6 ITB Syndrome Exercises to Fix Knee Pain for Good

Address the Root Causes for Lasting Relief

By Coach E

Today, we’re going to talk about iliotibial band syndrome (ITB syndrome). More importantly, we will get to the root cause to make sure that you address the factors that give you lasting results. 

We will start with what ITB syndrome is, how the iliotibial band works, and then move to 6 easy exercises to fix it for good. 

What is IT Band Syndrome?

It’s pain in the lateral aspect (outside) of the knee, usually toward the top of the joint. It’s common in runners and cyclists, especially when ramping up volume and intensity after a break from activity. 

For whatever reason, jumping back into exercises and going hard often results in IT Band Syndrome. It’s one of the most common injuries runners get. But you will notice that some runners are more prone to it than others. 

We will get to why momentarily, but first it helps to have a little bit of background in the anatomy of your outer thigh. [1]

Understanding the Iliotibial Band

First, what is the IT band?

The iliotibial band originates on the pelvis on the ilium. It runs on the outside of the thigh and inserts down into the tibia. 

There are a bunch of muscles under the IT band. You have the tensor fasciae latae, which inserts into the IT band. When it contracts, it pulls the ITB tighter. 

You have the glute medius, which also inserts into the ITB. Then there is the glute maximus. Nearly 80% of the fibers in your glute maximus insert into your IT band. 

Moving down to your outer thigh, there is the vastus lateralis muscle. (That’s the lateral quadriceps head.) It’s not attached to the ITB, but sometimes it can get stuck as you’ll learn in the first exercise. 

If the ITB is particularly tight, there can be adhesion to this underlying muscle, which is the first thing we have to solve. It’s also why we don’t recommend foam rolling because you end up compressing the tissue and nothing gets lengthened or stretched out. The active self-myofascial release in the first exercise separates the ITB from the vastus lateralis, allowing proper glide to occur between those two tissues. 

Now that you have a better understanding of the structures around the iliotibial band, we can look at the root causes of IT band tightness.

tfl muscle and iliotibial band

What Causes IT Band Tightness?

Functionally, the tensor fasciae latae (TFL) combined with the glute max puts the most tension on the IT band. The thing with the TFL is it’s often implicated in IT band syndrome. It has trigger points, and many people feel discomfort right in the front of the hip.  

It’s common for the TFL to jump in and take over for other muscles in your hip: your iliopsoas for hip flexion, glute maximus in hip external rotation, and the glute medius in hip abduction. 

The problem is the TFL is a small muscle. It can help out, but it can’t take over the jobs these other muscles perform. Over time, these compensatory mechanisms (specifically regarding the TFL) can result in increased tension of the IT band – ultimately leading to IT band syndrome and inflammation. 

But why do some runners get ITB syndrome when another runner takes the same time off and doesn’t feel a thing?

runners - it band pain

The risk factors fall into three main categories. 

First, we have structural risk. Structural refers to either knock knees (valgus knees) or bow knees (varus knees). Both of these structural conditions can increase your risk of IT band syndrome. 

Second, look at the bottom of shoes that you’ve worn for a while. If the tread is more worn on the outside of the shoe, that indicates you weight bear through the outside of your foot. That will predispose you to IT band syndrome. 

Third, we have another factor regarding compensatory mechanisms for people who sit much of the day. When we sit, we’re in this hip flexed position. The iliopsoas, aka hip flexor muscle, which is mainly responsible for hip flexion, shuts off. The glute maximus also shuts off. 

Now, the poor tensor fasciae latae muscle tries to compensate for the stronger shut-off muscles. To compound this issue, the TFL adapts to the shortened seated position and shortens up. 

All of these factors lead to increased tension on your iliotibial band, leading to increased wear and tear on your leg structures. Alternatively, it could affect the bursa, which will get painful and inflamed from the IT band slipping over the top of the bone with greater tension. [2]

Exercises for IT Band Syndrome

Now that you know the risk factors, I’m going to take you through six exercises that address the different aspects contributing to those risk factors causing IT band syndrome.

ASMR: ITB / Vastus Lateralis 

The first technique is active self-myofascial release. We’re specifically trying to separate the IT band from the vastus lateralis. Remember that the ITB sits right on top of the vastus lateralis which is the lateral quadriceps head. 

To do this technique, you want to lie on your side, and you’re going to use your thumb and index finger. 

Try to pinch around the ITB. Start with your knee fully extended, knees resting on top of each other, and then from here, bring your heel to your butt. Activate those hamstrings while you put tension down and in, sliding down towards your knee. 

Because you’re activating the hamstrings to bring your heel to your butt, that helps shut off the quad. You’re lengthening the quad at the same time so that combined with the thumb and index finger pressure, you’re helping strip the vastus lateralis from your IT band. 

Work all the way down for one to two minutes on each side. 

itb syndrome exercise - asmr vastus lateralis

  1. Lay down on your side with your hips and knees bent. 
  2. Pinch your iliotibial band with your thumb and index finger. You should be able to feel the IT band with your fingers. 
  3. Slowly push your finger toward your knee while bringing your heel toward your glutes. 
  4. Repeat the pinch and push for 1 to 2 minutes on each side.

Slumpy Psoas Activator

I call the second exercise for IT band syndrome the slumpy psoas activator. It does exactly that. It activates the psoas in the position where it often gets shut off, i.e. sitting. 

You will need something stable to sit on for this one, not the wheelie chair in your office. 

Start off in a slumped position. From here, you’re going to lift one knee up and press down on the lifted knee with your opposite hand. You should feel the activation in the hip flexor area. 

Then, as you’re holding and activating, you straighten from slumpy posture to good posture. Try to extend the lumbar spine and tilt your pelvis anteriorly a little bit. 

Once you’re there, hold this for six to seven seconds and then slowly let it down. Always release holds with control, avoiding letting your limbs drop. 

We don’t want the TFL muscle firing up here. If that’s happening, try externally rotating your hip and let the knee fall out a little bit. Try the exercise again with this extra bit of external rotation.

If that still doesn’t work, try jamming your thumb right into your TFL. Don’t injure yourself, but strong pressure will inhibit the muscle activation because when it does turn on, the pressure will hurt. Your body wants to avoid that pain. 

Perform two sets of this exercise, with or without modifications, with three to five reps on each side and holding for five to ten seconds. 

itb syndrome exercise - slumpy psoas activation

  1. Sit down with your spine in a flexed position.
  2. Place your hand on the opposite knee.
  3. Lift the foot off the ground and drive the knee into the opposite hand.
  4. Maintain psoas activation while extending the spine and anteriorly tilting the pelvis.
  5. Hold for 5 seconds, then let your knee down slowly and under control. 

Seated External Tibial Rotation

The third exercise addresses another compensatory mechanism. As we saw, the IT band inserts into the lateral aspect of the knee. When the knee is flexed, it can help with the movement of tibial external rotation if the muscle in charge of that movement isn’t working right. 

If that’s the case, the TFL via the IT band will try to come in and compensate for that. 

Again, we don’t want our bodies to use these compensatory mechanisms automatically, so this exercise wakes up the lateral hamstring to do this movement for us. 

Sit down again on something stable with your knees at 90 degrees. Lift your heels off the ground. Keeping your knees where they are, rotate the heels inward. This causes external rotation of the tibia. To turn on the hamstring, activate the muscles that pull your heel toward your butt – but don’t actually move your heels. 

Hold for 5 to 10 seconds to get the lateral hamstring activation while shutting off your TFL.

Return to neutral, then externally rotate your heels, fire up your hammies, and hold again for 5 to 10 seconds. 

itb syndrome exercise - seated external tibial rotation

  1. Sit down with your knees bent at 90 degrees.
  2. Lift your heels from the ground.
  3. Internally rotate your heels, hold at end range and activate the muscles for 5 seconds.
  4. Move into external rotation, hold at end range and activate the muscles for 5 seconds.

Monster Band Walk

For the monster band walk, you will need a strength band. It’s one of those long loops which are common and extremely useful in strength exercises. We’ll use it for this and the next exercise. 

Put the band around your mid-foot. It helps you activate external rotation because the band tries to turn your toes inward, and you have to fight that pressure. By fighting that pressure, you get external hip rotation, which will fire up your glute max a little more. 

Next, go into a quarter squat. Standing up straight here defeats the point. Make sure you’re in a quarter squat. 

From there, step out to the side and then in. Slowly and in control, move your foot in one direction, then bring the trailing foot in to maintain that inward pressure of the band. Do four steps in one direction, then four steps in the other direction. 

That’ll help fire up the glute max and the glute medius and hopefully shut off the tensor fasciae latae from overworking in this movement. 

Do two sets anywhere from four to six steps in either direction. 

itb syndrome exercise - monster band walk

  1. Place a resistance band around each foot at mid-foot.
  2. Get into a quarter squat position.
  3. With as little momentum as possible, side-step for 4 to 6 steps in one direction, then the other.

Midline Muscle Activator – Hinge

The fifth exercise is the midline muscle activator with the hinge movement. For this, you’ll need your strength band again. 

Loop it around something stable, like a squat rack. You don’t want a flimsy little chair because it will just fall over or get dragged around. Try a heavy table leg or find a partner to hold it. 

Loop the band just above your knee and fix the other end at roughly the same height. Step away from the anchor so that you have a little bit of tension. You don’t need a ton. 

Now, the first thing that you need is something called metatarsal pressure through the foot. The metatarsals are the bones right underneath each toe. I want you to be able to push through all of these bones. 

I’ve done an in-depth presentation on this, which I suggest you check out. Metatarsal pressure is really important for anybody who’s on their feet a lot, especially people who run or play sports like tennis. 

Metatarsal pressure fires up the intrinsic foot muscles, which are the deep muscles in your foot creating the arch. 

With metatarsal pressure (weight in your frog foot) and a slight knee bend, step your other foot back from your starting position. Don’t let your knee fall out here. 

Do a hip hinge with most of your weight on your front foot. Take it slow. 

This exercise activates the adductors and the internal rotators on your hip. These give you stability, help improve alignment, reduce TFL overactivity, and even out weight-bearing structures from your foot through your hip. 

Perform two sets of three to five repetitions per side. 

itb syndrome exercises - midline muscle activator hinge

  1. Place a resistance band above the knee, and step away from the anchor to create a little tension. 
  2. Push your weight through the front foot with metatarsal pressure. 
  3. Slightly bend the knees.
  4. Hinge at the hips with most of the weight on your front foot, while maintaining a neutral spine. 

Reverse Lunge & Twist

The last exercise is the reverse lunge and twist. There are a couple of reasons why it’s beneficial for IT band syndrome. First, it lengthens the tensor fasciae latae. When you rotate over, it stretches the whole TFL area, which can decrease the force and the tension through the IT band. 

Second, it’s great for firing up the glute max and the glute med. 

On the front foot, you will use metatarsal pressure again as you step back into a lunge. The key is staying nice and tall, maintaining alignment of the thigh over the foot. 

With your palms together, arms extended in front of you, rotate your arms out past your knee if possible bringing your torso into a twist. 

Do two sets of four to six reps per side. 

itb syndrome exercise - reverse & lunge twist

  1. Stand tall, keep feet flat with metatarsal pressure.
  2. Lunge back and rotate towards the front foot.
  3. Keep thigh in line with foot when rotating.
  4. Stay tall throughout. 

Summary

Exercises

Sets

Reps/Hold Time

ASMR: ITB / Vastus Lateralis

1 set

1-2 min

Slumpy Psoas Activator

2 sets

3-5 reps, 5 sec hold

Seated External Tibial Rotation

2 sets

3-5 reps, 5 sec hold

Monster Band Walk

2 sets

4-6 steps per side

Midline Muscle Activator - Hinge

2 sets

3-5 reps

Reverse Lunge & Twist

2 sets

4-6 per side

Now we have six exercises to address different aspects of IT band syndrome. I hope one or all of them feel great, but I really want one of two to be exercises that you might not have come across yet that can ultimately give you lasting relief. 

Now, if you like these exercises and want a little resource that has every exercise, reps, sets, and important form cues put together in a PDF, then click the link below for a free cheat sheet that my team put together. 

It’s a few pages and has everything that you’ve just read. 

I hope this helps, and if you want a walkthrough instruction, check out the video on YouTube. 

Until next time, take care.

About the Author

Eric Wong (aka Coach E) is the founder of Precision Movement and has a degree in Kinesiology from the University of Waterloo. He's been a coach since 2005 and spent his early career training combat athletes including multiple UFC fighters and professional boxers. He now dedicates himself to helping active people eliminate pain and improve mobility. He lives in Toronto (Go Leafs Go!) with his wife and two kids and drinks black coffee at work and IPAs at play. Click here to learn more about Eric.

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