What causes IT band syndrome, and why did I get it?

What is actually irritated

The iliotibial band is a thick strip of connective tissue along the outer thigh, firmly anchored to the femur and to the top of the shin. It does not slide much. Instead, as the knee bends and straightens, it compresses a layer of sensitive fat and tissue over the bony bump on the outside of the knee. Repeated compression, particularly around 20 to 30 degrees of bend, irritates that tissue.

Training factors

Most cases follow a change in what the knee is asked to do:

• A rapid increase in weekly distance, often while preparing for a race
• Long downhill runs or many stairs
• Running repeatedly in one direction on a track or the same side of a cambered road
• Long cycling sessions, especially with a saddle set too low or cleats positioned poorly
• New or very worn shoes
• Hiking with long descents

Body factors

Weakness or fatigue of the hip abductors and glutes lets the thigh drift inwards and the knee collapse slightly, increasing load on the outer knee. A narrow running style with feet crossing the midline, differences in leg length and previous injury may also contribute. Tightness of the band is often blamed, but the band itself is not very stretchable and tightness is unlikely to be the whole story.

Putting it together

Usually more than one factor is involved: a training change, a route or bike issue, and hip control that tires late in a session. Identifying these is what makes treatment work. If you are unsure what triggered it, or it is not settling, Dr. Gelber at Aman Hospital in Doha can review your training, examine your hip and knee, and rule out other causes of outer knee pain.