Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries among runners. It occurs when the iliotibial band, the ligament that runs down the outside of the thigh from the hip to the shin, is tight or inflamed. The IT band attaches to the knee and helps stabilize and move the joint. When the IT band isn’t working properly, movement of the knee (and, therefore, running) becomes painful. IT band pain can be severe enough to completely sideline a runner for weeks, or even longer.

Symptoms of IT Band Syndrome

Because the most notable symptom is typically swelling and pain on the outside of the knee, many runners mistakenly think they have a knee injury. The best way to tell if you have ITBS is to bend your knee at a 45-degree angle. If you have an IT band problem, you’ll feel pain on the outside of the knee.

Additionally, sometimes an MRI can confirm whether your injury can be diagnosed as ITBS. An X-ray will usually produce negative results, but an MRI can show a partial thickening of the band, which results from inflammation.

Common causes of IT Band Syndrome

ITB syndrome can result from any activity that causes the leg to turn inward repeatedly. This can include wearing worn-out shoes, running downhill or on banked surfaces, running too many track workouts in the same direction, or simply running too many miles. Unlike many overuse injuries, however, IT band pain afflicts seasoned runners almost as much as beginners. When the iliotibial band comes near the knee, it becomes narrow, and rubbing can occur between the band and the bone. This causes inflammation. Iliotibial Band Syndrome is more common in women, possibly because some women’s hips tilt in a way that causes their knees to turn in.

Prevention of IT Band Syndrome

Here are some steps you can take to prevent iliotibial band syndrome:

• Most importantly, always decrease your mileage or take a few days off if you feel pain on the outside of your knee.

• Walk a quarter- to half-mile before you start your runs.

• Make sure your shoes aren’t worn along the outside of the sole. If they are, replace them.

• Run in the middle of the road where it’s flat. (To do this safely, you’ll need to find roads with little or no traffic and excellent visibility.)

• Don’t run on concrete surfaces.

• When running on a track, change directions repeatedly.

• Schedule an evaluation by a podiatrist to see if you need orthotics.

Treatment of IT Band Syndrome

Once you notice ITB pain, the best way to get rid of it for good is to rest immediately. That means fewer miles, or no running at all. In the majority of runners, resting immediately will prevent pain from returning. If you don’t give yourself a break from running, ITBS can become chronic.

While you’re backing off on your mileage, you can cross-train. Swimming, pool running, cycling, and rowing are all fine. Stair-climbing is not, because it is too much like running.

Side stretches will also help, as will ice or heat, ultrasound, or electrical stimulation with topical cortisone.

If your ITB problem doesn’t get better after several weeks, seek help from a sports-medicine professional. You may need a cortisone injection to break up scar tissue and help speed healing. But cortisone presents its own risks, as it can weaken ligaments and tendons. Consider cortisone injections as a “second-to-last resort.”

Your last resort is surgery to release and mobilize the IT band.