IT Band Pain: Why the Outside of Your Knee Hurts

Mile two felt fine. By mile four, the outside of your knee was burning, and the downhill home was the worst part. The next day it feels almost normal, so you try again, and the same thing happens. That on-off pattern is classic IT band pain.

What is IT band pain?

IT band pain comes from irritation of the iliotibial (IT) band, a long band of tough tissue on the outside of your thigh. It runs from your hip to just below your knee and helps keep both joints steady⁴. When the band gets irritated where it crosses the bony outer edge of the knee, doctors call it iliotibial band syndrome, or ITBS¹.

It's common in people who run, bike, or do other aerobic activities⁴. A 2024 review of runners called it the second most common cause of knee pain in runners, after runner's knee². The same review found women are about twice as likely as men to develop it².

IT band pain is one of several causes of outer knee pain. Our knee pain guide covers the others, from ligament sprains to arthritis.

What does IT band pain feel like?

Most people feel an aching or burning pain on the outside of the knee. According to Cleveland Clinic¹, early pain often feels like an ache or burn. It turns sharper as the problem gets worse¹. Some people also notice clicking or snapping on the outside of the knee¹.

The pattern often changes over time if it's not addressed:

IT band trouble can also show up at the hip. Cleveland Clinic notes pain near the bony point of the hip, sometimes with a snapping sound¹. Outer hip pain has other causes too, covered in our hip pain guide.

What causes IT band pain?

It's usually a load problem. The band and the tissue beneath it take more repeated stress than they're ready for.

According to Cleveland Clinic¹, these can add strain:

• Weak hip muscles: especially the muscles on the side of the hip that keep your knee in line
• Foot mechanics: feet that roll inward a lot (overpronation)
• Leg shape: bowed legs, an inward-turned shinbone, or legs of different lengths
• A naturally tight band
• Training habits: too little warm-up or rest, too many miles too soon, and worn-out shoes
• Terrain: running downhill, or on a slanted road or track

Basketball, cycling, hockey, running, skiing, and soccer all raise the risk¹. So does weakness in the hip, buttock, or core muscles¹.

In Milwaukee, the crowned edges of neighborhood streets and long downhill stretches can add up. Cleveland Clinic specifically advises avoiding slanted surfaces and downhill running when the band is sore¹.

Is it IT band pain or runner's knee?

Where it hurts is the quickest clue. IT band pain sits on the outside of the knee and builds during activity. Runner's knee is a dull ache around or behind the kneecap. It's often worse on stairs, when squatting, or after sitting.

You can have both. Cleveland Clinic notes IT band syndrome can sometimes lead to runner's knee¹. If you notice new pain around the kneecap, mention it. Read more about runner's knee.

Other causes of outer knee pain include a sprained outer ligament or a torn meniscus. Those often follow a twist or a specific injury rather than building over miles. A knee that swells quickly, locks, or gives way deserves a prompt exam.

For a wider look at running aches, see common running injuries.

When should outer knee pain be checked right away?

IT band pain builds slowly and isn't an emergency. Some knee symptoms point to an injury that needs a medical provider first.

Also see a provider if knee or hip pain doesn't improve after a few weeks, or gets worse¹.

What helps IT band pain?

Calming the load and strengthening the hip help most people. Here's what the research and major clinics support.

Back off, but keep moving

Rest the leg from whatever sets it off until symptoms settle¹. Cut back on downhill and slanted routes. Cross-train with activities that don't bring on the pain.

Strengthen your hips

Hip strengthening is the most common core of treatment. A 2024 systematic review of 13 studies found it central to care for runners with IT band pain². The muscles on the side of the hip help keep your knee from drifting inward as you land.

Stretching and foam rolling

Cleveland Clinic lists stretching and foam rolling among treatment options¹. The 2024 review found no evidence that stretching changes the band's length². Stretching may still feel good, but strengthening seems to do more of the work². Learn how and when to use foam rolling.

Hands-on care

In the review, hands-on care plus hip strengthening worked better than hands-on care alone². The studies were small, and the authors called for better research². So hands-on care is best treated as a partner to exercise.

Your stride

Small changes to running form showed promise, but the evidence is still very limited². Cleveland Clinic also recommends supportive shoes and building intensity gradually¹.

Medical options

Your medical doctor may discuss a steroid shot if pain persists. Surgery is rare and considered only when other treatments fail¹.

Can a chiropractor help?

A chiropractor can look at your knee, hip, and foot together and guide a strengthening plan. Your doctor listens to your training history, then checks how your hips, knees, and feet move. X-rays are taken only when your exam calls for them.

Care may include hip strengthening, gentle muscle work, and gentle joint movement. Adjustments are an option only if you want them. Since foot mechanics can play a part, your doctor may suggest a free foot scan, with no obligation to buy orthotics. Our care for athletes and active adults focuses on getting you back to your sport.

How long does IT band pain take to heal?

Most people improve within a month or two. According to Cleveland Clinic¹, about 50 to 90% of people with IT band syndrome improve after four to eight weeks. Some improve in as little as two to six weeks¹.

Getting back to full training can take longer. The 2024 review noted that only 44% of runners returned to their sport after six to eight weeks of care². Without treatment, IT band pain can get worse¹.

Plan your return in steps. Start with flat, shorter runs at an easy pace. Add distance before speed or hills.

Find out what's behind your IT band pain

You've rolled it, stretched it, and rested it for a week. Then the burning shows up at the same mile marker anyway. It's frustrating to have a knee that feels fine at home and fails you halfway through a run.

We're here to help you find out. Chiropractic Company has cared for Greater Milwaukee since 1982, with 400,000+ patients, 1,400+ five-star Google reviews, and 20+ neighborhood clinics. Our doctors care for knee pain every week. We look for the cause of your pain, not just the symptoms. Your care is designed around your condition, your medical history, your training, and your goals. You choose your care, and you see the same doctor as it continues.

Care is natural and drug-free. Treatment begins at your second visit, or the same day in acute cases if your doctor decides it's appropriate. Some plans add physical therapy at our Menomonee Falls, Waukesha, and West Allis North clinics, or massage therapy at Hales Corners and Oconomowoc.

We're in-network with most insurance companies and accept Medicare and auto accident claims. Eligible new patients can start with the $29 new-patient special, which includes a consultation, an exam, and X-rays if needed. *See offer terms.

Visit one of our 20+ neighborhood clinics across Greater Milwaukee: Milwaukee East, Milwaukee North, Milwaukee Third Ward, Shorewood, Glendale, Mequon, Cedarburg, Grafton, Germantown, Brookfield, Menomonee Falls, Waukesha, Oconomowoc, New Berlin, West Allis, West Allis North, Greenfield, Hales Corners, Franklin, Muskego, and Cudahy.

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