Iliotibial Dressing Syndrome (IT) Causes and Treatment Options


The iliotibial (IT) band is a thick, strong strip of fibrous tissue that begins at the thigh and runs along the outer thigh, attaching to the outer edge of the tibia (tibia) just below the knee joint. . The strap works with the quadriceps (thigh muscles) to provide stability to the outside of the knee during movement.

Trauma or irritation to the iliotibial system, called iliotibial system syndrome, can cause sharp or aching pain, often felt on the outside of the knee. Sometimes the pain spreads to the hip and / or thigh area .

The diagnosis of IT group syndrome is often made clinically with a detailed history and physical examination. Once a diagnosis is made, your healthcare provider will develop a treatment plan that includes a combination of decreased activity, anti-inflammatory medications, and physical therapy.

Illustration by Alexandra Gordon, Get Meds Info


IT group syndrome is more common in runners, but also in cyclists, soccer players, field hockey players, basketball players, and rowers .

Since the IT bracelet acts as a stabilizer while running, it can become irritated and inflamed with overuse or stress.

This irritation can gradually lead to a burning pain that is felt on the outer (lateral) side of the knee or lower leg. Sometimes the pain is felt near the thigh. The pain is usually more intense when walking down the stairs or when getting up from a sitting position.

Over time, the pain can become constant and sharp or stabbing in quality. As the pain worsens, swelling may develop on the outside of the knee.


Overtraining and / or increasing training too quickly are common causes of IT group syndrome. In addition to poor training regimens, improper biomechanics can also make a person more vulnerable to developing IT streak syndrome .

Examples of susceptible biomechanical errors include:

  • Excessive pronation of the foot
  • Leg length discrepancy
  • Lateral tilt of the pelvis
  • Twisted legs

IT streak syndrome is also common in runners who perform unbalanced repetitive exercises, such as running on a single side of the road topped with roots or running one-way on the track. Most roads slope sideways, and running along the edges puts the outside foot lower than the inside. This, in turn, causes the pelvis to tilt to one side, which puts stress on the IT group.

Muscle tension or lack of flexibility in stretching the glutes (glutes), fascia lata (thighs), and quadriceps (thighs) can also increase the risk of developing IT brace syndrome .

When to contact a healthcare provider

It is important to see a doctor if knee pain is severe, worsens, or lasts more than a few days. Besides knee pain, other signs that require medical attention include:

  • Inability to walk comfortably or lock in the knees (inability to bend the knee)
  • Swelling or skin changes (such as discoloration, redness, or warmth)
  • Trauma or injury causing deformity of the knee joint.
  • Fever or other unusual symptoms


The diagnosis of iliotibial band syndrome is almost always clinical, meaning that only a medical history and physical examination are required. In rare cases, imaging is required to confirm the diagnosis of IT syndrome.

History of the disease

If you experience lateral knee / hip / hip pain, it is advisable that you write down a few notes of your pain before seeing your doctor. For example, try answering some of these questions your healthcare provider is likely to ask you during your visit:

  • When did your pain start?
  • Is your pain persistent or does it come and go?
  • What makes your pain worse? What makes it better?
  • Are you involved in any vigorous sports activity or training regimen?
  • Have you had any recent injuries or injuries?
  • Do you have symptoms other than pain, such as knee swelling or instability ?

Physical exam

During the physical exam, your doctor will examine and apply pressure (palpate) the entire knee joint.

The hallmark of iliotibial syndrome is pain over the lateral epicondyle of the thigh, a small protrusion of the lower femur through which the iliotibial apparatus passes.

Your healthcare provider may also perform the Noble Compression Test, in which your knee is flexed and extended while your doctor applies pressure to the lateral epicondyle of the femur with the thumb. If a popping or snapping sensation or pain is felt in or over the epicondyle when the knee is bent (often the greatest pain is felt at 30 degrees of knee flexion), the test is positive.

In addition to examining the knee joint, your doctor will assess the strength and flexibility of the quadriceps (located at the front of the thigh) and the hamstrings (located at the back of the thigh).


If imaging is used to confirm the diagnosis of iliotibial syndrome, it is usually magnetic resonance imaging (MRI) .

Differential diagnosis

Many of the differential diagnoses that may be considered in iliotibial ligament syndrome overlap with diagnoses of general or lateral knee pain, including patellofemoral pain syndrome, lateral meniscus tear, and lateral collateral ligament tear .

Two additional diagnoses, popliteal tendonitis and biceps femoris tendinopathy, largely overlap with IT brace syndrome because they are often also the result of excessive running, especially downhill running.

The good news is that a physical exam in conjunction with an MRI (in some cases) can usually distinguish between these diagnoses.

Popliteal tendonitis

The hamstring connects the thigh bone to the hamstring muscle (a small muscle located at the back of the knee). The hamstring muscle works with the hamstring to control forward movement and rotation of the knee.

Popliteal tendonitis, which refers to irritation of the hamstring, is usually the result of excessive running and downhill walking and causes pain on the outside of the knee that sometimes spreads to the back of the knee. . There may also be swelling and redness on the outside of the knee, along with knee instability.

Biceps femoris tendinopathy

The biceps femoris tendon connects the biceps femoris (one of the three hamstrings) to the side of the knee. Similar to iliotibial syndrome, running too much can irritate the biceps tendon insertion site and cause pain on the outside of the knee.

Watch out

Treatment for IT syndrome generally involves a comprehensive approach that includes the following.

RICE Protocol

The RICE protocol is important for the immediate and initial management of pain associated with the iliotibial ligament.

  • Rest (or reduced activity): Regardless of whether you have a suspected or diagnosed iliotibial syndrome, resting your affected leg should be your first step.
  • Ice: Place ice (such as a cold gel pack or a bag of frozen vegetables) along with a thin towel on the outside of the knee for 15-minute sessions every two hours to ease pain and relieve inflammation.
  • Compression: If you have been diagnosed with TI armband syndrome, speak with your healthcare professional about placing an Ace bandage or TI armband compression pad just above the knee. Compressing this area can help stabilize the knee and reduce friction (as the iliotibial apparatus slides over the lateral epicondyle of the knee).
  • Elevation: If your knee is freezing, try to keep your leg above your heart.


To ease the pain and swelling of ITB, talk to your doctor about taking non-steroidal anti-inflammatory drugs (NSAIDs) . If you are intolerant to oral NSAIDs like ibuprofen or Alev (naproxen), talk to your doctor about taking topical (applied to the skin) NSAIDs.

In the short term, an injection of a steroid (cortisone) can relieve pain. This treatment is generally considered if the person continues to experience pain despite following the RICE protocol, taking NSAIDs (if possible), and undergoing physical therapy for 6 to 12 weeks.


After the swelling and pain of the initial IT group subside , physical therapy will be the next key step in healing. The physical therapist will use a variety of techniques to improve the strength, mobility, and flexibility of your legs.

In addition to teaching you how to do strength and flexibility exercises correctly, a trained gymnast can also help you correct any biomechanical errors and correct technique, as well as muscle weakness or tension.


IT band lengthening surgery is rarely required to treat IT band syndrome. This is generally only indicated if pain persists and limits activity despite conservative treatments for about six months .

Although there are different types of TI range lengthening surgical procedures and recovery depends on the specific surgery performed, most patients can return to running activity within six to twelve weeks.


Since runners are most affected by IT bracelet syndrome, here are some running tips to help prevent IT bracelet irritation and pain:

  • When exercising, increase the distance no more than 10 percent per week, take a rest day between running days, and gradually increase the speed or intensity of the incline.
  • Since the amount of support or shock absorber in your shoe can exacerbate or alleviate IT bracelet problems, be sure to choose suitable running shoes and replace old running shoes (at least every 400 miles).
  • Avoid overtraining and get plenty of rest and recovery. Frequent high intensity running workouts can do more harm than good.
  • Consider mixing workouts to balance your body (like swimming or kayaking)
  • Run on a smooth, level surface or in another direction to avoid damaging the IT bracelet.
  • Try running backwards to correct muscle imbalances and relieve pressure on your knees.

Get the word of drug information

For the vast majority, IT brace pain can be relieved with simple measures such as reducing activity and taking NSAIDs. To prevent recurrence of IT pain, it is important to address potential underlying issues, such as overtraining, improper biomechanics, and tight muscles.

Be proactive about the health of your IT group; For example, talk to your doctor and physical therapist about exercises you can do at home to strengthen the surrounding IT groups. Also, if you are an avid runner or athlete, seek help in developing a gentle, simple, and progressive training program.

Frequently asked questions

  • It is very common among physically active people. According to the National Academy of Sports Medicine, TI armband syndrome is the number one cause of knee pain in runners and accounts for 22% of all leg injuries.

  • It depends on many factors, such as the cause and extent of the injury and how it is treated. However, according to studies, about 44% of people with IT injuries were able to return to their usual activities after eight weeks of treatment, including two to six weeks of rest, in addition to stretching and other conservative measures.

  • There are many effective ways to stretch the IT band. This simple standing stretch has proven to be particularly effective:

    1. Cross your right leg behind your left, with the toes of both feet pointing forward.
    2. Raise both arms above your head and clasp your hands.
    3. Bend over to the right until you feel a stretch on the outside of your left thigh.
    4. Hold at 30; repeat three times, then switch sides.

  • There is no one-size-fits-all shoe recommendation, given the difference between anatomy, running style, and other factors among runners. It may be wise to consult a podiatrist who can determine if a problem such as excessive pronation may be contributing to the development of IT range syndrome. In this case, they can prescribe an individual orthopedic device that will help solve the problem.

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