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Five Ways to Address Your Iliotibial Band Pain

What is Iliotibial band (IT-band) pain?

IT-band pain is the second most common running injury behind patellofemoral pain. It’s much more common in men (~75%), novice runners and individuals that increase mileage/intensity too quickly. It’s the number one injury with trail runners; likely due to the amount of downhill and single-leg track running (both things that load the IT-band).

We used to believe that IT-band pain was a friction injury from the IT-band rubbing back and forth on the outside of the knee and treatment often consisted of stretching, foam rolling, and soft tissue massage. Our understanding has evolved that it is actually a compression injury. As your knee flexes there is increased compression on the lateral aspect of the knee. If you load this area too fast and exceed your tissue’s capacity – you end up with pain. Treatment has evolved as well. We want to avoid compression and enhance the capacity of the IT-band.

What are common symptoms of IT-band pain?

  • Pain on the outside of knee
  • Lateral knee pain descending stairs
  • You’ve recently increased your training volume, intensity, or added in trail running

Five ways you can address your IT-band pain

1. Keep as active as possible! Instead of completely stopping all activity, try to maintain as much load as tolerated. This will help decrease your pain without entirely sacrificing all your tissue’s capacity. Keep pain <3/10 during and after activity. Ideas listed below are in order from least amount of load for your IT-band to most.

  • Stationary cycling
  • Uphill treadmill walking (8-10% incline)
  • Uphill treadmill running (~5% incline)
  • Easy running on a relatively flat surface
A woman in purple leggings and white sneakers is jogging on a matrix treadmill in a well-lit gym with exercise equipment in the background.

2. Hip abduction and extension strength exercises. If your knee is quite irritable, you want to load above (hip) and below (ankle – see number 3.) your knee and avoid exercises that make your IT-band symptoms worse. For example, the hip thrust. Aim for 12-15 reps, 3-4 sets. You can progress to single-leg when double-leg gets too easy.

A woman in fitness attire reclines on a chair in a room, lifting one leg while looking at her phone, engaged in a workout break or exercise setup.

3. Calf strength exercises. Load below your knee by performing a single-leg calf raise. This can be done bodyweight or holding weight. Aim for 15-20 reps, 3-4 sets.

A woman in workout attire performs a step-up exercise on an aerobic stepper while holding dumbbells at her sides in a modern, well-lit gym.

4. Heavy slow resistance strength training. When you are no longer having pain with walking or descending stairs, start to load your IT-band. This will help increase the stiffness and resilience of your IT-band to increase it’s capacity. Rear foot elevated split squat is an excellent way to do this. Aim for 3-4 sets, 8-12 reps, with a 3 second down 3 second up tempo.

A woman performs a lunging exercise indoors while holding a dumbbell close to her chest. she wears workout attire and sneakers, with an exercise step visible nearby.

5. Plyometrics to help bridge the gap between strength training and dynamic activities like running. Lateral hopping like skaters is a good way to load the IT-band. Repeat for 30 seconds, 3 sets.

A woman in exercise attire doing a leg stretch in a modern home office with a desk, chair, and storage drawers. she is focused and in mid-motion, with a laptop and personal items around the room.
A woman in athletic wear stands in an office space, balancing on one leg with her hands on her hips. she wears leggings, a jacket, and sneakers, near a black chair and a wooden side table.


  • IT-band pain is pain that is felt on the outside of your knee that can be provoked with downhill running or just running in general, and going downstairs.
  • It often occurs after a change in training – an increase in volume, increase in intensity, or addition of trail running.
  • When your knee is highly irritable – try to find an activity that allows you to keep moving with pain <3/10 and start to incorporate hip and ankle strengthening.
  • When pain has decreased, start to incorporate heavy slow resistance training and then finally plyometrics.
Our Mission:

Here at Peak Endurance Performance & Physical Therapy we help active adults in the Madison Area get back to the activities they love without pain or limitations. We see people of all ages, ability levels, and individuals trying to get back to a multitude of movements including: getting back into running, women postpartum, CrossFit athletes, climbers, gymnasts, wrestlers, overhead athletes, and your recreational weekend warrior. If you’re looking to get back to the activities that give you meaning, relieve stress, and make you feel like you again, feel free to reach out below and we’ll see if we’re the right fit for you.