Iliotibial Band Friction Syndrome 

Iliotibial (IT) band friction syndrome is a common cause of lateral (side) knee pain in runners, cyclists, and endurance athletes.  It accounts for 15 to 22% of leg injuries in these athletes.  

What causes Iliotibial Band Friction Syndrome? 

The IT band is a long tendon of a muscle that starts at the outside of the pelvis (hip bone) and attaches at the shin bone (tibia). The syndrome results from the IT band sliding over a bony prominence on the outside of knee when the leg is bent and straightened. This repetitive motion can create friction at the IT band, which leads to inflammation (swelling) and pain. 

Risk factors for the syndrome include a tight IT band, weak hip muscles, alignment abnormalities at the knee and foot, and leg length discrepancies (one leg being shorter than the other).  

What are the symptoms of Iliotibial Band Friction Syndrome? 

The main symptom is pain on the outside of the knee that occurs with activity and typically improves with rest. The pain is generally worse with when running downhill, running on hard surfaces, or running in shoes with decreased shock absorption. Some people may also experience a "snapping" sensation at the outside of the knee with activity. In more severe cases, the pain may also occur when walking or climbing stairs, and may radiate up the thigh.  

How is Iliotibial Band Friction Syndrome diagnosed? 

The diagnosis is typically based on the patient's medical history and a physical examination. The doctor will review the athlete’s symptoms and training habits. X-rays or MRIs are not usually needed, though the doctor may order imaging tests to look for other causes of knee pain if the diagnosis is unclear. 

How is Iliotibial Band Friction Syndrome treated? 

Treatment requires modification of activities to allow the inflammation and pain to resolve. Ice may also help reduce pain and inflammation. The doctor may also prescribe non-steroidal anti-inflammatory medication and address any training modifications to be made.  

A physical therapy program that includes hip muscle, hamstring, and IT band stretching and strengthening will help reduce tension on the IT band, and can speed recovery and the return to sports. The doctor may also recommend shoe inserts (orthotics) to redistribute pressures during activity. Rarely, surgery may be necessary to loosen the IT band if rest and physical therapy fail to relieve symptoms. 


Lavine, R. Iliotibial Band Friction Syndrome. Curr Rev Musculoskelet Med. 2010; 3(1-4):18–22. 

Anderson SJ and Harris SS, eds. Care of the Young Athlete, 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics