Iliotibial Band Syndrome: Why Your Knee Hurts and How to Fix It
Happy Halloween! Hope it's filled with candy, the ultimate carb snack on the run.
If you’ve been training hard for a hybrid race, running longer distances, or just stacking miles on the road, there’s a good chance you’ve felt a sharp, stabbing pain on the outside of your knee. Annoying, right? That’s classic iliotibial band syndrome (ITBS) — one of the most common overuse injuries in runners and hybrid athletes.
The good news: it’s fixable. All injuries are. But first, let’s break down what’s happening inside your body so you can actually do something about it (and not just slap an ice pack on it and hope for the best).
What Is the Iliotibial Band?
The iliotibial band (ITB) is a thick band of connective tissue that runs down the outside of your thigh. It starts up at your hip, blending with the tensor fascia latae (TFL) and gluteus maximus muscles, and travels all the way down to attach at the outside of your shin bone (the tibia).
Think of it like a stabilizing strap for your leg — it helps control side-to-side movement and provides tension that keeps your knee stable when you run, squat, or carry heavy loads.
Something to keep in mind here is it IS NOT a muscle. Which means you can't stretch it, you can't strengthen it. But that does not mean you can't do anything about it.
How IT Band Syndrome Happens
Here’s the catch: the IT band itself doesn’t “stretch” much. It’s not like a hamstring you can just loosen up. Instead, problems happen when there’s too much tension or friction where the band passes over the outside of your knee (the lateral femoral condyle). This is another misconception, that the IT band "gets tight," and this tightness causes the pain. It's actually due to the friction over the lateral knee.
In runners and hybrid athletes, IT band syndrome usually shows up when:
Training loads spike too quickly. Adding volume or intensity without giving your body time to adapt. Definitely look at this first.
Weak hips. If your glutes aren’t pulling their weight, your TFL overworks, tugging more on the ITB.
Poor mechanics. Excessive hip drop, crossover running stride, or knee collapse inward all add extra tension. This may not be entirely the case, but if it is associated with pain, then it's worth taking a look at running mechanics.
Hybrid-specific stress. Movements like sled pushes, lunges, or squats done in high volume can overload the IT band when combined with running.
The result? Sharp, burning pain on the outside of your knee — usually worse with running downhill, single-leg movements, or after longer efforts.
Why Hybrid Athletes Are at Risk
Hybrid racing (HYROX, DEKA, OCR) puts you in the perfect storm for IT band irritation:
You’re combining repetitive running with high-volume strength work.
Events include lunges, sleds, carries, and step-ups — all loading the hip and knee.
Fatigue sets in, your mechanics break down, and your IT band gets cranked on even harder.
If you don’t get ahead of it, ITBS doesn’t just slow your running — it makes hybrid-specific stations miserable, too.
What to Do to Improve IT Band Syndrome
Spoiler: foam rolling your IT band into oblivion isn’t the solution. The ITB itself is too tough to “roll out” like a tight quad. Instead, you need to address the muscles that control the ITB tension and your movement patterns.
Step 1: Calm Down the Irritation
Relative rest: Cut back on high-mileage or aggravating workouts, but don’t stop moving completely. If it hurts too much to run, try biking or rowing instead for a minute.
Modify training: Swap downhill runs for flat or treadmill work, and cut back on lunges until symptoms settle.
Ice for pain: Short-term, it helps calm irritation, but it won’t fix the root problem.
Step 2: Strengthen the Weak Links
This is where you win the long game. Most ITB issues come from weak glutes, weaker quads and poor hip control. Target these muscles:
Side-lying hip abductions (straight-leg raises)
Strengthens glute medius, reduces hip drop.
3x12–15 reps each side.
Single-leg glute bridges
Builds posterior chain support while controlling hip stability.
3x10–12 reps per leg.
Lateral band walks
Directly targets hip abductors and TFL balance.
2–3 sets of 10–15 steps each way.
Step-downs (from a low box)
Teaches knee control and prevents valgus collapse.
3x8–10 reps each side.
Curtsy step ups or lunges
Loads up the lateral glutes and lateral quads together.
4x6 reps each side
Step 3: Retrain Your Gait
If you keep running with the same mechanics, the problem will come back. A few key gait changes that help with ITBS:
Increase cadence (steps per minute). Aim for 5–10% higher than your natural rhythm. This shortens your stride and reduces hip adduction forces.
Avoid crossover gait. Imagine running on railroad tracks instead of a tightrope. Keep your feet landing under your hips.
Strengthen hip extension. Runners who rely too much on quads/TFL often neglect glutes. More glute drive and calf push off= less ITB strain.
Working with a coach or getting a gait analysis can help pinpoint your specific breakdowns.
Step 4: Long-Term Maintenance
Mobility work: Loosen up quads and hip flexors to reduce downstream ITB tension.
Strength progression: Move from basic rehab to heavy lifts (single-leg squats, lunges, RDLs) once pain is controlled.
Balance training: Single-leg stability carries over to both running and hybrid events.
The Bottom Line
IT band syndrome is frustrating, but it’s not a career-ending injury. For runners and hybrid athletes, it’s your body’s way of telling you something’s off in your training load, your hip strength, or your running mechanics.
The fix isn’t endless foam rolling — it’s smarter training, targeted strength work, and small but powerful gait changes.
If you put in the work, you won’t just get rid of IT band pain — you’ll come back stronger, more stable, and more efficient, which means faster running splits and smoother transitions through your hybrid stations. If you're struggling with IT band pain, then you aren't alone; click here to set up a plan to become pain free.
