IT Band Pain in Athletes: Causes, Movement Faults, and Exercises That Help

Key Takeaways:

• The IT band is a thick band of connective tissue that helps stabilize the hip and knee, assists with side-to-side control during running, cutting, and jumping, and works with the glute max and TFL.

• The IT band cannot be stretched. Pain develops with excessive tension or compression due to muscle imbalances, faulty movement patterns, and restricted flexibility.

• The cure for IT band pain lies in balancing muscle strength, restoring flexibility, and correcting movement patterns.

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IT band pain, or iliotibial band syndrome (ITBS), is a common source of outer knee and hip pain in athletes, especially runners, soccer players, basketball players, and dancers. While it’s often thought of as an “adult runner” injury, IT band dysfunction can show up early when growing bodies are exposed to repetitive training without adequate strength, flexibility, and movement control.

As a pediatric physical therapist, I see IT band pain most often as a movement and muscle imbalance problem, not a problem with the IT band itself. Understanding what the IT band does—and why it becomes irritated—is key to treating it and preventing it from coming back.

What Is the IT Band?

The iliotibial (IT) band is a thick band of connective tissue that runs along the outside of the thigh, from the hip (iliac crest) down to the outer knee (tibia).

The IT band:

• Helps stabilize the hip and knee

• Assists with side-to-side control during running, cutting, and jumping

• Works with nearby muscles, especially the gluteus maximus and tensor fasciae latae (TFL)

⚠️ Important to know:

The IT band itself does not stretch well. Pain develops when it is placed under excessive tension or compression due to poor movement patterns and muscle imbalances.

Why Youth Athletes Develop IT Band Pain

IT band dysfunction rarely happens because the IT band is “too tight” on its own. In athletes, pain usually develops due to a combination of:

1. Muscle Strength Imbalances

Common weaknesses include:

• Gluteus medius (hip stabilizer)

• Gluteus maximus

• Deep core muscles

When these muscles are weak, the IT band takes on extra load to stabilize the leg—leading to irritation at the knee or hip.

2. Muscle Flexibility Restrictions

Tightness often contributes to IT band pain, especially in:

• Hip flexors

• TFL

• Quadriceps

• Hamstrings

During growth spurts, bones lengthen faster than muscles adapt, increasing tension through the IT band.

3. Rapid Training Changes

Youth athletes are particularly vulnerable when there is:

• A sudden increase in mileage or practice intensity

• A new sport season without gradual conditioning

• There is no focus on stretching and strengthening outside of sport-specific training

Movement Patterns Linked to IT Band Dysfunction

From a pediatric PT standpoint, how an athlete moves is often the biggest contributor to IT band pain.

Common movement impairments include:

• Knee Valgus (Knee Caving In)

Seen during:

• Running

• Squatting

• Jumping and landing

This increases stress along the outside of the knee.

While running, the hips should be level and the leg on the ground should be straight with the knee in line with the hip and in line with the 2nd toe. The push off should be through the toes pointing straight.

While squatting, the knees should be straight with the knees in line with the hips and the 2nd toe. The hips should sit back so that the knee doesn't pass the shoelaces.

• Hip Drop During Single-Leg Activities

Often visible when:

• Running

• Standing on one leg

• Going down stairs

A dropped hip increases tension through the IT band.

When putting weight on a single leg, be certain the hips are level and the knee is straight in line with hips and 2nd toe.

• Poor Trunk Control

Excessive side-to-side trunk movement shifts load to the outside of the leg.

• Over-Striding or Poor Running Mechanics

Can increase repetitive friction and compression at the IT band near the knee.

Stretches for IT Band–Related Pain

While the IT band itself doesn’t stretch easily, addressing surrounding muscles can reduce tension and improve mechanics.

1. Standing Hip Flexor Stretch

• Targets tight hip flexors that pull on the pelvis

• Focus on keeping the core engaged and pelvis tucked

2. TFL Stretch

• Cross the affected leg behind the other

• Lean away from the painful side until stretch is felt in the outer hip

3. Quadriceps Stretch

• Especially important during growth spurts

• Avoid arching the low back

Tip for youth athletes:

Stretches should feel gentle, not painful, and be held for 30-60 seconds.

Strengthening Exercises to Correct IT Band Dysfunction

Strengthening is the most important part of long-term recovery and prevention.

1. Side-Lying Leg Lifts

• Focus on slow, controlled movement

• Keep hips stacked and toes facing forward

2. Clamshells and "Crab" Walks (With Proper Form)

• Engage glutes, not the low back

• Progress with resistance bands as tolerated

With resistance band at the lower legs, step sideways. The knees are straight (knee in line with 2nd toe) and focus is using gluteal muscles (hips sitting back and knees not passing the shoelaces).

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3. Single-Leg Balance

• Progress to reaching, hopping, or catching a ball

• Improves hip and trunk control

4. Lunges With Good Alignment

• Knees track over toes (in line with 2nd toe and doesn't go past shoelaces)

• Emphasize glute engagement

Lunges should be done with hips level and knee straight (in line hip with 2nd toe). Sit back into the lunge (don't let knee go forward past shoelaces).

5. Step-Downs

• Control the knee as the heel taps the ground

• Excellent for correcting knee valgus

Why Foam Rolling Alone Isn’t Enough

Foam rolling can:

• Reduce short-term discomfort

• Improve tolerance to movement

But foam rolling does not fix the underlying cause of IT band pain. Without improving hip strength, flexibility, and movement patterns, symptoms often return once sport activity increases.

When Should a Youth Athlete See a Pediatric Physical Therapist?

Consider evaluation if:

• Pain lasts more than 1–2 weeks

• Pain returns each season

• There is limping or reduced performance

• Pain interferes with running, jumping, or cutting

A pediatric PT assesses:

• Strength and flexibility

• Running and jumping mechanics

• Growth-related factors unique to youth athletes

Key Takeaways for Parents and Coaches

• IT band pain is not just a tight band problem

• Weak hips and poor movement control are common causes

• Growth spurts increase injury risk

• Strength and movement retraining are essential for recovery

• Early intervention helps prevent chronic pain and missed seasons

Helping Youth Athletes Move Stronger and Pain-Free

With proper strength, flexibility, and movement education, most youth athletes recover fully from IT band pain and return to sport stronger than before. Addressing the root cause—not just the symptoms—helps protect growing bodies and supports long-term athletic development.