IT Band Syndrome: What It Is, Why Runners Get It, and How Sports Massage Helps

If you've ever felt a sharp, burning pain on the outside of your knee during a run — typically arriving between 2 and 5 kilometres in and forcing you to stop — you've likely encountered iliotibial band syndrome (ITBS). It's one of the most common overuse injuries in running, affecting an estimated 10–12% of recreational runners, and it has a reputation for being stubbornly persistent when mismanaged.

At Athletic Health Sports Massage in Pretoria, ITBS is a condition we treat regularly. Here's what you need to understand about why it happens and how soft tissue therapy fits into effective management.

What Is the IT Band and Why Does It Get Irritated?

The iliotibial band is a thick band of connective tissue that runs along the outside of the thigh from the hip (ilium) to the shin (tibia). It functions as a stabiliser during running and walking, helping to control the inward movement of the knee. When the IT band repeatedly passes over the lateral femoral condyle (a bony prominence on the outside of the knee) during repetitive flexion-extension cycles, the underlying bursa or fat pad can become irritated and inflamed.

Contrary to popular belief, the IT band itself doesn't "stretch" (it's largely inextensible connective tissue) and "loosening" it directly with foam rolling the band isn't really the mechanism of relief. The more accurate picture involves tension in the muscles that feed into the IT band — particularly the tensor fasciae latae (TFL) and gluteus maximus — as well as hip abductor weakness that causes excessive hip drop and knee valgus during ground contact.

Common Contributing Factors in Runners

ITBS rarely has a single cause. The most common contributing factors include rapid training load increases (too much too soon), inadequate hip abductor and glute strength, tight TFL and hip flexor complex, running on cambered or consistently one-sided road surfaces, downhill running exposure, and biomechanical factors like excessive crossover gait pattern or significant leg length discrepancy.

How Sports Massage Helps With ITBS

Sports massage addresses several of the key mechanical contributors to ITBS. Targeted soft tissue work on the TFL and gluteus maximus reduces the tension feeding directly into the IT band. Trigger point therapy in the hip complex — particularly the TFL, piriformis, and glute medius — releases the active trigger points that alter force transmission through the lateral chain. Myofascial work along the lateral line addresses the broader fascial tension pattern, and hip mobility restoration reduces the mechanical compression at the lateral knee during the running gait cycle.

Sports massage should be used alongside — not instead of — appropriate loading and strengthening work. If hip abductor weakness is a contributor, no amount of massage alone will resolve the issue permanently. But soft tissue work significantly reduces the pain and tension that makes returning to training difficult, and removes the mechanical tension that perpetuates the irritation cycle.

What to Do If You Suspect ITBS

If you're experiencing lateral knee pain during running that resolves with rest but returns predictably on the same stretch of run, ITBS is the most likely culprit. Reduce running load temporarily to allow acute irritation to settle. Book a sports massage to address the hip and lateral chain tension. Begin hip abductor strengthening exercises (clamshells, lateral band walks, single-leg work). And have your running gait assessed for crossover pattern or excessive hip drop.

At AHSM in Pretoria, we work with runners dealing with ITBS at all stages — from early-stage irritation through to chronic, recurring presentation. A 60-minute or 90-minute session will address the hip and lateral chain tissue comprehensively. Book online or contact us to get assessed.