Are you a runner dealing with IT band pain and wondering “Why do runners get IT band pain?” Maybe you’re not even sure what the IT band is or what it does. Well you’re in the right place. In this post, I’m going to teach:

  • The anatomy of the IT band
  • What the IT band does
  • Why you get IT band pain
  • Why IT band pain is so common in runners

This is part of series of blogs dedicated to running injuries. If you’re looking for more content on common running injuries make sure you check out our other blogs and videos.


The Anatomy Behind IT Band Pain

If you have IT band pain, you may be frustrated and wondering what causes it. IT band pain is caused by a condition called iliotibial band syndrome or iliotibial band friction syndrome. This condition is an overuse injury and caused by issues with the IT band tendon where it attaches on the outside of your knee.

IT band syndrome is most common in runners and cyclists because of repetitive knee flexion and hip flexion with these activities. In order to understand an IT band injury, you first have to know the anatomy of the IT band.

There are two distinct areas of the IT band:

The upper portion, in the front and side of your hip, is like a tendon.

Here, it conjoins with some of the muscle fibers from your gluteus medius, a muscle also on the side and back of your pelvis above your hip joint. It attaches to your pelvis and encases the tensor fascia lata muscle and then runs down towards your knee on the side of your thigh. This tendon has a fascia component that actually attaches to your femur. This may be why patients report deep thigh pain when it’s “acting up.”

The lower portion can be found on the outside of your knee and is more like a ligament.

It fans out and creates a broad attachment at the outer part of the end of your femur. It also attaches to the outside and front of your lower leg, the tibia. Underneath this area, there’s a fat deposit that cushions the attachment site. This fat is to “pad” the IT band so it’s not rubbing on the underlying bone. Interestingly, there isn’t a bursa, or cushioning sac of fluid. If you’ve ever had someone tell you your IT band pain in this location is bursitis, I hate to tell you this but they’re wrong.

hip pain during running

What Does the IT Band Do?

The IT band has a really important job, especially in runners, because it takes the force and load of the tensor fascia lata and gluteus maximus muscles. Tension on the IT band is the highest when in a single leg stance, a position that runners are in when their other foot is off the ground during a stride.

If anyone has ever referred to your IT band as a muscle, I hate to tell you this again, but they’re wrong. The IT band is really just a dense piece of connective tissue. This connective tissue forms the tendon and ligament components. It is NOT a muscle.

A secondary job of the IT band is to support the structure of the femur. By doing this it helps keep this long bone from bowing inward when under significant load. For some reason, the IT band is really misunderstood! This is true not only of the general public but of the chiropractic, physical therapy, athletic training, fitness, and medical community as well.

What Causes Pain in the IT Band?

The cause of pain in the IT band is, believe it or not, not because your IT band is tight. Unfortunately, this is a really common thing to hear. I’m busting all sorts of myths in this post, right? I can’t count the number of patients who have mistakingly told me their IT band is tight. From the research we have, IT band pain on the outside of your knee may be the result of two different processes:

  1. The IT band is compressing the fat pad between itself and the outside of the femur. The fat pad underneath the IT band is dense with sensory nerve receptors and therefore this compression can create significant pain (which you’re perceiving in your brain.)
  2. Where the IT band attaches on the outside of your distal femur (outside knee) is undergoing “enthesopathy” changes. Essentially the fibers of the IT band are irritated and undergoing small microscopic damage, which is causing pain. This process is similar to what occurs in achilles tendinopathy.

I’m trying not to overwhelm you with these explanations, but I do want you to be aware of what we know to be the cause of IT band pain. If there’s one thing you take away from this, know that IT band pain is not because of IT band tightness or bursitis.

Why is IT Band Pain Common in Runners?

There’s one big reason why IT band pain is common in runners. Runners repetitively flex (bend) and extend (straighten) their knee while they’re in a single leg stance (one leg is touching the ground.) Obviously, other sports require running, but movements are more complex and not as repetitive as they are in runners. For example, in football players are running but also moving side to side, jumping, and making other athletic moves.

This position is so common in runners is so common that:

  • IT band pain will affect 12% of runners at some point.
  • IT band pain is responsible for a quarter of all leg injuries in runners.

There are factors that may make you more likely to experience IT band pain. Some of these risk factors include:

  • Your tensor fascia lata muscle (basically the muscle associated with the IT band) is tight
  • High mileage running
  • You run on a circular track
  • Your hamstrings, quadriceps, and gluteal muscles have a relative weakness
  • High foot arches

If you’re a runner suffering from IT band pain, don’t hesitate to reach out to our office. Schedule a free consultation or a treatment and get back to hitting your running time and distance goals.


Dr. Jason Williams DC is a chiropractic physician practicing at AccessHealth Chiropractic in Cary, NC. He treats neuromusculoskeletal pain and injuries using chiropractic manipulation, dry needling, acupuncture, rehab exercise strategies, and other supportive therapies. Primary areas of focus include back pain, neck pain, muscular pain, extremity pain, and orthopedic injuries. Dr. Williams is experienced in treating athletes, especially those in the running, CrossFit, Brazilian Jiu-Jitsu, Muay Thai, and MMA community.