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Injury Highlight: Why Does My IT Band Hurt When I Run?
- Kate Mihevc Edwards PT, DPT
- 5 days ago
- 4 min read
Its getting nice outside and when the weather gets nice running injuries increase. As runners it is difficult not to run far, up hills or faster when the sun is shining and you no longer have to bundle up. IT band syndrome is a very common injury for runners all year round, but especially in the spring when mileage can pick up quickly. I recently did a podcast with two RUNsource experts about IT band syndrome if you want to check it out!
IT band pain, often called iliotibial band syndrome (ITBS) is one of the most common overuse injuries in runners.
The symptoms usually follow a pattern.
Many runners first notice tightness or an achy sensation on the outside of the knee or hip early in a run. At first they can ignore it and often do. But, as the irritation progresses, the pain often becomes sharp and localized, especially along the outside of the knee. In more severe cases, the pain can become intense enough that stairs, walking or straightening the knee becomes difficult.
What Is the IT Band?
The IT band is not a muscle that you can stretch it is a thick band of connective tissue that runs from the outside of the hip down to the outside of the knee. It works with the hip muscles to stabilize the leg while running.
During running, the IT band helps control the knee and assist with hip stability through thousands of repetitive loading cycles.
When training load exceeds the body’s ability to tolerate that stress, irritation can develop around the lateral knee or sometimes near the hip.
Why IT Band Pain Happens in Runners
From a physical therapy perspective, IT band pain rarely has a single cause. Instead, it usually develops from a combination of training load, consistency, and movement mechanics.
Sudden Increases in Mileage
One of the most common triggers for IT band pain is a sudden spike in running distance or intensity.
Research examining over 588,000 running sessions from more than 5,000 runners found that sudden increases in running distance significantly increased injury risk. When tissues are exposed to more load than they are prepared to tolerate, irritation can develop along structures like the IT band.
Inconsistent Training
Another common factor is inconsistent training.
A large cohort study of 7,391 runners in the Garmin-RUNSAFE study found that runners who trained less frequently and accumulated very low weekly mileage had higher injury proportions.
Running places repetitive mechanical stress on the body. Consistent training allows muscles, tendons, and joints to adapt to those stresses over time.
When running is sporadic, the body may not be prepared to tolerate the workload.
Hip Strength and Control
Weakness or poor control of the hip muscles can also contribute.
When the hip muscles, particularly the gluteus medius and hip rotators do not stabilize the pelvis well during running, the knee may turn inward (femoral internal rotation) or dive in (knee valgus). This increases stress on the lateral knee and tension through the IT band. Over thousands of steps, that repeated stress can lead to irritation.
4. Foot and Ankle Mobility
Foot and ankle mechanics can also play a role in IT band pain. Limited ankle mobility, particularly restricted dorsiflexion, can change how forces move through the leg during running. When the ankle cannot move forward adequately over the foot, runners often compensate by increasing motion at the knee or hip.
Excessive pronation can also contribute. When the foot collapses inward excessively, the tibia and femur tend to rotate internally, which can increase tension along the IT band as it stabilizes the lateral knee.
Downhill Running and Terrain
Many runners notice IT band pain during downhill running or going down the stairs.
Downhill running increases knee flexion angles and loading at the lateral knee, which can increase stress where the IT band crosses the knee joint. Running downhill or going down the stairs also requires more eccentric control of the knee and if you aren't strong enough or fatigue too much during a run you won't be able to control what your knee is doing.
Additionally, sudden changes in terrain, hills, or speed work can contribute to symptoms if the body is not prepared for those demands. Remember anytime you add something new start small and gradually increase.
What Runners Can Do About It
IT band is a common injury that can be treated with the combination of :
Adjusting training load
Improving hip strength and control
Foot and ankle mobility
Dynamic control exercises
Gradually rebuilding mileage
Proper fueling, sleep and nutrition
Reducing mileage temporarily and avoiding aggravating runs, especially downhill running can help calm symptoms while strength and mechanics improve.
IT band pain usually isn’t caused by the IT band alone. More often it’s the result of training spikes, inconsistent training, and hip mechanics combining to overload the lateral knee. Addressing those factors early can prevent a small irritation from becoming a bigger problem.
If the pain continues or starts affecting your ability to run or walk normally, working with a physical therapist who understands running mechanics and running injuries can help you get back to running safely. The RUNsource app has a program to help you recover from IT Band syndrome. check it out!
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