IT band syndrome: symptoms, treatment and how to recover

MSK Dorset suggests relative rest, ice and anti-inflammatory medication at first, to improve pain, swelling and tenderness. For ice it says to use a damp cloth around an ice pack or frozen peas for up to 20 minutes, up to 3 times a day, never directly on the skin, and to be cautious with altered skin sensation or circulation problems. It says painkillers such as paracetamol need to be taken regularly to control pain, that ibuprofen should not be taken for 48 hours after an initial injury, and that you should speak to your GP if you need ibuprofen for more than 10 days.

The next stage is stretching and then strengthening. MSK Dorset says stretching the muscles on the outside of the leg helps mobility of the band, quadriceps, hamstrings, gluteals and calf, and gives examples such as a standing band stretch held for 30 seconds and repeated 3 times, and squat variations of 10 repetitions repeated 3 times. The final phase is a strengthening programme and progressive return to activities such as running once pain free.

The Sports Injury Clinic says that, while resting from running, you can keep fit with swimming or cycling, and it recommends gradual return, starting from much lower than before the injury. It says a reduction to 50% of the original mileage or time should be okay, to increase running time rather than distance at first, and to increase distance by no more than 10% a week depending on fitness. If pain returns, go back a couple of steps.

For stubborn cases, NHS Tayside says that a podiatry or orthotics referral may be appropriate if footwear or pronated feet are involved, and that a corticosteroid injection may help more severe cases but is unlikely to completely cure it. It states there are no proven effective operations. MSK Dorset adds that if you are not improving, a physiotherapist can help, and it links to self-referral.

The main symptom is pain on the outside of the knee. The Sports Injury Clinic, a UK injury information site, says it usually develops gradually and becomes progressively worse, and that in runners it often comes on at around the same time in a run. It also says rest makes the pain disappear, only for it to come back when normal training resumes, and that it tends to be worse when running downhill.

MSK Dorset gives the same core pattern: pain that worsens with continued movement and settles with rest. A sudden sharp pain after a twist, a locked knee, or a knee that gives way suggests something different and should be assessed.

• Outer knee ache or sharp pain that builds during exercise.

• Relief with rest, and a return of pain when the activity is restarted.

• Tenderness at the side of the knee.

• Pain that is often worse on downhill running (Sports Injury Clinic).

The iliotibial band is a thick band of fibrous tissue running down the outside of the thigh. MSK Dorset explains that it works with several of the thigh muscles to give the knee stability and to help bend it. When it becomes irritated, movement of the knee becomes painful.

NHS Tayside refers to it as friction of the band over the outer bony prominence at the lower end of the thigh bone, a source of localised outer knee pain, particularly in distance runners.

The condition is often called runner's knee, according to MSK Dorset.

IT band syndrome is primarily an overuse injury, according to the Sports Injury Clinic, but several factors can raise the risk. It lists weak gluteal muscles, tight hip muscles, a naturally wide iliotibial band, and foot mechanics such as overpronation, in which the foot rolls in and the lower leg and knee rotate inwards. Leg length difference, running on hills, and running on cambered roads are also mentioned.

NHS Tayside notes that type of footwear and pronated feet have also been implicated. Training errors matter too, and the Sports Injury Clinic suggests keeping a training diary to look for a recent jump in mileage, a change of surface or another change that coincided with the onset.

A physiotherapist or doctor usually diagnoses it from the history and examination. The Sports Injury Clinic describes a test in which the knee is bent and straightened while pressure is applied at the side of the knee, with a reproduction of your pain suggesting the diagnosis. Clinicians may also look at foot mechanics, weakness in moving the leg out to the side, and tender spots in the gluteal muscles.

The sources describe diagnosis as clinical, based on examination. If the history is unusual, if there was an injury, or if pain does not settle, a clinician may look for other knee problems.

Prevention follows the causes. Build mileage gradually, avoid long stretches of running on a slope or camber, and keep up the hip and gluteal strengthening that formed part of rehabilitation. The Sports Injury Clinic also suggests checking that your footwear suits your running style and seeing a podiatrist for a biomechanical assessment if foot problems may be involved.

If the same pain keeps coming back despite sensible rest and a gradual return, speak to your GP or a physiotherapist rather than pushing through it.

IT band syndrome is not an emergency, but other knee problems can look similar. The NHS says to get advice from 111 now if your knee is very painful, you cannot move it or put any weight on it, it is badly swollen or has changed shape, it locks, gives way or painfully clicks (painless clicking is normal), or you have a very high temperature or feel hot, cold or shivery with redness or heat around the knee, which can be a sign of infection.

The NHS also says to see a GP if knee pain does not improve within a few weeks. In many areas you can refer yourself to NHS community musculoskeletal (MSK) services for help such as physiotherapy without needing a GP referral.

Most people with IT band syndrome are managed through self-care and physiotherapy. On the NHS, the NHS says you may be able to refer yourself to a local community MSK service for physiotherapy, and a GP can advise on pain relief and refer you if you are not improving. NHS Tayside guidance says a podiatry or orthotics referral may be appropriate where footwear or pronated feet are involved.

You can also see a physiotherapist or sports medicine clinician privately. The principles of treatment described above are the same: reduce irritation, restore flexibility and strength, and return to running gradually.