Iliotibial band pain (or IT band pain) is a condition that causes lateral knee pain (pain on the outside of the knee). While it is often thought of as an overuse injury because it is common in sports with a lot of repetitive lower body motion (like running or cycling), IT band pain can affect anyone.

If you’ve ever been to the mobility area of your gym, you’ve likely noticed people trying to stretch their IT band or use a foam roller to massage this painful area on their outer thigh. Perhaps you’ve even tried doing this yourself. Unfortunately, stretching and foam rolling the IT band is doing nothing to address the root cause of IT band pain on the outside of the knee.

The key to addressing IT band pain in the long term is achieved through 3 steps. First, you must release the tension in the muscles that connect to the IT band, thereby reducing the pull on this area, as well as any other muscles that may be contributing to the issue. Second, you must improve the alignment of your body. Third, strengthen key muscles that support the healthy function of the IT band.

Anatomy and function of the iliotibial band

The IT band is a thick band of fascia that runs along the outside of the thigh and down towards the knee. The IT band originates near the hip joint and is influenced by the deep fascia of the gluteus maximus, gluteus medius, and tensor fascia latae (or TFL). The IT band continues along the outside of the leg before inserting into Gerdy's tubercle on the outside of the knee at the tibia.

The IT band supports movement of the hip and also stabilizes the hip and knee during activities like walking and running. Because the IT band plays an important role with movement and stability of the lower extremities, it is an area of the body more susceptible to pain and tightness.

Is the IT band a muscle?

No, the IT band is NOT a muscle and it does not contract and stretch in the same way that your hamstrings or other muscles do. Instead, the IT band is a fibrous connective tissue that is supported by its surrounding muscles that connect to it.

What are the symptoms of IT band pain?

As we’ve just discussed, the IT band is a common area to develop tightness and pain. Some of the most common symptoms of a tight IT band include:

• Outer hip pain – this is due to inflammation caused by the friction of the IT band repeatedly rubbing near the greater trochanter towards the top of your femur, potentially leading to hip bursitis.
• Outer knee pain – the repeated rubbing of a tight iliotibial band increases friction in the knee when you flex and extend, causing inflammation of the tendon and pain on the outside of your knee.
• A sensation or feeling of clicking, popping, or snapping on the outside of the knee or hip.
• The inflammation can cause noticeable redness around your knee, and your skin may feel warm to the touch.

IT band pain is frequently the result of a tight IT band that rubs excessively against the femur or iliotibial bursa on the outside of the knee. When you repeatedly bend and extend your leg, the movement can cause irritation, leading to inflammation and pain of the iliotibial band and adjacent tissue. A tight IT band can also compress the tissue and impact the nerves beneath it, causing pain.

What causes the IT band to become tight?

It's clear that tightness in the IT band coupled with repetitive bending and extending of the knee are usually linked to IT band pain. But what causes the IT band to become tight in the first place?

As we talked about earlier, the IT band is not a muscle. However, there are 3 key muscles that insert into the iliotibial tract and influence the tightness in the IT band. These muscles are the tensor fascia latae (or TFL), gluteus maximus, and gluteus medius.

When these muscles are tight and not functioning properly, they pull on the IT band and cause the increased friction and rubbing that happens between the IT band and the outside of the hip, thigh, and knee. As this happens over time, this is what causes irritation and outside knee pain.

Some potential signs and symptoms of dysfunction in the TFL and glutes that are contributing to IT band issues include:

• Excessive foot pronation – when you walk, your foot and ankle roll inwards too much. This contributes to the knee moving inwards, where the IT band is placed under more stress to support and stabilize the knee.
• Knee valgus – when standing, walking, running, squatting, or moving, your knee tends to cave inwards. Again, the IT band is placed under more stress in this position and rubs more on the outside of the hip, thigh, and knee.
• Hip abductor muscle weakness – abduction of the hip is when your hip moves away from your body. A weakened ability to use these muscles might cause your iliotibial band to be tight. Hip abductor weakness significantly impacts pelvis, hip, and leg stability and is a component of many lower extremity issues and even back pain.
• Anterior rotation of the pelvis – anterior rotation is where the alignment of the pelvic bone (or ilium) is tipped forward relative to its neutral position. This impacts the alignment of the pelvis, the movement of the hips, the relative length of your legs, and the function of the surrounding muscles. Anterior pelvic tilt contributes to issues with the lower back, hips, and knees.
• Limited hip rotation – the hip joints are supposed to be a very mobile joint in the body. The ability to flex, extend, adduct, abduct, internally rotate, and externally rotate allows for the full recruitment of the muscles needed to stabilize the pelvis and hips. Tight hips can cause knee pain (such as IT band pain) and other lower back related issues to develop.

Additionally, several other lifestyle factors or workout habits can make a person more susceptible to a tight IT band that rubs against the bones and causes outside knee pain, including:

• Excessive amounts of sitting – sitting places the hips into a flexed position for longer periods of time, which often leads to tightness and weakness developing in many key muscles responsible for the alignment of the pelvis, movement of the hips, and stability of the knee. Tightness and weakness in the hip flexors, TFL, gluteus medius, and gluteus maximus affect the IT band.
• Improper or inadequate warmup for exercise – failing to prepare your body for a run or workout that involves your hips and knees (or any other part of the body) increases the chances that your body will look to compensate for pre-existing tightness or movement restrictions, potentially placing more stress on the IT band.
• Improper or inadequate cool-down from exercise – failing to help your body relax following your workout (such as with stretching or other light active body movement) may impact recovery and lead to the muscles utilized developing tightness, which may tug on the IT band if your hips and glutes remain tight.
• Overuse and lack of recovery – repetitive stress placed on the hips and knees (without adequate rest) leads to overuse of the tissues and does not allow them to recover, which may increase the risk for IT band tightness, pain, or other injury.

Now that you know many of the possible contributing factors to IT band pain or IT band tightness, let’s talk more about what to do to begin improving that pain on the outside of your knee.

Stretching or foam rolling the IT band is NOT the solution

Again, the IT band itself is not a muscle that can be stretched or released. It is a piece of connective tissue with the purpose of holding things tightly together. While it might feel painful and give you the illusion that it “hurts so good” when pressing directly on the IT band, it is not doing you any good.

Any relief that you get will be temporary, and the pain and tightness on the outside of the knee will soon return because the tightness and/or weakness in the TFL, gluteus medius, and gluteus maximus has not been addressed. Instead, you should focus on the muscles in the surrounding area.

The muscles you should focus on to improve IT band pain

To more effectively treat IT band pain, you should focus your attention on the muscles that directly insert into the iliotibial tract – these are the TFL, gluteus medius, and gluteus maximus muscles.

Because we spend so much time sitting down, these muscles are prime candidates for becoming tight and weak, causing them to pull on the IT band. You can improve the health and functioning of each of these muscles (and lessen their pull on your IT band) through targeted stretching, releasing, and strengthening exercises.

You may even consider adding attention to your main hip flexor muscles, the iliacus and the psoas, due to their function in the body and their relationship with the TFL, gluteus medius, and gluteus maximus that impacts tightness in those areas.

IT band pain exercises for the TFL muscle

The tensor fascia latae (TFL) is a muscle located on the outside of the pelvic bone and inserts into the iliotibial tract near the greater trochanter at the outside of the hip. The TFL helps to stabilize the hip and knee, performing several functions including: internal rotation, flexion, and abduction of the hip and lateral rotation of the knee.

A great TFL stretch for IT band tightness can be performed as follows:

1. Start in the half-kneeling position with your hips and knees around 90 degrees. The side with the knee down is the side of the TFL that you will be stretching.
2. Squeeze your glute on the kneeling leg, tucking your pelvis under you.
3. Slightly shift your body weight forward over the kneeling side. This is moving your hip into extension.
4. Slowly shift your body weight towards the kneeling side. This is moving your hip into adduction.
5. Reach your arm overhead to intensify the stretch.
6. Hold this position for 30-60 seconds and take deep breaths. Repeat 2 times.

When stretching alone isn’t enough to help, you may consider releasing the TFL first by applying direct pressure to the muscle using a ball. Here’s how you do it:

1. Start lying down on your side. Line up the ball with your TFL muscle and roll your bodyweight over the ball.
2. Move your top knee to the ground with your hip and knee bent. You will be part on your side and part on your stomach. This will help to manage the amount of pressure being applied to your TFL.
3. Once you find a tighter spot, hold this pressure (don’t rub around, just stay there) and take deep breaths for at least 90 seconds.

To strengthen the TFL muscle, you can do so from either a standing or supine position. Add a light loop resistance band around your feet for an added challenge. Here’s how you do it:

1. Start in a standing or supine position with a band around your feet.
2. March one knee towards your chest, trying to keep your pelvis level.
3. With your knee in the air, now move your hip into internal rotation by moving your foot away from your body, but keep your knee still.
4. Hold this position for 5-10 seconds. Repeat 5 times.

IT band pain exercises for the gluteus medius muscle

Similar to the TFL, the gluteus medius is a muscle located on the outside of the pelvic bone and inserts into the greater trochanter near the iliotibial tract at the outside of the hip. The gluteus medius helps to stabilize the hip and knee, is the primary abductor of the hip and also assists with internal and external rotation of the thigh.

A great gluteus medius stretch for IT band tightness is the Figure 4, which can be performed as follows:

1. Lie down on your back with your knees bent.
2. Cross one ankle over the opposite knee.
3. Use your hands to grab behind your knee and pull it towards your chest to intensify the stretch.
4. Remember to breathe and relax as you hold this stretch for 30-60 seconds. Repeat 2 times

Releasing the gluteus medius muscle will be done with a lacrosse ball in the same way we described for the TFL, but the placement will be slightly different. The TFL is towards the front side of the outside of the pelvic bone, whereas the gluteus medius is more in the middle of the outside of the pelvic bone. Find a tight spot and maintain the pressure (without rubbing) for at least 90 seconds as you take deep breaths.

Among the best exercises to strengthen the gluteus medius includes the clamshell, which is a simple yet challenging exercise when performed correctly and with intention. Here’s how you do it:

1. Lay on your side with (or without) a loop resistance band around your thighs. Bend your knees to about 90 degrees and position them slightly in front of your body.
2. Lift your top leg using your outer hip and glute muscles, keeping your top knee aligned over your bottom knee. This is key because if you go for more range of motion, you will be recruiting other muscles and decrease the focus on the gluteus medius.
3. Perform 10-15 reps. Repeat 3 times.

IT band pain exercises for the gluteus maximus muscle

The gluteus maximus is a muscle located primarily on the back side of the pelvis, having muscle fibers that insert into the greater trochanter near the iliotibial tract at the outside of the hip. The gluteus maximus helps to stabilize the hip and pelvis, and is a primary extensor and external rotator of the hip.

A great gluteus maximus stretch for IT band tightness is the seated knee to chest stretch, which can be performed as follows:

1. Sit on the ground with your legs straight out in front.
2. Bring one knee up and cross it over the opposite straight leg.
3. Hug your knee to your chest.
4. Twist your upper body and press on the outside of your leg to intensify the stretch.
5. Hold this stretch for 30-60 seconds and take deep breaths. Repeat 2 times.

When it comes to releasing the gluteus maximus, there is a lot more area to explore within the muscle than for the TFL and gluteus medius. Use a lacrosse ball (or a larger ball) and position it anywhere along the back side of your pelvis. Search for a tight spot and hold pressure there (without rubbing) with the ball for at least 90 seconds. Remember to take deep breaths and relax.

To strengthen the gluteus maximus, an easy exercise you can perform is a glute bridge. You may add a loop resistance band around your thighs to increase the difficulty. To do this:

1. Begin lying on your back with your knees bent and with your heels about an arm’s length away.
2. Lift your hips up using your glutes and be sure to keep your core muscles engaged to avoid arching the lower back. At the end range of motion, you should be able to draw a line between your shoulders, hips, and knees.
3. Perform 10-15 reps. Repeat 3 times.

What role do the hip flexors play in IT band pain?

We’re all about trying to get to the root cause of an issue. By now, you’ve learned that pain at the outside of your knee, hip, or thigh is a symptom of irritation to the IT band that is caused by tightness in the TFL, gluteus medius, and gluteus maximus muscles that attach to the iliotibial tract.

But is there a root cause somewhere else that is creating tension in these muscles that is ultimately contributing to IT band pain or tightness? It’s very possible.

If you’ve tried everything we’ve already talked about to improve your IT band tightness, then it’s time for you to consider the potential impact that tightness in your hip flexors have on your IT band pain.

Your body's largest and strongest hip flexor is called the iliopsoas which is made up of 2 separate muscles: the iliacus and the psoas. The iliopsoas muscles are deeper within your core and actually are the only muscles that connect the upper and lower halves of your body. This muscle serves a critical function as a mover and stabilizer for the lumbar spine, sacroiliac joints, pelvis, and hips.

When these hip flexor muscles are tight, they pull the pelvic bone forward into an anterior rotation. This affects the movement of the hips and can lead to compensations occurring in the surrounding muscles. Tightness in the iliacus and psoas muscles inhibits the function of the gluteus medius, glute maximus muscles, and TFL muscles (among others) and can create tightness in these areas – the same exact areas that typically pull on the IT band and cause pain.

3 steps to improving IT band pain

In addition to tightness in your TFL, gluteus medius, and gluteus maximus muscles, tension in your iliacus and psoas muscles could be the missing piece to address to help you make long-lasting improvements with IT band issues. The best approach will give attention to each of these key areas and perform them in a sequential order that accelerates your progress.

Step 1: Release your muscles

Releasing tension is an important first step to help reduce the pulling force that tight muscles are having on your pelvis, hips, and IT band. Use direct and prolonged pressure to your tighter spots for at least 90 seconds, remembering to take deep breaths to help your muscles to relax and let go.

We feel that the iliopsoas has the biggest potential impact on your IT band pain, so we recommend releasing the iliacus and psoas muscles first. From there, move onto releasing tension in the TFL, gluteus medius, and gluteus maximus.

This can be followed by some gentle stretching to help increase circulation to these areas, but stretching alone will not be as effective, especially if there are muscle knots or trigger points in your muscles.

Step 2: Realign your hips and pelvis

After releasing tension in the key muscles around your hips, you have a good opportunity to improve a pelvis misalignment issue that could be affecting your IT band pain. Many people have one side of their pelvis that is more anteriorly rotated than the other because of muscle imbalances. If you know which side of your pelvis this is, you can perform the pelvic realignment exercise only on the side of your pelvis that is more anteriorly rotated.

Step 3: Remember to strengthen your muscles

Tight muscles become weak muscles. Once you’ve released tension and aligned your pelvis, you are in a great position to begin strengthening exercises to improve stability, range of motion, and support your body in a better position. This will enable you to move better in your body and use the right muscles, which allows your IT band to make progress and heal over time. Focus on the muscles we talked about earlier in this blog post, as well as your core. And yes, you can even strengthen your hip flexors.

A message from the Aletha Health team

We hope you found this article helpful and we’d love to support you on your healing journey. Our customers have experienced lots of success improving pain-related issues in their body using our products and methods, including IT band pain, SI joint pain, lower back pain, and more. We hope that you can achieve the same level of success. We encourage you to reach out to us directly at hello@alethasupport.com if you have any questions and we’ll do our best to help you out!

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