Runner’s Guide to IT Band Pain: What It Feels Like, Why It Happens, and What Triggers It
- Marie Whitt
- Jun 23
- 6 min read
A litany of "ITB-band solutions" you've probably tried that either don't work OR never fully fixed your pain:
A butt-ton of NSAIDS
Foam rolling until you're black and blue
Sitting super uncomfortably on a tennis ball or lacrosse ball trying to "release" your glutes.
Clam shells
Stretching
Even a stint in physical therapy, but all they did was massage you (*facepalm*)
If some of these worked for you: fantastic!
But since you're here, I'm guessing they didn't.
Let me give you the no-fluff, clear cut version.
This blog post will give you the answers to what it IT band pain, what causes it, what does it feel like (yes, this important because it could be something else), what irritates it and sets it off, and the lies you've been told about why IT Band syndrome happens.
Let's jump in.
What is IT Band pain and What Causes It?
Get ready for a deep dive.
The old school thought of how and why IT Band happened was known as the "friction model".
It was assumed that the IT Band didn't have a firm "plug in" into the distal end of the femur (the part of your long leg bone closest to your knee). As a result, it was thought that the IT Band flapped around and rubbed against the bony prominences, or bumps, of the femur resulting in your crippling lateral (outside) knee pain.
However...now we know better.
We now know that the friction model is NOT anatomically plausible. We've found that, yes, the IT Band is actually tethered to most of the length of your femur.
This is good news. It means your ITB is much more anchored than originally throught and not just flapping around in the wind, rubbing into things.
Which leads us to what causes this injury?
IT Band syndrome is now considered a compression injury.
As your knee is bend, the anterior (or most forward) band if the ITB is tight. That tension then transfers to the posterior band (or further back portion of the band). As this tension naturally travels along the length of this tough, connective tissue, it ripples along until it meets the lateral knee (the outside portion of your knee).
Here's where the magic happens.
That tension results in the distal (or far away) part of the band to become taught, applying pressure. And UNDERNEATH the ITB is highly innervated adipose tissue (adipose tissue is fat, and yes it's supposed to be there). When there is TOO MUCH of the pressure, resulting in too much compression, you begin to feel pain.
Why? Because "high innervated" means that fat tissue is a source of nociception; it has many pain sensors.
The IT Band itself is not highly innervated, meaning it can't tell you when something is wrong. But that adipose tissue that's getting squeezed like a tube of tooth paste can.
What Does IT Band Pain Feel Like? like actually.
IT Band pain is the most common source of lateral knee pain for runners. It's usually described as deep, almost vague ache, which doesn't help with the diagnosis process.
So instead of relying on accurate descriptions of pain, we pay attention to where symptoms or pain is located.
Typically, symptoms are localized to lateral femoral epicondyle region, meaning the higher up on the outside of your knee. Pain also travels along an anatomical land mark called Gerdy’s tubercle which also lives along the outside of your knee. This is the most distal, or far away, attachment of your IT Band.
Looking at the picture above, you can follow the red and black lines. This is often where IT Band pain is experienced in addition to the pain sweeping into the front, or anterior aspect, of the knee towards another bony land mark called your tibial tuberosity.
This last part is important because this is why IT Band issues can incorrectly be diagnosed as patellar or tendon issues.
Another mistake that's often made is we assume because IT Band starts higher up in the hip and into the glute, that pain and symptoms must exist there too.
NOPE.
Often, deep aching, unrelenting pain along the outside and top of the hip that travels into the glute are actually from gluteal tendinopathy, an entirely different, but somewhat related condition.
Because remember: IT Band pain comes from an overly taught band of connective tissue squeezing and compressing aggressively on a patch of highly-sensitive fat tissue that screams "OUCH!" when it's had enough.
Gluteal tendinopathy, which is also a compression injury, is instead caused by the tendon of your glute med (a butt muscle) being asked to do too much, too soon and being squeezed against your femur and your ITBand until that tendon is effectively injured.
Different tissues. In different areas. With different pains.
What Causes IT Band Pain to Flair Up?
So here's the fun part:
Your IT Band is more than a random piece of connective tissue.
We now know it functions similarly to your Achilles Tendon. Yup, you read that correctly.
It's not quite at beast-level as your Achilles, but it still plays a huge roll in energy-storage and release...which is imperative for better running economy. ;)
Let's break this down for comparison.
Your Achilles tendon stores and releases 35% of total work energy.
Your IT band stores 5-14%.
If we think about your IT Band more as a tendon, that has a key role in storing and releasing energy to make you a better, more efficient runner,...
this means the STIFFER your IT Band is, the better.
Because in tendon-land, "stiffness" (not the feeling or sensation of stiffness) is the equivalent to strong.
And tendon injury and pain occurs when we overload the structure with too many speed or demanding workouts like hill repeats too soon. (It's essentially not stiff, or strong enough, to handle what got thrown at it.)
You end up feeling that pain typically 4-6 weeks after you accidently over do it.
And as you're trying to stuggle bus your way through the pain and keep running, you notice you feel the pain most when...
your injured leg is the trailing leg, swept backwards in your stride with your hip in extension and your knee flexed (or bent)
you're running down hill or descending stairs (again, with the injured leg being the back leg)
you're running faster during a speed workout (because the faster you run, more energy your store and release compounded by flowing through more repeated hip extension and more knee flexion)
Lies You've Been Told About IT Band Pain:
This is going to burst some bubbles and some of you may not like it but...
Glute weakness DOES NOT PREDICT the onset or likelihood of ending up with IT Band pain.
In fact...
not stretching
having one leg marginally longer than the other
having flat feet or pronating a lot
or having weak hips
...none of these mean you're more likely to end up with IT band pain.
For the longest time, we had a preconceived notion that weak glutes or hips were a risk factor contributing to runners suffering with repeated IT Band issues. But after several studies, it was found that those runners with ITB pain and those without demonstrated no difference in hip strength!
So it was confirmed: a runner with strong hip abductors or glutes does NOT have a lower risk of ITB.
So what puts a runner at risk then? A lot of the points we talked about above:
poor IT band stiffness (remember: in tendon-land, stiffness = strength)
ramping up mileage too fast, too soon
ramping up intense workouts like hills plus speed workout too much, too soon
overall not fantastic single leg strength that can result in funky movement and running compensations placing more stress or load on the IT Band that it's meant to handle.
It was determined that runners struggling with IT Band issues presented to PT with weak glutes, but as a RESULT of pain, not "you ended up with IT Band issues because of weak glutes". Very "chicken or the egg".
In other words, the painful stimulus coming from the adipose tissue being compressed by the IT Band was inhibiting the proximal hip musculature (the glutes), making them appear weak.
I mention this because strengthening hip abductors, your glutes, is still VERY important during your IT Band rehab.
WRAPPING UP
BUT WHERE ARE THE EXERICSES?
Yes, I know.
I usually have exercises in each blog post.
Don't worry.
They'll be in the next one.
But I wanted you to have this information first.
Because knowledge is power.
And understanding your body helps put you in back in control.
Not to mention, the amount of incorrect information I see on the internet and on reddit threads is astounding.
So if I can provide the tiniest amount of illumination in my little corner of the internet, you better believe I'm doing it.
For You.
Last thing: bodies are complex.
Diagnosis aren't always straight forward.
If nothing else, take away from this blog post an appreciation for all the different ways your body talks to you and begin to take note.
You don't have to obsess and wonder what each little ache or niggle "mean". Just pay attention to patterns. Write them in your training log.
Because this is how you go from a novice runner to an experienced runner.
Dare to Train Differently,
Marie Whitt, PT, DPT // @dr.whitt.fit
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