Some conditions in sports medicine are easy to diagnose but hard to treat. A good example is IT band syndrome — iliotibial band friction syndrome — which mainly causes pain on the outside of the knee in runners. So does a cortisone injection for IT band syndrome help?
This page covers the IT band injection at the knee. For the hip muscle that feeds the band, see tensor fasciae latae pain; for the Botox option, see Botox for knee pain.
What is the iliotibial band?
The iliotibial band starts above the hip from the tensor fascia lata muscle, then runs down the outside of the thigh to the outer shin (tibia). It stabilises the outside of the knee, and is prone to inflammation and swelling as it passes over a bony bump on the outer knee.
What causes IT band syndrome?
ITB syndrome is caused by pressure or friction of the iliotibial band against the outside of the knee. Recent research suggests pressure is the more important factor, peaking at about 30 degrees of knee flexion. As with runner’s knee, contributing factors include biomechanical issues such as tight quadriceps and weak buttock muscles.
IT band syndrome symptoms
Most people with IT band syndrome have pain on the outside of the knee, brought on by running and eased by rest. Runners are usually fine for the first 5–10 minutes, then develop sharp outer-knee pain that’s hard to run through. Less commonly, hiking, walking, and cycling trigger it.
It’s essential not to miss other causes of outer knee pain — a torn meniscus, biceps femoris tendonitis, or pain referred from the back or hip. An MRI or ultrasound often helps confirm the presence of fluid under the ITB and exclude other causes.
What treatments are available for IT band syndrome?
First, we treat the pain and inflammation with anti-inflammatory tablets such as ibuprofen or a cortisone injection. Then we work on biomechanics, which is crucial. A step-by-step approach works best:
- Stop the activities that aggravate the ITB, such as running and cycling.
- Stretch the hip flexors, ITB, and glutes; deep-tissue massage can loosen tight muscles.
- Strengthen the ITB and glute muscles.
- Use orthotics when foot biomechanics place load on the ITB.
- Adjust running style — a higher step rate and less leg-crossing can help.
- Return to running gradually to avoid a flare.
The best approach for IT band syndrome
Many people muddle through with bits and pieces, often unsuccessfully, leading to months of pain, and long-term pain tends to lay down scar tissue. Our approach is more aggressive: complete rest from running, anti-inflammatory tablets, and a rehab programme to address biomechanics. An early cortisone shot can reduce swelling and help rehab progress. For complex, chronic cases, we sometimes add Botox to the tensor fascia lata muscle — covered on its own page.
More on the cortisone injection for IT band syndrome
Cortisone is a potent anti-inflammatory. IT band syndrome inflames as the band passes over the bony prominence on the outer knee, so directing cortisone to the band at that level reduces inflammation and pain. It’s essential to use ultrasound to place the injection accurately, which improves the effect and reduces side effects.
A cortisone injection for IT band syndrome reduced pain significantly more than a placebo in this study, and Dr Masci has co-authored a paper summarising cortisone injection results for conditions such as IT band syndrome.
Botox as well as cortisone?
For chronic cases, relaxing a tight tensor fasciae latae (TFL) muscle with Botox can reduce IT band tightness and reduce knee pain. Dr Masci often combines cortisone to the IT band with Botox to the TFL in stubborn cases. Because that’s a treatment in its own right, we cover the procedure, evidence, and costs in full on the Botox for knee pain page.
What about IT band surgery?
Surgery usually involves releasing the IT band at the outer knee, open or keyhole, with mixed results. We strongly advise runners to avoid it in almost all cases — a five-year follow-up after IT band surgery shows 80% have ongoing knee pain and 74% have reduced or stopped running. We recommend at least 12 months of conservative treatment before considering surgery.
Frequently asked questions about the IT band injection
Should you rest after a cortisone shot for the IT band?
Yes. We recommend resting from running for about a week, which helps prevent a flare — usually seen 24–48 hours after the injection.
Are there side effects from an IT band injection?
A cortisone shot for the IT band may not work and carries small risks of skin changes, infection, and a steroid flare. Ultrasound guidance reduces these.
Can you run with IT band syndrome?
It depends on severity. Most people can’t run because of pain, but mild cases can sometimes be managed with intensive physiotherapy.
What cardio can I do with IT band syndrome?
Avoid running until the inflammation settles and you’ve seen a physiotherapist. Walking, cycling, swimming, and cross-training are usually fine.
Does stretching help IT band syndrome?
Yes. Most people have tight ITBs, hamstrings, and TFLs. Stretching, yoga, and foam-roller massage all help relax these structures.
Are there other IT Band injection options besides cortisone?
Yes — Botox into the tensor fascia lata for persistent cases, often combined with an IT band cortisone injection. See the Botox page for details.
Can shockwave therapy help IT band syndrome?
Possibly. Some studies suggest that shockwave helps during a race or marathon build-up, with the advantage of no downtime compared with an injection.
Final word from Sport Doctor London about the IT band injection
IT band syndrome is a complex condition in runners. We suggest aggressive early treatment — including an IT band injection if the pain is severe — alongside a serious rehab programme. Ignore IT band syndrome at your peril.
Dr Masci performs an ultrasound-guided cortisone injection for the IT band and, in chronic cases, combines it with Botox to the TFL. For costs and booking, contact his team here or review the fees here.
I had total hip replacement surgury 19 months ago. Ever since I keep getting the same diagnosis IT BAND syndrome. I just had a cortisone shot 5 days ago & started physio. The pain in my thigh & the outside of my knee are excruciating & I never get relief for very long. I work & walk 5 to 13 kms 7 days a week ,& have quit golfing because of the pain. Are there any good alternatives to IT Band surgury ?
Hi Robert – your problem is a tough one. I’d suggest physio combined with one or two cortisone shots. As I mention in my blog, some practitioners are using Botox to relax the muscle called TFL (tensor fascia lata) close to the hip bone. We think this muscle becomes tight and is a factor in causing ITB friction.
all the best
Lorenzo
Ciao Lorenzo,
I am a retired physician in the USA with a laurea from the the Faculty of Medicine and Surgery from Bologna.
At this time I have severe pain over the lateral aspect of my left knee andhave osteoarthritis of the same joint.
I have been receiving physiotherapy for the last 6 months with no great success and have had Kenalog 40 injections, one in April and the second in the first week of August.
Unfortunately, neither of these have appeared to be successful.
I read with great interest, your paper on ultrasound-guided corticosteroid injections and think that my treatment has been going down the incorrect path. I am scheduled for an MRI this next week
Since I reside about 80 miles north of NYC, I wondered whether you know of any Sports Medicine physines the do these procedures?
I thank you for your patience in reading my email.
With Regards,
Dr. Michael A. Solomon
Hi Michael,
Sorry to hear about your problem.
In general, I think that cortisone has little benefit in someone who has lateral compartment osteoarthritis. You should consider either hyaluronic acid or PRP as an adjunct to exercise therapy and a knee brace. See my blogs on hyaluronic acid, PRP in knee osteoarthritis and treatment for osteoarthritis.
https://sportdoctorlondon.com/prp-injections-for-knees/
https://sportdoctorlondon.com/hyaluronic-acid-injection/
In regard to your specific question: I don’t know anyone in the New York area.
All the best
Lorenzo
Hello Dr. Masci,
Ten years ago at age 62 I sustained a femoral head fracture due to a fall while running and to the degree of osteoporosis in my hips. An orthopedic surgeon has diagnosed the current pain radiating down my left leg as irritation of the IT band caused by the heads of the screws in the hip and a little resulting bursitis. He could feel the nail heads while pressing on my hip. He said since there’s no fracture or arthritis and the cartilage is excellent he recommends physical therapy, anti-inflammatories, and Voltaren gel, to be followed by Corticosteroid injection if the initial measures don’t work, to be followed finally by hip replacement if injection isn’t successful.
Do you think Botox to relax TFL close to the hip bone as described on your website would be a possible treatment for me, or does that muscle have nothing to do with my situation? My osteoporosis is severe per my last dexa scan in 2020 – hip T score was -2.9. Doctors have given me little to no guidance with treating it over the years. I took Fosamax twice for several years each but have read it can make bones more brittle. I asked about Prolia but my doctor said it’s not good if you have acid reflux (which I have on occasion but not regularly). I had initially been on Evista as a preventive but subsequent doctors have not wanted to prescribe it. Serious potential side effects of all treatments are also concerning. Any thoughts you might have would be welcome.
Many thanks.
so to answer your question about ITB – I think you should exhaust other treatments such as physical therapy and a cortisone injection before considering botox. However, I think botox in the TFL could be an option even in your special situation. But I’d try the other options first. And I’d certainly try botox before a hip replacement. Lorenzo
Thank you very much for your prompt and helpful reply – I appreciate it! My doctor prescribed Gabapentin yesterday for the pain so I can get off Ibuprofen and I start PT tomorrow.
My left it band is frozen. It causes low back pain. A recent mri shows l4,5,6 bulging disc. I feel the cause of my spinal problems is due to the it band. Can this be the case?
It could be. You need to speak to your doctor.
LM
I had bilteral knee replacement 14 years ago. I workout 4 days a week and walk approximately 12-15,000 steps per day, I am not an athlete like your other questioners have been. I am though truly suffering from from IT band pain on both legs. This radiates on the outside of my legs from about 4 inches below my hips and about 4 inches above my knees with the most severe pain being in the middle (of the outside) of my legs. I do IT stretches every day along with a foam roller that hurts terribly. Do you have any suggestions? I’ve just reade about botox treatments. I look forward to hearing from you.
Hi Diane – I mention the Botox option in the blog. It’s a potential option for persistent ITB syndrome.
LM