Are you experiencing sharp, burning pain on the outside of the knee? Does it radiate up into the thigh or down around the kneecap? If so, you probably have iliotibial band, or IT band, pain. The IT band is commonly problematic in people who run or bike. It is especially susceptible to injury when an exercise program is progressed or altered too quickly. For example, when a runner takes up biking pain can gradually set in. IT band pain usually starts with stiffness that is sometimes not easily detected. Stiffness can be initially felt in the front of the hips because of the attachment of the IT band to a small hip muscle. The problem with the IT band is that it crosses both the hip and the knee and is involved in a variety of hip and knee movements.

In general terms, the IT band is aggravated with activities that require a lot of work by the quadriceps and combine hip and knee movements (such as biking and running). When the knee gets out of alignment between the foot and the hip, especially if the knee moves inward relative to the hip and foot, the IT band gets pulled tight. Over time, small irritations in the fibrous IT band become areas of scar tissue that prohibit the band from functioning normally. Treatment of IT band pain should be started early. If left untreated it will likely worsen, forcing time off from activity and exercise. As with most musculoskeletal overuse injuries, it is easier and more effective to prevent the problem than it is to treat it once it occurs.

Prevention strategies are not complicated, nor do they take a lot of time. The most basic strategy is to stretch the hip flexors and quadriceps, especially after working out. In addition to stretching, keeping the partner muscle, the gluteus medius, strong helps the IT band from becoming overused. These exercises are progressively introduced during rehabilitation of an IT band injury. As with most movements, if you are inefficient problems may occur. The most common movement issues leading to IT band injury are the knees turning inward during running, biking or squatting. A gait analysis may be helpful to correct running-related problems. If you are a biker, make sure that your knees are not moving toward the bike's frame as you reach the top of the stroke and transition to the downstroke. Additionally, as a biker you may wish to limit the use of shoe clips or toe straps temporarily or limit the amount of pulling up on the upstroke. Pulling up uses the small hip flexor muscle that attaches to the IT band and causes stiffness. If squatting or jumping increases the pain, practice with a mirror to make sure that the knees are staying in line with the hips and feet.

If you end up with an IT band injury or have one now, movement correction is a must. However, other effective treatments may include icing, massage, ultrasound, iontophoresis or augmented soft tissue treatment. The primary goals of good treatment are to reduce the irritation, heal the scarred tissue, correct the movement problem and return to the desired activity. Finally, if you are required to perform prolonged sitting or driving, you will likely benefit from getting up every 1-2 hours and doing some hip stretching. Sitting causes hip flexor stiffness that has been noted to contribute heavily to IT band stiffness and pain.

IT band injury or pain is not a permanent or “career ending” injury, but it can be very debilitating in the worst cases. Early treatment, prevention, altering how you move and your training strategies will help get you back on the road.