IT band friction syndrome (ITBFS) is one of the most common causes of pain on the outside of the knee, particularly in runners. We usually manage it with physiotherapy and anti-inflammatory treatment, including a cortisone injection. But in chronic cases that resist these, some doctors use Botulinum toxin (Botox) injections, mainly where hip-muscle tightness is the problem. So how does Botox work for knee pain and IT band friction syndrome, and what should you know?

This page covers the Botox procedure. For the cortisone injection and the condition itself, see IT band injection; for the hip muscle involved, see tensor fasciae latae pain.

What is IT band friction syndrome?

Iliotibial band friction syndrome occurs when the IT band rubs against the bony prominence on the outside of the knee (the lateral femoral condyle) during knee bending and straightening. This friction causes inflammation and pain. Common symptoms include sharp pain on the outside of the knee — typically starting after 5–10 minutes of running and worsening as you continue — and tenderness over the outer knee.

How do we normally treat IT band friction syndrome?

We usually start by modifying an activity such as running or cycling. Anti-inflammatory measures reduce swelling. It’s then critical to reduce friction between the IT band and the knee by strengthening the hip muscles and easing tightness in the IT band and hamstrings. Sometimes we use an ultrasound-guided cortisone injection deep to the IT band at the knee to help rehab — but not every case settles with this.

How can Botox help with knee pain?

Botulinum toxin (Botox) is a neurotoxin that temporarily prevents a muscle from contracting by blocking the nerve signal to the muscle. It’s best known for cosmetic use, but it also relaxes muscles in musculoskeletal conditions.

In IT band friction syndrome, Botox works by relaxing the IT band and reducing friction at the knee — but we don’t inject the IT band directly. Instead, we inject the tensor fascia lata (TFL) muscle on the outside of the hip. Relaxing the TFL forces the glute muscles to work harder, which reduces the IT band’s pressure on the knee.

The Botox procedure for knee pain, step by step

  • Your sports doctor assesses you to confirm the diagnosis and exclude other causes of outer knee pain. The ideal candidate has a tight IT band and weak glutes.
  • The TFL muscle is located on the ultrasound.
  • The skin over the hip is cleaned with an antiseptic.
  • Local anaesthetic is applied to keep the procedure comfortable.
  • 75 units of Dysport (a type of Botox) are injected into the middle of the TFL muscle under ultrasound guidance.

What happens after the Botox injection?

Avoid activity for 48 hours, though gentle walking and stretching are fine. Physiotherapy restarts about 3–4 days later to build on the Botox effect. The effect typically begins within a week, peaks at around four weeks, and lasts three to six months. Working with your physiotherapist afterwards is essential — focus on glute strength in both lying and standing positions, for at least six weeks.

Evidence for Botox in knee pain and IT band friction syndrome

A key 2018 paper found 80% of patients injected with Botox reported improved pain and function, and about 67% returned to running, with minimal side effects and no long-term complications. A follow-up paper in 2021 found Botox reduced runners’ pain by up to 70% and allowed an earlier return to running than traditional methods.

Botox offers longer-lasting relief than a steroid injection, without the risk of soft-tissue damage. But it works best as a complement to physiotherapy, not a stand-alone fix.

Who should consider Botox for knee pain?

The best candidates have:

  • IT band pain that hasn’t responded to physiotherapy, NSAIDs, or a steroid injection
  • Significant IT band tightness from an overactive TFL muscle
  • A willingness to combine the injection with a rehabilitation programme

Potential side effects of Botox injections

Botox is generally safe, but possible side effects include temporary muscle weakness that could alter running mechanics (accurate ultrasound placement prevents spread to other muscles), bruising or mild pain at the injection site that settles within days, and — rarely — an allergic reaction. Unlike a steroid injection, Botox doesn’t damage soft tissue and can be safely repeated if needed.

Frequently asked questions about Botox for knee pain

Does Botox actually work for knee pain?

For chronic IT band friction syndrome, the evidence is encouraging — around 80% of patients improved, and most returned to running in published studies. It works by relaxing the TFL muscle rather than treating the knee directly, and it’s best combined with rehab.

Can you combine a Botox injection with a cortisone injection?

Yes, and the combination may work better. The Botox goes into the TFL muscle at the hip, while the cortisone goes deep into the IT band at the knee. Dr Masci often combines the two in persistent cases.

How long does Botox for knee pain last?

The effect starts within about a week, peaks at four weeks, and lasts three to six months. It can be repeated safely if needed, unlike repeated steroid injections.

Is Botox better than a cortisone injection for the IT band?

They do different jobs. Cortisone reduces inflammation in the knee quickly; Botox relaxes the tight TFL muscle that drives the friction, providing longer-lasting relief without soft-tissue damage. For chronic cases, Botox (often with cortisone) is the more durable option.

How much does Botox for knee pain cost?

Dr Masci performs Botox for chronic IT band friction syndrome for £650, including the ultrasound. Combined Botox and cortisone is £850.

Final word from Sport Doctor London about Botox for IT band friction syndrome

Botox is a promising treatment for IT band friction syndrome, particularly in athletes with persistent pain despite other treatments. Reducing TFL muscle overactivity can offer long-lasting relief and improve the results of physiotherapy — but it’s best reserved for cases that have failed other treatments.

Dr Masci performs Botox for chronic IT band friction syndrome (£650, including ultrasound; £850, including cortisone). To book, contact the team here or call +44 (0) 203 488 0350.

Related conditions: