Few things are more annoying to a lifter than being unable to perform squats due to pain. Knee pain, in particular, is notorious, with one such common pain being from the IT band.
If you're dealing with IT band pain with your squats, you want to get it under control as quickly as possible so that it doesn't develop further.
This article will give you the keys to ensure you can wipe out this pain as quickly as possible.
Fixing IT band pain when squatting consists of ensuring you have perfect squat mechanics, performing targeted hip muscle strengthening, performing various soft-tissue treatment techniques, and avoiding unnecessary compression around the outside of your knee.
So, if you want to know the details, here's the step-by-step process to go through:
- Make sure you understand the anatomy
- Check your squat mechanics
- Make sure it's not your hamstrings
- Strengthen your hip rotator muscles
- Perform these soft-tissue techniques
- Ditch your knee sleeves for the time being
Note: Hi – I’m Jim Wittstrom, a physiotherapist from Calgary, Alberta, Canada. With that said, I’m not your physiotherapist. As such, if you are experiencing any pain, I recommend you seek advice from a qualified medical professional that can diagnose your individual situation and propose a tailored rehab plan.
Make Sure You Understand the Anatomy
The iliotibial band (IT band, for short) is a long tract of fibrous tissue that originates from a portion of your hip and runs all the way down the side of your leg to the very upper outside part of your shinbone. The IT band itself is not a muscle, so it doesn't have the ability to contract the same way that muscles do.
Its primary purpose is to provide attachment points for two muscles of your hip (the tensor fascia latae and the gluteus maximus), with these attachments playing a critical role in stabilizing the knee throughout various positions and activities.
In essence, the IT band helps to control knee positioning and stability with the movements and activities we perform.
Understanding IT Band Syndrome
IT band syndrome is a generalized term for a condition involving an individual experiencing knee discomfort arising from the IT band, most often around the bottom, outside portion of the knee (this region of the IT band is referred to as the distal end).
Since the IT band crosses the knee joint along the outer portion of the knee, it is prone to incurring repeated friction (which in turn becomes irritation) as it slides over a bony prominence on the end of the thigh bone (the femur). This bony prominence is known as the lateral femoral condyle.
If the IT band is under excessive tension (due to faulty squat mechanics, weak hip muscles, etc.) while the knee is bending and straightening, it rubs against the lateral femoral condyle much more aggressively than it should. Do this enough times and you will have a painful, irritated IT band right along the outer portion of your knee.
Check out this video for more information:
Voila, IT band knee pain when squatting. Now let's learn how to fix it.
Check Your Squat Mechanics
The best place to start when trying to eliminate a painful condition such as IT band syndrome is to determine why it's actually happening in the first place.
If your IT band/knee is giving you grief with your squats, analyzing your mechanics might reveal the flaw that brought on or is at least provoking your IT band pain.
Analyzing your squat mechanics can be an extremely detailed process if you want it to be. But, here's a solid, rudimentary checklist of three critical items to go through when watching your squat mechanics:
(Just be sure to film yourself squatting and watch your mechanics afterwards. Trying to watch your technique in the mirror as you control a heavy load makes it hard to spot some of the fine details you need to look for).
Item 1: Watch for Your Knees Caving Inwards at Any Point
When the knees cave inwards (a common movement error with squats), your femur (thigh bone) will internally rotate to a certain extent in the process.
When this inwards rotation occurs, the IT band must “wrap around” the knee a bit more. This will, in turn, put more friction/pressure onto the distal portion of the band as it, therefore, presses down onto the lateral femoral condyle a bit more. This also applies to any single-leg squat or lunge variations (cossack squat, pistol squat, forward/backward lunge, etc.) that you may be performing as well.
Strengthen your lateral hip rotator muscles (discussed further in the article) and actively cue yourself to ensure your knees and thighs don't collapse inwards throughout any portion of the movement.
If you think this is the problem, check out our detailed article on:
Item 2: Check Your Foot Placement
There can be a lot to unpack when it comes to discussing foot placement during your squats, but when only considering IT band pain, you may want to look at how much toe-out you have in your squat stance.
If you squat with your toes pointing directly forwards, it may impact the amount of tension the IT band is under (or predispose your knees to collapse inwards a bit more).
Try experimenting with a greater degree of external rotation from your hips when squatting (the more you rotate your hips outwards, the more toe-out positioning you'll have when you squat).
You may find that this not only improves your hip activation (reducing the likelihood of knees caving in) but that it also reduces or eliminates your knee pain since it essentially “slackens” the IT band to an extent.
Want to learn more about different squat stances? Check out our articles on:
- How Far Apart Should Your Feet Be When Squatting?
- Are Wide Squats Better For Powerlifting?
- Narrow Stance Squats: Pros, Cons, & Should You Do It?
Item 3: Watch for Any Weight Shifting
It's not uncommon to see amateur and even seasoned lifters shift their weight ever-so-slightly to one side of their body when squatting, often subconsciously.
Reasons for this can be numerous, including a subconscious pain-avoidance strategy (such as shifting away from a painful hip), faulty motor control mechanics or even favouring a leg that is slightly stronger than another.
Regardless of why it's occurring, it's imperative to realize that if you're subconsciously shifting a bit of your weight onto the painful knee, it's loading the knee in a way that forces the IT band to work more aggressively to stabilize the joint throughout the lift.
Remember, we're dealing in subtleties here, especially at heavy loads, so even the tiniest of weight shifts is worth identifying and correcting.
Determine why you're loading up on one side of your body more than the other. Once you know why it is, attack the underlying issue and pay specific attention to your positioning on your future squats.
Back off the weight if you have to, and slowly work your way back up while avoiding any shifting in the process.
If you want a more detailed guide on fixing imbalances, check out our article on:
Make Sure Your Pain Isn’t From Your Hamstrings
I often have lifters and other active individuals that I treat in the clinic who have been told by others, or have self-diagnosed their issue as being from the IT band.
But many of the times I find that their IT band isn't the culprit (or at least the sole culprit). Often, I find that it's the short head of the biceps femoris muscle (one of the hamstrings) being the cause of their pain.
The short head of the biceps femoris muscle is the next-door neighbour to the distal portion of the IT band, so it's certainly easy to misinterpret the pain from this muscle as pain from the IT band itself. Hamstrings are certainly prone to enduring high volumes of activity, which in turn can create tension in the muscle that is perceived as pain.
If you're not sure if this portion of hamstrings is to blame, try performing some seated or prone-lying hamstring curls. Hamstring curls in these positions allow the hip muscles to relax, which puts much less demand on the IT band during the movement.
If the pain is worse with squats but not as bad with these hamstring curls, it may signify that you need to address your hamstrings. If the pain is exactly the same, it may signify that the primary culprit is indeed your IT band itself.
Strengthen Your Hip Rotator Muscles
You'd likely find it quite remarkable as to how often I'm able to clear up a lifter's knee pain by strengthening their hip muscles.
In particular, the external hip rotators (muscles that rotate the thigh outwards) can yield game-changing outcomes when it comes to reducing various types of knee pain, hip pain and even low back pain.
The gluteus maximus in particular, plays a critical role in creating knee stability with movements such as squats. This is because approximately half of this muscle attaches directly onto the IT band. When strong enough to do so, these particular muscle fibres externally rotate the hip and thigh, which renders the knee largely incapable of caving inwards.
This wouldn't be the case nearly as much if the IT band didn't directly run all the way down across the knee joint. But it does, so these glute max fibers that attach to the top of the IT band act as a hand grabbing a long, fibrous control stick that can steer the knee into specific (and more ideal) positions.
Other key muscles to target are the gluteus medius and gluteus minimus muscles. These two muscles also help to control hip positioning during the squat and can thus also influence knee position.
There are numerous ways to effectively train up these particular hip muscles, and what's more important than worrying about which is the BEST one (there are lots of “best” ones) is that you pick ones you'll actually adhere to and commit to on a consistent and sustainable basis.
If you're looking for a good starting point on some highly effective hip exercises to try for this particular issue, check out the following video, where they mention how weak hip muscles can lead to faulty knee mechanics (and thus, pain):
Perform These Soft Tissue Techniques
When it comes to getting your IT band under control, you'll likely experience the best results by treating the tissues north of the area that's painful.
Performing hands-on treatments techniques directly to the area that's already irritated might not be all that beneficial. Let that area cool off and instead treat the surrounding tissues that “plugin” to that region.
Think of it this way:
If the painful area outside of your knee is the scene of a highway traffic accident, you'll likely have traffic backed up north all along the highway. Get the traffic congestion under control all along the highway up the leg, and you'll provide an effective way to clear the scene of the accident.
Here are my favourite ways to reduce tension and restore mobility all along the IT band and the outer leg region in general:
The quickest and most effective way to enhance the suppleness of your IT band and quadriceps muscles is to use the sleeve of a barbell. Think of your IT band and quads as dough and the barbell sleeve as a rolling pin; you're going to knead the dough and get all the “lumps and bumps” out.
Using a handheld object to improve tissue mobility is a treatment method known as Instrument Assisted Soft Tissue Mobilization (IASTM). It has some decent scientific evidence to show that it can help improve the mobility of the targeted tissues.1-3
The weight of the barbell sleeve is likely going to be uncomfortable as you slowly roll it up and down the front and side of your thigh, but as long as it's manageable (i.e. not excruciating), it's worth doing this for a minute or two.
You may have some minor soreness the next day (since this is like a deep tissue massage), but you'll soon get to a point where you won't have any post-rolling soreness. Once this occurs, try to get in the habit of doing this at least once a day, if not twice a day (if possible).
Remember, you can always use a foam roller if you find the barbell sleeve to be too uncomfortable.
Still, I find that most lifters have much better success with using a barbell sleeve. Regardless of whichever you use, keep in mind that the more uncomfortable a section is to roll over, the slower you should go, spending more time on that section. It's not pleasant, but if you're going to perform this tissue intervention, you want to get the most out of it.
Get in the habit of doing a quick round of barbell rolling before each of your squat sessions as part of your warm-up. This often makes substantial differences in how the knees feel during the squat session for many of the lifters I treat.
Just like with lifting, it can take a bit of continual effort to see the fruits of your labor. Stick with this technique for a week or two, and you'll likely begin to feel a difference in how your squats feel.
Compression flossing (often referred to as VooDoo flossing) is a unique and straightforward self-treatment technique since it adds a component of tissue shearing into the movement-restoration process.
While barbell rolling works primarily through direct compression, flossing not only compresses the tissue by pinning it down, but also creates shearing forces throughout the fascial tissue of the muscles and IT band. The shearing force occurs from forcing the tissue to move while simultaneously being pinned down. The movements are simple; knee extensions, squats, or any other movement that forces the tissues in your thigh to glide and slide underneath the compression.
You'll often hear this described as the “tack-and-floss” method or as a “self active-release-technique.”
Compression flossing has been shown to create favorable changes to the environment of tissues and enhance mobility, so it's certainly something worth trying.4,5 All you need is a latex band (assuming you're not allergic to the stuff), and you're good to go. You can get these flossing bands just about anywhere online, and they're dirt-cheap.
While many lifters will perform flossing around the knee joint itself, it may be a better idea to start out with only wrapping and flossing the thigh (north of the irritated area), as some lifters may have enough irritation around the bottom portion of their IT band to warrant avoiding wrapping over this area, at least in the initial stages of recovery.
Check out this video to get the rundown on how to compression floss the thigh:
As with barbell rolling, get in the habit of doing it daily and immediately before a squat (or lower body) session. Stick with it for a couple of weeks, and you'll likely begin to feel some of the positive effects this treatment can make.
Ditch Your Knee Sleeves for the Time Being
If you're a lifter who regularly squats in knee sleeves, it might be a worthwhile idea to forego them for the time being until you get your knee pain under control. This can be especially true if you squat in thicker, tighter-fitting sleeves.
The reason is that the compression around your knee occurs in the same region that is already irritated, likely from preexisting tension involving the IT band rubbing over the lateral femoral condyle.
This isn't a guarantee that your knee sleeves are aiding the ongoing pain or discomfort that you're having, but if you have your knee pain anywhere around the distal portion of the IT band, but certainly can be the case, especially with more chronic conditions, especially if only experienced when squatting.
IT band pain is one of the more common knee conditions that can hinder or even eliminate a lifter's ability to squat. Thankfully, it's a condition that can usually be remedied with great success if the proper steps are taken.
Be sure to follow the tips in this article to reduce the friction that is likely occurring around the outside of your knee. Your IT band will certainly thank you for doing so, and you'll be back to squatting pain-free as a result.
What To Read Next
- How To Avoid A Powerlifting Injury (Complete Guide)
- Knee Pain While Squatting (Why It Happens & How To Fix)
- Quads Sore After Squats: Is This Good or Bad?
- Hamstrings Sore After Squats: Is This Good or Bad?
1. Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Med Sci Sports Exerc. 2019;51(10):2166.
2. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical application. J Exerc Rehabil. 2017;13(1):12-22. doi:10.12965/jer.1732824.412
3. Baker RT, Nasypany A, Seegmiller JG, Baker JG. Instrument-Assisted Soft Tissue Mobilization Treatment for Tissue Extensibility Dysfunction. Int J Athl Ther Train. 2013;18(5):16-21. doi:10.1123/ijatt.18.5.16
4. Kaneda H, Takahira N, Tsuda K, et al. The effects of tissue flossing and static stretching on gastrocnemius exertion and flexibility. Isokinet Exerc Sci. 2020;(Preprint):1-9.
5. Ross S, Kandassamy G. The effects of ‘tack and floss’ active joint mobilisation on ankle dorsiflexion range of motion using Voodoo floss bands. J Phys Ther. Published online 2017.
About The Author
Jim is a physical therapist, strength & conditioning specialist and former competitive powerlifter. He loves treating lifters and other active individuals in the clinic and working with them in the gym in order to help them move better, feel better and maximize their training potential.