point on the outer side of the knee
- Pain that eases with rest but returns when activity resumes
Causes and risk factors
- A rapid increase in running or cycling distance or intensity
- Lots of downhill running or running on cambered roads
- Differences in hip and knee movement, such as the knee rolling inwards when running
- Hip muscle weakness or fatigue
- Poorly set-up bike position in cyclists
What the evidence says helps
- A 2024 systematic review found that conservative care built around hip abductor (outer hip) strengthening reduced pain and improved function in runners, though studies were small and varied.2
- Moderate evidence suggests a six-week programme combining short-term anti-inflammatory medication, stretching and hip strengthening can reduce pain and recurrence for up to six months.3
- Non-surgical treatment reduced symptoms in all the studies that assessed it, and surgery is reserved for the small number of people who do not respond.4
- Changes to running style and advice on footwear and running surface may help, but high-quality evidence is limited.12
Things you can try at home
- Reduce your running or cycling to a level that does not bring on the pain, rather than stopping completely
- Avoid long downhill runs and cambered roads while symptoms settle
- Do regular strengthening for the outer hip and buttock muscles
- Return gradually, increasing distance before speed or hills
- Cyclists: check saddle height and cleat position
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- Your knee is suddenly hot, red and swollen and you feel feverish or unwell: get same-day medical help (NHS 111, or A&E if very unwell), as a joint infection needs urgent treatment.
- After a fall, collision or twisting injury you cannot put weight on the leg, the knee looks deformed, or it swells up within a few hours: go to A&E or an urgent treatment centre.
- Your knee locks and you cannot straighten it, or it suddenly gives way repeatedly: see a GP or urgent care promptly.
- Your foot or lower leg becomes numb, cold, pale or weak: seek urgent medical help (A&E).
How Apollo can help
We assess your hips, knees and feet and look at your training history to understand what has overloaded the outer knee. We then plan a strengthening programme and a graded return to running or cycling. A gait and biomechanics assessment can help us look at your running style, and soft tissue work may be used alongside exercise if it helps you stay comfortable and active.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Should I foam roll my IT band?
Foam rolling may feel helpful in the short term for some people, but the iliotibial band is a very strong, stiff structure that rolling is unlikely to lengthen. Strengthening the hip and managing training load are generally more important.
How long does IT band syndrome take to get better?
Many people improve within six to eight weeks of reduced load and hip strengthening, although some cases take longer. Returning to running gradually reduces the chance of it coming back.
Can I keep running with ITB syndrome?
Often yes, at a reduced level. Try shorter, flatter runs that stay below the point where pain starts, and build up slowly as symptoms settle.
References
- van der Worp MP, van der Horst N, de Wijer A, Backx FJG, Nijhuis-van der Sanden MWG (2012). Iliotibial band syndrome in runners: a systematic review. Sports Medicine, 42(11), 969–992. View source
- Sanchez-Alvarado A, Bokil C, Cassel M, Engel T (2024). Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Frontiers in Sports and Active Living. View source
- Balachandar V, et al. (2019). Iliotibial band friction syndrome: a systematic review and meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscles, Ligaments and Tendons Journal. View source
- Bolia IK, et al. (2020). Operative versus nonoperative management of distal iliotibial band syndrome—where do we stand? A systematic review. Arthroscopy, Sports Medicine, and Rehabilitation. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
