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What is Causing Your Knee Pain? Iliotibial Band Syndrome? How to Tell

Bob and Brad explain if your pain is likely caused by iliotibial band syndrome.

What is Causing Your Knee Pain? Iliotibial Band Syndrome? How to Tell
Published On 

Aug 1, 2025

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Pain on the outside of your knee is often Iliotibial band syndrome. Iliotibial band syndrome (ITBS) is one of the most common knee injuries. It is caused by friction between the iliotibial band (band on side of hip) and the lateral epicondyle of the femur (bony bump on the outside of the knee). The pain is most intense when the knee is at 30 degrees of flexion.

The syndrome often appears with endurance sports such as cycling and long-distance running. Weight training with heavy weights may also bring on the pain.


Signs and Symptoms:


Pain or a stinging sensation may be felt over the bump on the outside of the knee. This is where the IT band slides over the bone.

(IT Band)
(IT Band)

The pain may also travel up the side of the knee and slightly below. You may also feel swelling or a thickening of the tissue over the bone. The pain is most intense when the knee is bent to 30 degrees. The pain may not be felt immediately with the activity but may intensify with time.


Causes:


The pain may be the result of muscle imbalances or training habits.


Your hip abductor muscles may be weak. You also may be internally rotating the hip (weak hip external rotators), which is causing your knee to bend in. Flat feet (pronating) would do the same.


Training Habits that can contribute to ITBS include:


• Sitting in the lotus position for prolonged periods.

(Lotus Position)
(Lotus Position)

• Running on a surface which is banked or has a camber (like the side of a typical road).


• Excessive running uphill or downhill.


• Incorrect fit of a bike.


• Excessive heel strike force when running.


• Running up and down stairs


• Hiking long distances- common in the army.


• Using a rowing machine.


Two Simple Tests:


1. Sit on the edge of a mat, bed, or chair with your knee bent to 90 degrees. Place your finger over the lateral epicondyle (bump on the side of the knee). Straighten the knee while continuing to press on the bump. Increased pain or a recurrence of the pain on the outside of the knee as it bends (at 30 degrees) is indicative of ITBS


2. In a standing position, place all your weight on the painful knee. With all the weight on the leg, bend the knee to approximately. 45 degrees. Increased pain or a recurrence of the pain on the outside of the knee as it bends (at 30 degrees) is indicative of ITBS.

Check out the full Knee Pain Relief Program series of videos, along with downloadable guide sheets, here: https://www.bobandbrad.com/health-programs/knee-pain-relief-program



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Pain on the outside of your knee is often Iliotibial band syndrome. Iliotibial band syndrome (ITBS) is one of the most common knee injuries. It is caused by friction between the iliotibial band (band on side of hip) and the lateral epicondyle of the femur (bony bump on the outside of the knee). The pain is most intense when the knee is at 30 degrees of flexion.

The syndrome often appears with endurance sports such as cycling and long-distance running. Weight training with heavy weights may also bring on the pain.


Signs and Symptoms:


Pain or a stinging sensation may be felt over the bump on the outside of the knee. This is where the IT band slides over the bone.

(IT Band)
(IT Band)

The pain may also travel up the side of the knee and slightly below. You may also feel swelling or a thickening of the tissue over the bone. The pain is most intense when the knee is bent to 30 degrees. The pain may not be felt immediately with the activity but may intensify with time.


Causes:


The pain may be the result of muscle imbalances or training habits.


Your hip abductor muscles may be weak. You also may be internally rotating the hip (weak hip external rotators), which is causing your knee to bend in. Flat feet (pronating) would do the same.


Training Habits that can contribute to ITBS include:


• Sitting in the lotus position for prolonged periods.

(Lotus Position)
(Lotus Position)

• Running on a surface which is banked or has a camber (like the side of a typical road).


• Excessive running uphill or downhill.


• Incorrect fit of a bike.


• Excessive heel strike force when running.


• Running up and down stairs


• Hiking long distances- common in the army.


• Using a rowing machine.


Two Simple Tests:


1. Sit on the edge of a mat, bed, or chair with your knee bent to 90 degrees. Place your finger over the lateral epicondyle (bump on the side of the knee). Straighten the knee while continuing to press on the bump. Increased pain or a recurrence of the pain on the outside of the knee as it bends (at 30 degrees) is indicative of ITBS


2. In a standing position, place all your weight on the painful knee. With all the weight on the leg, bend the knee to approximately. 45 degrees. Increased pain or a recurrence of the pain on the outside of the knee as it bends (at 30 degrees) is indicative of ITBS.

Check out the full Knee Pain Relief Program series of videos, along with downloadable guide sheets, here: https://www.bobandbrad.com/health-programs/knee-pain-relief-program



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