Knee & Hip Pain

IT Band Syndrome: What Causes It and Why Does the Pain Keep Coming Back?

Name: IT Band Syndrome: Causes, Symptoms and Recovery
Creator: Abbas Dhami
Published: 2026-11-10T14:07:24.487Z

IT band syndrome is pain on the outer side of the knee or hip. It is caused by the iliotibial band, a thick strip of connective tissue that runs from the hip to just below the knee. It often flares up during repeated activities such as running. Pain that keeps coming back usually points to an underlying alignment problem in the leg, hip or pelvis. Standard lying-down scans can miss this.

Key points

The IT band runs from the hip to the knee. When it tightens or rubs, it causes pain on the outer leg.
Repeated movement, weak hip muscles and leg alignment problems are the most common causes.
Lying-down scans relax the muscles and can hide the alignment problems behind the pain.
A standing, weight-bearing EOS scan captures the whole leg from hip to ankle under real load.
ScanAlign is a diagnostic imaging clinic. It does not treat IT band syndrome, but its imaging helps guide the right treatment.

You may have been told your IT band is "tight". If stretching, foam rolling and rest have not solved the problem, something else may be going on. Your body is a connected chain. When one part is out of line, other areas make up for it. The IT band is often caught in the middle.

What does IT band syndrome feel like?

IT band syndrome usually causes a sharp or burning pain on the outer side of the knee. It can also show up as a dull ache along the outer thigh or at the hip. The pain usually gets worse with repeated bending and straightening of the knee, for example when running, cycling or walking downhill.

Outer knee pain A sharp or stabbing feeling on the outside of the knee. It often starts after a set distance or time.

Pain on stairs or slopes Going down stairs or running downhill often makes the pain worse, because of how the band moves across the knee.

Outer hip ache Some people feel the tightness or pain higher up, along the outer thigh or near the hip bone.

Snapping or clicking A snapping feeling on the outside of the knee as the band slides over the bone during movement.

Symptoms usually build up slowly. Many people notice the pain comes on at a predictable point during a run. It then eases with rest, only to return the next time they exercise.

What causes IT band syndrome?

IT band syndrome is usually caused by a mix of overuse and biomechanical factors. The band itself does not stretch much. The hip, pelvis and lower leg sit around it. When they are not properly aligned or not strong enough, the IT band takes on extra load and becomes irritated.

IT band syndrome: causes, symptoms and recovery. ScanAlign clinic illustration

Overuse Sudden increases in running distance, intensity or frequency overload the band before the body adapts.

Weak hip muscles When the glutes and hip stabilisers are weak, the knee drifts inward. This tightens the IT band.

Leg alignment A slight knock-knee angle or uneven leg length shifts load to the outer knee, where the band attaches.

Pelvic tilt An uneven pelvis changes how the hip and thigh muscles work. This adds strain to the IT band on one side.

This is why IT band syndrome often keeps coming back. Foam rolling and rest address the symptoms. But if the underlying alignment problem or muscle imbalance is still there, the irritation returns as soon as you become more active.

Why does alignment matter for IT band pain?

Alignment matters because the IT band does not work on its own. It connects the hip to the knee, so it is directly affected by how the pelvis, thigh and lower leg line up under load. Even a small shift at the hip can change the angle at the knee. This increases tension on the band with every step.

Think of your body as a chain. The pelvis sits at the top of the leg. If it tilts or rotates, the thigh bone sits at a different angle, the knee tracks differently and the foot lands differently. The IT band runs along the outside of this chain, so it has to absorb the extra strain.

This is also why pain from IT band syndrome can appear at the knee even when the root cause is higher up, at the hip or pelvis. A scan that only looks at the knee may miss the bigger picture completely.

How does a standing EOS scan help with IT band syndrome?

A standing EOS scan captures the full picture of your alignment from hip to ankle while you are upright and bearing weight. This matters because lying-down scans, such as a standard X-ray or MRI, relax the muscles. They also let gravity take the strain off your joints. This may hide alignment problems that only show up when you stand.

An EOS scan uses about 90% less radiation than a standard X-ray, around ten times less. It produces a full-length image of both legs in a single exposure. Your clinician can then see whether your leg alignment, pelvic position or knee angle could be adding to the IT band problem.

Want to find out if your alignment could be behind your IT band pain? A free video consultation lets you talk through your situation with our team from home, before you decide on a scan or plan a trip to London.

Book a free video consultation

When MRI is the better choice: EOS shows bones, joints and alignment under load. If your clinician suspects soft-tissue damage, a tendon tear or bursitis around the IT band, MRI is usually the better tool for that. The two types of imaging work well together, and each shows different information.

How long does IT band syndrome take to heal?

Recovery varies from person to person and depends on the underlying cause. Mild cases may settle within a few weeks of cutting back on the activity that makes it worse. More stubborn cases, especially those driven by alignment or biomechanical problems, can take several months. They often need a more targeted approach.

Common approaches a physiotherapist or specialist may recommend include:

Strengthening the hip and glute muscles to stabilise the pelvis and knee.
A gradual return to activity rather than rest alone.
Gait analysis or a footwear review to address how your foot strikes the ground.
Addressing any leg alignment problems found on imaging.

ScanAlign does not provide treatment. It provides detailed standing imaging that helps your physiotherapist, surgeon or sports medicine specialist understand what is driving the problem. They can then shape your recovery plan around the cause, not just the symptoms.

Before you start treatment, or change the one you are on, it is worth getting a detailed diagnosis. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.

To learn more about how standing imaging works, see the EOS scan overview.

Frequently asked questions about IT band syndrome

What is IT band syndrome?+

IT band syndrome, also called iliotibial band syndrome, is irritation of the thick connective tissue that runs along the outside of the thigh from the hip to just below the knee. It causes pain on the outer knee or hip, most often during repeated activities such as running or cycling.

What does IT band pain feel like when running?+

Most runners describe a sharp or burning pain on the outside of the knee. It usually appears at a predictable point during a run. It often gets worse if you push through it, and eases once you stop.

Can IT band syndrome affect the hip as well as the knee?+

Yes. The IT band attaches at the hip, so tightness or irritation can cause pain along the outer thigh and around the hip bone, not just at the knee.

Why does my IT band syndrome keep coming back?+

IT band pain that keeps returning often points to an underlying alignment or biomechanical problem that has not been addressed. Weak hip muscles, a pelvic tilt or a leg alignment problem can keep overloading the band even after rest.

Does foam rolling fix IT band syndrome?+

Foam rolling may give temporary relief, but it does not address the root cause. The IT band is very stiff connective tissue and does not stretch much. Strengthening the muscles around the hip and addressing any alignment problems is generally more effective in the long term.

How is an EOS scan different from a normal X-ray for IT band problems?+

An EOS scan is taken while you stand. It captures the full length of both legs in one image under real weight-bearing conditions. A standard X-ray usually shows a smaller area and may be taken lying down, which relaxes the muscles and can hide alignment problems. EOS also uses about 90% less radiation than a standard X-ray, around ten times less.

Do I need a referral from my doctor to book a scan at ScanAlign?+

No. ScanAlign is a private, self-pay clinic. You can refer yourself. The process starts with a free video consultation so we can make sure the scan is right for your situation.

Is an EOS scan safe?+

Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. You can find more details about safety on the FAQs and safety page.

How much does an EOS scan cost?+

The price for patients travelling from abroad is confirmed during the free video consultation. You can find more on the FAQs page. ScanAlign is a private, self-pay service with no hidden fees.

Can ScanAlign treat my IT band syndrome?+

No. ScanAlign is a diagnostic imaging clinic. It provides detailed standing imaging and a specialist report. This information helps your physiotherapist, surgeon or sports medicine doctor plan the right treatment for you.

Find out what is driving your IT band pain

A free video consultation lets you talk through your symptoms from home. You can find out whether a standing alignment scan in London could help identify the cause.