Blogs from December, 2022

woman runner with sports running knee injury

IT Band Syndrome Part 2: Causes and Risk factors

IT band syndrome is a common overuse injury in runners and cyclists. The cause of IT band syndrome is controversial, but our therapists in New York can help explain.

  • One thought is that it is caused by excessive friction of the lower part of the IT band at the knee joint as the knee repetitively bends (flexes) and straightens (extends) during running and cycling.
  • Another theory is that it is caused by impingement of the IT band against the lateral part of the knee at approximately 20 – 30 degrees of bending. In other words, the IT band is pressed tight against the bony protuberance on the outside of the knee at this angle of knee bend.

Risk factors associated with IT band syndrome:

These are risk factors that you are born with and are not modifiable:

  1. Leg length difference with the longer leg being more at risk for IT band syndrome
  2. Some people are born with more prominent bone at the lateral (outside) part of the knee – this bone protrudes more and may be more at risk of friction or impingement of the IT band

These are other risk factors that are modifiable over which you have some control:

  1. Flexibility of muscles around the hip and knee
  2. Strength of muscles around the hip and knee
  3. Biomechanics of running form – some studies have shown more hip adduction (leg closer to the midline) and knee internal rotation (lower leg turning in) in patients with IT band syndrome
  4. Training intensity – rapid increases in mileage or intensity (either increased speed or increased hills)
  5. Fatigue – one study showed changes in biomechanics that put more strain on the IT band at the end of a long run
  6. Running on a slanted surface or downhill
  7. For cyclists, improper height of bicycle seat

IT Band Syndrome Part 3 will address these biomechanical faults in more detail.

Call our therapists in our New York Clinics to schedule a consultation!

  1. Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord. 2015;16:356. Published 2015 Nov 16. doi:10.1186/s12891-015-0808-7
  2. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R. 2011 Jun;3(6):550-61. doi: 10.1016/j.pmrj.2011.01.002. PMID: 21665168.
  3. Ferber R, Noehren B, Hamill J, Davis IS. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010 Feb;40(2):52-8. doi: 10.2519/jospt.2010.3028. PMID: 20118523.
  4. Physical Therapy Guide to IT Band Syndrome , Choose PT website available at: