Treating ITB

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Laura Kennelly had been running for several years before the pain hit. Two days after finishing her first marathon, she went off with her regular running group for an easy 5-km. But after 2 km, the outside of her leg began to hurt — big-time. “My leg just blew out. I stopped running and could barely walk,” she recalls. “I hobbled home in pain.”

Kennelly was suffering from iliotibial band syndrome, one of the most common overuse injuries among runners.

Because the most notable symptom typically is swelling and pain on the outside of the knee, many runners mistakenly think they have a knee injury.

But it’s not the knee, it’s the ligament that runs down the outside of the thigh from the hip to the shin. “When the band comes near the knee, it becomes narrow, and rubbing can occur between the band and the bone. This causes inflammation,” says Dr. Freddie H. Fu, an orthopedic surgeon and chairman of the board of the Pittsburgh Marathon.

What causes ITB 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 km. Unlike many overuse injuries, however, ITB pain afflicts seasoned runners almost as much as beginners.

“40% of the runners we see for ITB syndrome have been running 5 or more years,”says John Pagliano, a sports-medicine podiatrist and a 2:26 marathoner. “That’s quite a high number. About 50 percent of them are running between 30 and 50 km a week.

“Also ITB syndrome is much more common in women,”Dr. Pagliano notes. “Why? It could be the way some women’s hips tilt, which can cause their knees to turn in.”

Dr. Pagliano describes most runners with ITB pain as “Type A’s.” “They run high mileage,” he says. “They’re not willing to back off, and they are willing to run through pain.”

How can you tell if you have ITB syndrome?

“The best way is to bend your knee at a 45-degree angle. If you have an ITB problem, you’ll feel pain on the outside of the knee,” says Dr. Fu. “Sometimes an MRI can confirm it. An X-ray is usually negative, but an MRI can show a partial thickening of the band — which results from inflammation.”


Here are some steps you can take to prevent ITB syndrome:

  • Most importantly, always decrease your mileage or take a few days off if you feel pain on the outside of your knee.
  • Walk half-a-km 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.
  • Avoid doing any type of squats.


Once you notice ITB pain, the best way to get rid of it for good is to rest immediately. That means fewer km, or no running at all.

“In the majority of runners – 85% – once they rest, the pain doesn’t come back,” Dr. Pagliano says. “But I’m not talking about the guy who finally decides to rest after feeling pain for 6 months during 100-km weeks. You have to rest immediately.”

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.

One of the best at-home remedies is to roll out the kinks with a foam roller.

Side stretches will also help, as will ice or heat, ultrasound, or electrical stimulation with topical cortisone. This last method is useful “particularly in the acute phase,”says Dr. Fu.

If you don’t give yourself a break from running, ITB syndrome can become chronic. “Then you’ll need to run fewer km and give up marathons,” says Dr. Fu.

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,” Dr. Pagliano says.

Your last resort is surgery. “Once you’ve tried everything else, and nothing helps, we can surgically release the IT band,”Dr. Fu says. Adds Dr. Pagliano: “But surgery makes your knee a little floppier, and patients are never happy with it.”

As Laura Kennelly reports, “I’ve had other injuries since — including fractured bones in my foot — but none of them took as long to heal or still troubles me as much as that ITB strain. I know now that I have to respect that weakness in my leg, and back off when it acts up.”

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4 Responses to Treating ITB

  1. Stuart Clifton May 24, 2013 at 10:53 am #

    There are a lot more options to try before Cortisone and surgery!

  2. Don Cawdry May 2, 2014 at 7:40 am #

    I currently have ITB. I got it during the training runs for my first Comrades Marathon. I think the saying “too much, too soon” is appropriate for me.
    It is now one month to go before the comrades, will there be long term damage if I go ahead with it? At the moment, the ITB is getting very painful around the 35km mark.

    • Voice Netshimbupfe May 28, 2014 at 10:44 am #

      I have the similar problem with ITB. For the past months I have been struggling with it and now it gets worse when I reach the 10km mark and I want to go to comrade. Please advice should I skip comrades and rest it or should I go and run it.

  3. Antony January 15, 2015 at 8:43 pm #

    My ITB was very successully and almost immediately treated by a chiropractor who said my hips were misaligned. Two days after a single appointment, the inflamation was gone, and I havent had ITB in more than a year of running.

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