ITB Syndrome Exercises – Physio Penrith

Iliotibial Band Syndrome (ITBS) is a common issue for runners and active people. It causes pain on the outside of the knee and can really slow you down if not treated properly. Luckily, there are some great exercises you can do to manage and even prevent ITB syndrome.

This blog will walk you through everything you need to know about ITBS, especially the best exercises to treat it. If you’re in pain or trying to stay injury-free, this guide is for you.

What is Iliotibial Band Syndrome (ITBS)?

What is your IT band?

The IT band is a thick band of connective tissue that runs from your hip down the outside of your thigh to the top of your shinbone. It helps stabilise your knee and hip during movement, especially when running.

What is IT band syndrome?

IT band syndrome happens when the IT band gets irritated, usually from overuse. It causes pain on the outer part of the knee and can affect your ability to run, walk, or even go down stairs.

Iliotibial band (ITB) syndrome is a common knee injury in runners and other long distance athletes caused by inflammation of the distal portion of the iliotibial band (ITB), which results in lateral knee pain or pain on the outside of the knee joint. The distal part of the iliotibial band slides over a bony prominence called the lateral femoral epicondyle, and during repetitive knee bending and straightening activities there can be excessive friction and this potential irritation results in pain.

More recent literature is shedding a different light on ITB syndrome – one that describes the iT band as a big tendon (even though it is actually a ligament), thus making it an interesting injury to assess and treat:

• In a 2007 study the authors found that the ITB blended with the connective tissue wrappings of the thigh and the knee joint capsule. It is also quite well-connected with many discrete deep attachment points (“insertions”) on the femur, the tibia, and the patella.

• The IT band is tightly anchored to the full length of the femur, from hip to knee – especially just above the knee.

• The upper reaches of the IT band also penetrate all the way into the hip, from the bottom of the TFL muscle to the lateral surface of the hip joint – this feature of the IT band was first clarified in 2017. The feature has no direct relevance to IT band syndrome, but it’s interesting anatomy that’s really at odds with the conventional picture of the IT band as a superficial strap running down the outside of the thigh.

Most people still think of the IT band as being free to move relative to the femur, but the iliotibial band is not free to move relative to the femur. It is anchored to the femur between the big muscles of the front and back; it clings to it like a barnacle to a rock, this is why it has been suggested that “the ITB cannot actually create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee”.

Symptoms and Causes

What are the symptoms of ITBS?

People with with ITB syndrome will have typical symptoms that include a sharp or burning pain roughly 2 cm above the lateral joint line. The pain may radiate proximally or distally, and in less severe cases, the pain may quickly subside upon cessation of activities. Often pain will occur as activities proceed. It is not uncommon that individuals will experience popping on the lateral aspect of the knee with activities. Potential risk factors for the development of iliotibial band syndrome include preexisting iliotibial band tightness, high weekly mileage, time spent walking or running on a track, interval training, and muscular weakness of knee extensors, flexors, and hip abductors.

The main symptoms to consider are:

• Pain on the outside of the knee (sharp or aching)

• Pain during or after running

• Pain going down stairs or hills

• Tenderness on the outer knee

What causes ITBS?

• Overtraining or sudden increase in mileage

• Weak glutes and hip muscles

• Poor running form (like crossover gait)

• Tight muscles around the hip and thigh

• Improper footwear or poor ankle control

Diagnosis and Tests

ITB syndrome is a clinical diagnosis and is best concluded during a thorough history. Most often additional diagnostic tests and imaging are not necessary. It should be suspected in overuse and non-traumatic cases of knee pain where rest has not been helpful. Short-term resolution of symptoms following corticosteroid injection and be both diagnostic and therapeutic.

At Sydney Muscle & Joint Clinic our physiotherapists listen for typical signs and symptoms that are related to a tendon injury, these may any of the following related to ITB syndrome:

• Localised pain – demonstrated when the individual can point to where it hurts.

• Start up pain – sharp stabbing pain about the outside of the knee when rising from a chair or getting out of bed. The start up pain improves as movement continues.

• Pain on compression – pressing down on the area, foam rolling or lying on ones side can all irritate a painful IT band.

• Weakness of muscles that are part of the ITB – weakness of hip abductors, lateral hamstrings and quadriceps is very apparent.

How Do You Treat IT Band Syndrome?

As the iliotibial band is usually described as a tendon, the research supported interventions for tendon injuries should be applied to anyone suffering from ITB syndrome. These include:

• No rest – rest does not help a painful IT band

• Modifying training load – slightly reducing your running mileage or reducing frequency of other ballistic loading may be necessary in the short-term.

• No stretching – stretching is not helpful and can cause compression of the irritable tendon (IT band).

• No foam rolling – as with stretching, foam rolling can cause compressive, irritable load.

• Add heavy slow resistance exercises – to the muscles of the hip including gluteus medius, minimus and maximus; lateral hamstrings and soleus.

Step 1: Manage the pain and irritability

• Cut back on running, especially hills or long distances

• Apply ice to reduce inflammation

• Avoid painful activities temporarily

• Consider isometric contractions
  
  

Step 2: Strengthen your hips and glutes

Start with simple, non-weight bearing exercises. Gradually move to more dynamic and standing exercises.

Hip Thrusters

• Sit with upper back on a bench, feet flat

• Lift hips until your body forms a straight line

• 3 sets of 15 reps (progress to weighted sets)
  
  

Hip Hikes

• Stand with one leg on a step

• Let the free leg drop slightly and use hip to lift it back up

• 3 sets of 15 reps (add a small weight for more challenge)
  
  

Banded Glute Pulley

• Stand with a resistance band around both ankles

• Balance on one leg, pull the other leg diagonally back

• 3 sets of 15 reps
  
  

Step 3: Movement Control Exercises

These exercises help improve form and prevent the knee from drifting inward.

Banded Split Squats

• Add a resistance band just below the front knee

• Perform controlled squats while resisting inward knee pull

• 3 sets of 15 reps
  
  

High Knee into Reverse Lunge

• Add a high knee drive to the banded split squat

• Improves balance and control

• 3 sets of 10-15 reps
  
  

Step 4: Dynamic Exercises

Once the pain is under control, add these tougher moves:

Step-Ups

• Use a 30cm box

• Step up and drive opposite knee high

• 3 sets of 10-15 reps
  
  

Walking Lunges

• Big steps forward, focus on straight alignment

• 2-3 sets of 10-15m walks
  
  

Should You Foam Roll the IT Band?

Foam rolling directly on the IT band is not very effective and can be painful. Instead, roll and stretch the glutes and TFL (tensor fasciae latae) muscles, which connect into the IT band. Check out blog on foam rolling: https://www.physiopenrith.com.au/foam-rolling-myths-physio-penrith/

How Long Does Recovery Take?

• Mild: 2-4 weeks

• Average: 7-8 weeks

• Severe: 9-24 weeks
  
  

ITBS often takes at least 3 months to fully recover. Stick with your rehab plan and be patient. If progress stalls, consult a physio.

Prevention Tips

• Strengthen hips and glutes regularly

• Avoid sudden changes in mileage or intensity

• Improve running form (avoid crossover gait)

• Use proper shoes with good support

• Include mobility and control drills in your routine
  
  

FAQs about ITB Syndrome Exercises

What are the best exercises for ITB syndrome?

Single leg hip thrusters, hip hikes, banded split squats, and walking lunges are among the most effective. These target glutes and hip control.

Can I run with IT band syndrome?

Yes, if the pain is mild and doesn’t worsen after running. Cut back on intensity and hills.

Does stretching help ITBS?

Stretching the IT band doesn’t do much, but stretching the glutes and TFL may help.

How often should I do ITB syndrome exercises?

2–3 times per week is ideal for strength and rehab exercises.

Can foam rolling cure ITBS?

Foam rolling won’t cure it but may provide short-term relief. Focus on strengthening instead.

FAQs about Sydney Muscle & Joint Clinic

Does Sydney Muscle & Joint Clinic treat ITB syndrome?

Yes. Our team offers tailored treatment plans for ITBS, including manual therapy, rehab exercises, and running assessments.

Do I need a referral to see a physio at your clinic?

No referral is needed. You can book directly online or by calling.

Where is the clinic located?

We’re located in Penrith, Sydney and offer both in-person and telehealth appointments. Check our website for details.

Need help with ITB pain?
Book an appointment with the team at Sydney Muscle & Joint Clinic for expert assessment and a personalised rehab plan. Your knees will thank you!