Illiotibial Band Syndrome & Outer Knee Pain
Iliotibial Band Syndrome (ITB Syndrome or ITBS) is a common cause of pain around the outside of the knee.
It can cause sharp, burning or aching pain on the outer side of the knee, particularly during activities involving repeated bending and straightening of the knee.
ITB Syndrome is often associated with activities such as running and cycling, although it can occur in anyone who repeatedly loads the knee.
At MK Orthotics in Milton Keynes, we can assess your feet and lower-limb mechanics to help identify factors that may be contributing to your symptoms.
What is the iliotibial band?
The iliotibial band, often called the IT band or ITB, is a strong band of connective tissue that runs along the outside of the thigh.
It extends from the region of the hip towards the outer side of the knee and helps provide stability to the outside of the leg.
The IT band works together with muscles around the hip and thigh during movement.
When the tissues around the IT band become irritated, activities involving repeated knee movement can become painful.
What does ITB Syndrome feel like?
Symptoms can vary, but commonly include:
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Pain on the outside of the knee
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Sharp or burning pain during activity
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Aching around the outer knee after exercise
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Pain that becomes worse with continued activity
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Pain that may extend along the outer thigh
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Tenderness around the outside of the knee
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Occasionally, swelling around the painful area
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A snapping or popping sensation during knee movement in some people
Pain is often associated with repetitive activities such as running, cycling or walking.
Some people find that symptoms settle when they stop the aggravating activity, only to return when they resume it.
Who can develop ITB Syndrome?
ITB Syndrome is commonly associated with activities involving repetitive knee movement.
It may occur in:
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Runners
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Cyclists
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Hikers
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People who walk long distances
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Athletes involved in repetitive lower-limb activity
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People who have recently increased their training or activity levels
A sudden increase in training volume, distance, intensity or frequency may contribute to symptoms.
However, ITB Syndrome is not limited to athletes.
What can contribute to ITB Syndrome?
There may be several factors involved in the development or persistence of ITB symptoms.
These can include:
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A sudden increase in activity
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Repetitive loading
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Training errors
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Reduced strength or control around the hip and knee
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Changes in running or walking mechanics
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Muscle weakness or reduced endurance
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Reduced flexibility in some individuals
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Previous injury
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Changes in footwear or training surfaces
There is not necessarily one single cause.
This is why it can be useful to consider the whole lower limb rather than focusing only on the painful area.
ITB Syndrome and lower-limb mechanics
The hip, knee, ankle and foot all work together during walking and running.
Changes in the way the lower limb moves can influence how forces are transferred through the leg.
Your foot position and movement may therefore be relevant in some people with ITB symptoms, but having a particular foot posture does not automatically mean that it is causing the problem.
An assessment can help determine whether your foot and lower-limb mechanics appear to be relevant to your symptoms.
Could orthotics help?
Orthotics are not automatically required for ITB Syndrome.
In some people, the way the foot moves and loads during walking or running may be one of several factors contributing to symptoms. If this is identified during an assessment, an orthotic may sometimes be considered as part of an individual management plan.
The aim would not be to “correct” your feet simply because they look a particular way.
Instead, any orthotic would be considered in relation to your symptoms, activity, footwear and the way your foot and lower limb function.
Orthotics may be appropriate for some people but not others.
Rehabilitation and managing ITB symptoms
Managing ITB Syndrome often involves modifying the activities that aggravate your symptoms and gradually returning to normal activity.
Rehabilitation may focus on strength and function around the hip and knee, as well as addressing factors that may have contributed to the problem.
Depending on your individual circumstances, your management plan may include:
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Temporarily reducing aggravating activities
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Gradually returning to running or sport
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Hip and lower-limb strengthening
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Improving movement control
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Reviewing training volume and intensity
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Reviewing footwear
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Physiotherapy
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Advice about activity and load management
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An orthotic where appropriate
If you are a runner or athlete, a gradual return to your normal training load is usually preferable to repeatedly stopping and restarting at a high level of activity.
Running and ITB Syndrome
ITB Syndrome is commonly associated with running.
Symptoms may become noticeable during a run, particularly as distance increases, and may settle after stopping.
If your symptoms are repeatedly returning when you run, it can be useful to look at the overall training picture rather than focusing only on the painful knee.
This may include:
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Recent changes in running distance
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Training frequency
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Running intensity
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Hills or changes in terrain
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Recovery between sessions
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Strength and conditioning
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Footwear
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Your running mechanics
A gait assessment may be useful where appropriate to understand how your feet and lower limbs move while walking or running.
How we assess ITB Syndrome
At MK Orthotics, your assessment begins with a detailed discussion about your symptoms and activities.
We may consider:
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Where your pain occurs
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When the pain starts during activity
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What makes it better or worse
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Your normal walking and running activities
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Recent changes to training
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Previous injuries
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Your footwear
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Foot posture and structure
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Foot and ankle movement
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Knee and hip movement
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Lower-limb strength and function
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Your walking or running mechanics
Where appropriate, video gait analysis can be used to look more closely at your movement during walking.
The initial consultation is approximately 90 minutes, allowing time for a detailed assessment and discussion of the findings.
What happens after the assessment?
Following your assessment, we will discuss the findings with you and consider what may be contributing to your symptoms.
Treatment does not automatically mean orthotics.
Depending on the assessment, recommendations may include footwear advice, activity modification, exercises or rehabilitation, or referral to another healthcare professional where appropriate.
If an orthotic is considered suitable, we can explain how it may be intended to help with your individual biomechanics and symptoms.
When should ITB pain be assessed?
Consider seeking professional assessment if:
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Pain on the outside of your knee keeps returning
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Your symptoms are stopping you from running or exercising
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Your knee becomes painful during longer walks
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You have persistent lateral knee pain
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Changing your activity has not resolved the problem
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You are unsure whether your pain is actually coming from the IT band
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You have previously tried orthotics or other supports without improvement
Outer knee pain can have several possible causes, so persistent symptoms should not automatically be assumed to be ITB Syndrome.
If your knee pain followed a significant injury, you have marked swelling, cannot put weight through the leg, or experience significant instability, appropriate medical assessment may be required.
Related conditions
You may also find these pages useful:
ITB Syndrome assessment in Milton Keynes
If pain on the outside of your knee is affecting your walking, running or other activities, a detailed assessment may help identify factors that could be contributing to your symptoms.
At MK Orthotics in Blakelands, Milton Keynes, we assess the feet and lower limb as a whole rather than assuming that an orthotic is required.
If an orthotic is appropriate, we can discuss how it may fit into your individual management plan.