A sharp or burning pain on the outside of your knee that comes on partway through a run, or an ache on the outside of your hip after a long walk. IT band pain is common in runners, cyclists and walkers, and it can stop you in your tracks. The good news is that it usually responds well to adjusting your load and building strength.

What the IT band is

The iliotibial band, often called the IT band, is a thick band of tissue that runs down the outside of your thigh, from your hip to just below your knee. It helps steady your hip and knee when you walk, run and cycle.

IT band pain usually happens on the outside of the knee, though some people feel it on the outside of the hip. It often comes on at a predictable point in a run or walk, and may ease when you stop. Running downhill, long runs and sudden increases in distance often bring it on.

Why it happens

The pain is thought to come from the sensitive tissue sitting under the IT band where it passes the outside of the knee or hip, rather than the band itself being tight. It usually develops when load increases faster than your body can adapt, like a jump in weekly distance, more hills or a new event.

A note on stretching and foam rolling

The IT band is very strong and does not stretch much. Many people try to stretch or foam roll it hard, but this can be uncomfortable and may not help much. Building strength and managing load tends to help more. Gentle stretches of the muscles around the hip can feel good, though.

If you have been given advice by a physiotherapist, keep following that.

Managing load

Adjusting how much you do, rather than stopping completely, usually helps. Some ideas:

• Run or walk a distance that does not bring on pain, then build up gradually.
• Avoid downhill running and walking for a while.
• Choose flatter routes and even surfaces.
• Take slightly shorter, quicker steps when running.
• If you run on a track, change direction regularly.

Cycling and swimming can help you keep your fitness up while it settles, as long as they do not bring on pain. If cycling brings it on, checking your saddle height and position can help.

Strengthening

Strengthening the muscles around your hips helps control how your knee and hip move, taking some of the load off the area. Something to try two or three times a week:

• Side-lying leg lifts. Lie on your side and slowly lift your top leg a little way, then lower.
• Bridges. Lie on your back with your knees bent, lift your hips, then lower slowly. Progress to single-leg bridges.
• Sit to stand. Rise from a chair without using your hands, keeping your knees in line with your toes.
• Step-ups. Step up onto a low step, keeping your pelvis level, then step down slowly.

If you would like to follow along, VIDA has short videos of bridges and sit to stands you can use at your own pace. Start with a few repetitions and build up gradually.

Getting back to running or walking

Building back up step by step helps reduce the chance of it returning. Something like this tends to work well:

• Start with shorter distances on flat ground, stopping before the pain comes on.
• Add a little more distance each week, as long as it stays comfortable.
• Bring back hills and downhill sections last.
• Keep strength work going alongside.

Check how your knee or hip feels the next morning. If it is sorer, ease back a little next time.

Footwear

Wearing supportive shoes that are not too worn helps. If you have run many miles in the same pair, the cushioning may have flattened.

When to get it checked

If your pain is not easing after several weeks of adjusting your load and building strength, a physiotherapist can help tailor a plan to you.

Your VIDA pain check-in can help you notice how your knee or hip responds as you build back up.

What to take away

• IT band pain is common in runners, cyclists and walkers.
• It usually responds well to adjusting load and building hip strength.
• Hard stretching or foam rolling of the IT band itself may not help much.
• Avoid downhill running and walking while it settles.
• Build back up gradually, stopping before the pain comes on.

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