How to Fix IT Band Syndrome and Keep It from Coming Back

If you’ve ever felt a sharp, nagging pain on the outside of your knee while running or cycling, there’s a good chance you’ve experienced Iliotibial Band Syndrome (ITBS). It’s one of the most common overuse injuries in endurance athletes especially runners, cyclists, and triathletes.

The good news? With the right approach, most cases of IT band pain can be managed and fixed without injections or surgery, using smart training, mobility, and strengthening strategies.

The even better news? A lot of times you don’t even have to stop runnning!

What Is the IT Band?

The iliotibial (IT) band is a thick band of connective tissue that runs from your hip to just below your knee. It helps stabilize your leg during walking, running, and cycling.

The IT band itself doesn’t “stretch” much — it’s not a muscle — but it can become irritated when the surrounding muscles (especially the glutes, quads, and TFL) are weak, tight, or overworked.

When this happens, friction occurs between the IT band and the outer part of the knee — resulting in that classic sharp, burning, or aching pain on the outside of the knee joint.

Why IT Band Pain Happens

Most IT band problems aren’t caused by the band itself, they’re caused by the muscles and mechanics around it.

Here are the most common contributors:

• Weak glutes and hip stabilizers → the knee collapses inward, increasing strain on the IT band.

• Excessive downhill running or mileage spikes → increases repetitive knee flexion and friction.

• Tight quads or TFL (tensor fasciae latae) → pull on the IT band, creating extra tension.

• Poor running mechanics or worn-out shoes → amplify impact and lateral knee stress.

Research shows that gluteal weakness and hip abductor imbalance are strongly associated with ITBS (Fredericson et al., 2000; Journal of Orthopaedic & Sports Physical Therapy).

How to Fix IT Band Syndrome Yourself

Most cases of IT band pain respond very well to load management, targeted strength, and mobility work. Here’s a step-by-step guide to start addressing it:

1️⃣ Reduce Load — But Don’t Stop Completely

Avoid full rest for long periods. Instead, reduce your running or cycling volume and remove downhill or high-intensity workouts for the time being.

Replace those sessions with low-impact alternatives like treadmill running, swimming, or cycling in an easier gear to maintain fitness while symptoms calm down.

2️⃣ Target the Root Cause: Strength

The key muscles to strengthen are the glute medius, glute max, and hip rotators.

Try these exercises 3x/week:

• ✅ Side-Plank Hip Abduction Isometric Holds – 3 sets to failure isometric holds

• ✅ Banded Single Leg Squats – 3 rounds of 6 each leg

• ✅ Single-Leg Glute Bridge – 3 sets of 10 reps

• ✅ Hip Airplanes – 3 sets of 8 reps per side

A 2019 study in the Journal of Sports Rehabilitation found that progressive hip strengthening reduced ITBS pain and improved running tolerance more effectively than stretching alone.

3️⃣ Mobility Work for the Quads and TFL

You can’t stretch the IT band directly, but you can reduce tension on it by relaxing the tissues that feed into it.

• Thomas Stretch and Activation

• Eccentric Hip Flexor Lengthening with foot under KB

• 90/90 hip stretch for rotational mobility

Avoid aggressive foam rolling directly on the IT band, this will make it WORSE.

4️⃣ Check Your Running Mechanics

If your knee collapses inward (valgus) or your stride crosses midline, it can stress the IT band.

Try this:

• Keep your cadence around 170–180 steps per minute

• Maintain a slight forward lean from the ankles

• Avoid overstriding

A running analysis at Rival Physical Therapy can identify these movement faults and show you how to fix them with form drills and strength work.

5️⃣ Gradually Reload

Once your pain decreases and strength improves, it’s time to build back up.

Follow this checklist before returning to full training:

✅ No pain with walking or stairs

✅ Able to perform 15 single-leg squats pain-free

✅ No tenderness to palpation on the outside of the knee

✅ Able to jog for 20–30 minutes pain-free

Start with run-walk intervals and progress your mileage slowly (no more than 10% increase per week).

When to Seek Help

While most cases can be self-managed, seek professional evaluation if you experience:

• Pain that worsens despite rest or mobility work

• Sharp pain that limits daily movement

• Swelling or warmth at the outer knee

• Numbness or tingling down the leg

These could indicate a different issue such as a lateral meniscus injury or nerve irritation.

The Bottom Line

IT band syndrome is one of the most common and fixable injuries in endurance athletes. With the right approach, you can not only get out of pain but also return stronger and more resilient than before.

At Rival Physical Therapy, we combine hands-on treatment, Dry needling, strength programming, and running analysis to help athletes recover smarter and perform better.

Train smarter this season. Recover. Rebuild. Rival.

📍 Rival Physical Therapy — Wyckoff, NJ💬 1-on-1 Care | Sports Injury Rehab | Triathlon Physical Therapy📲 Visit RivalPhysicalTherapy.com to learn more