How To Treat ITB Pain

If you've ever suffered from Ilio-Tibial-Band Syndrome, you might recognize that sharp pain to the outside of the knee, that comes on like clockwork around a certain mileage point every time you run.

You try to push through, but the pain gets worse and now it also feels tighter and tighter and tighter.... and you give up on your run for that day.

Stretching and deep tissue massage are both common treatments in the management of ITB syndrome. But studies show that the ITB does not need to be stretched and, in fact, it can't be stretched out (i.e. lengthened), due to it's structural make-up. And massage.... apparently massage can make symptoms worse rather than better!

What is the ITB?

The ITB is a large fibrous connective tissue that runs from the hip area, down to the outside of the knee. It provides stability to the knee, and also acts a bit like a spring in absorbing and releasing energy.

Whenever someone mentions the "ITB" it's usually in relation to pain, tightness, or some other negative experience they associate with it.

But the ITB is great. We need it. Without it, our legs would flap around all over the place. Kind of like Phoebe in that F.R.I.E.N.D.S episode when she runs in Central Park, all four limbs flailing about (to Rachel's embarrassment). That was for all you Gen X-ers who needed a visual. Anyway, the ITB is strong. It's resilient. It's very adaptable. It's our friend. LOVE YOUR ITB!

If it's so strong and great, why does it hurt so much?

Every time we bend our knee slightly, while loading it (such as in walking or running), the ITB compresses an adipose tissue (fat) that's situated underneath it, just on the outside of the knee. This is normal mechanics. It's part of how the ITB stabilizes the knee joint. When applying a sudden increase in load, such as when we increase our running mileage or speed too quickly, the repetitive compression causes irritation to the the adipose tissue; the tissue did not expect to be compressed so frequently under such new forces. It didn't have time to adapt! So the fat has become....angry.....and now you feel that sharp pain.

Will this syndrome damage my knee?

Your knee will be fine. It's a sturdy joint that can handle running and walking just fine. However, that angry adipose tissue could damage your running routine and goals. The pain can become severe enough that you can't keep running. You also might start limping from the pain (and ya' shouldn't be running while limping!). Simply put, ITB syndrome can put a hamper on your running. We need to treat it!


Foam rolling, stretching and massage won't do it, huh? Researchers have even said that massage can increase the symptoms, by irritating the tissues further. Yes, if you do a deep massage RIGHT onto the area that's already being compressed and irritated, then you might just provoke symptoms. But, the rest of the iliotibial band and the quads, and the hamstrings are all fair game for massage. It won't "cure" ITB syndrome, but massage has so many other benefits, both locally and systemically. I would definitely incorporate massage in the surrounding areas.

Stretching? Well, if you're doing a quad stretch or a hip flexor stretch with some rotation, you might feel like you're "getting" the ITB as well. You can keep those stretches if it feels good, but you're really only stretching the quads/hip flexors (and what's wrong with that?).

What works?

Aaaah, here's the tricky part. It depends on the individual! But let's dig deeper and see what might work for you. If you've read this far, you deserve some practical tips.

- Don't eliminate your running completely - but decrease your running distance. Stop running before the pain comes on. You might want to run farther, but resist the temptation. If your pain comes on after 30 minutes, stop running at 20 minutes. It's actually beneficial for recovery to keep running in this pain free zone, as it allows neural tissues in the brain to decrease the association of running with pain.

- Avoid downhill running (for now). Running downhill is a risk factor for ITBs, so stay away from it for a little while. Go back to hill-running gradually as your pain is getting under control

- Running technique. Though there has not been much research on how changing running techniques can impact ITB syndrome, there are a few things that we can tweak in running styles that make sense clinically. For example, a cross-gait puts undue compression onto the painful area. So if you have a narrow gait pattern when you run, it can be beneficial to widen it slightly. Imagine running on a thin line, with each foot striking on each side of this line.

- Strength training. Most runners (and cyclists for that matter) do not get ITB syndrome due to being weak in general. However, the high repetitive loading that endurance training entails, requires adequate musculature to withstand the stress. You might be putting more load on your body than your muscles can adequately handle. Time to hit those weights!

However - the BEST way to treat ITB syndrome is with an individualized plan. What holds true for one runner, might be different for another. Did you get ITB syndrome from running hills, or from having a cross-over gait pattern? Did you increase your mileage recently, or perhaps your speed? How often do you run? What are your rest days like? Are there other factors in your running form that is contributing to your condition?

Have questions you'd like to get answered in regards to your situation? Call us! We'd love to chat. We're offering phone consultations at: 973-845-8972

You can also shoot me an email at:


Katarina Erlandsson, PT DPT

Madison, NJ

Our Mission is to empower runners to train smart, recover well, and reach an optimal state of health & wellbeing.