Sensible advice for aches, pains & injuries

IT Band Stretching Does Not Work

Stretching the iliotibial band is a popular idea, but it’s very hard to do it right, and it’s probably not worth it

by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about
IT band stretches do not work as advertised.

What’s wrong with this picture?

She’s not doing much with this classic IT band stretch — even if her technique was good (it’s not). Read on to find out why.

Iliotibial band stretches don’t work? Really?! So why does it seem like they prescribed for iliotibial band syndrome by practically every physical therapist in the world?

IT band stretching is just another obsolete bit of simplistic conventional wisdom, like a million other bad ideas that have been repeated infinitely on the Internet. Stretching your iliotibial band is probably only a slightly helpful treatment, at best. At worst, IT band stretching is a complete waste of your time, and reinforces an incorrect understanding of how IT band pain works.

And that’s assuming you are actually even stretching your IT band in the first place.

Most people never succeed in applying a good, strong stretch to their IT band. All the commonly prescribed IT band stretches are mechanically ineffective.1 There is research available that shows how to apply tension to the IT band, but it appears to be unknown to most doctors, therapists, and trainers.

Prefer video? I have a good video tour of basic IT band myths, including the stretching myth:

3 IT Band Myths & Common Treatment Mistakes 8:11

Stretching is generally over-rated, but it’s especially over-rated for IT band syndrome

Stretching is probably the most common advice given to people with lateral knee pain. Almost every ITBS patient is told to stretch by a doctor or therapist, and it is repeated literally tens of thousands of times on the internet.

But there is no evidence that stretching will prevent2 or fix3 IT band pain. No researchers have studied the problem properly, and preliminary data are underwhelming. Not only is the IT band a difficult structure to stretch, but it is doubtful that IT band tightness is even a problem that needs solving.

All preliminary scientific tests of stretching for ITB syndrome are underwhelming at best.

It is not safe to assume that stretching works just on the say-so of your physiotherapist, or running mates who swear by it, or because it’s recommended by every article on the internet about IT band syndrome. Stretching is generally over-rated, and especially in this case.4

Applying strong tension to the IT band is just really tricky

The most common kind of stretches recommended for the iliotibial band are also the least likely to be effective, simply because they are focussed on stretching the iliotibial band and the tensor fasciae latae muscle, and there is no good way of applying any significant amount of stretch to these structures. Not everything in the body can be stretched.5 There are biomechanical difficulties:

Diagram of iliotibial band anatomy.

Two things are missing from standard IT band stretches

The usual IT band stretches are missing a particularly crucial component: knee flexion. For any hope of stretching this structure, you simply have to include knee flexion. And yet almost no one does.

As discussed above, the iliotibial band does not have a well-defined attachment point on the knee, the way most tendons do. Instead, it spreads out and blends into the capsule of connective tissue that surrounds the knee. Thus, knee position clearly affects tension on the iliotibial band — and it has long been recognized that the iliotibial band is tightest around 30˚ of flexion.7 An iliotibial band stretch without knee flexion is just not much of an iliotibial band stretch.An iliotibial band stretch without knee flexion is just not much of an iliotibial band stretch.

And there’s more.

Another other vital thing that is rarely included is “anchoring” the pelvis. The tensor fasciae latae muscle and the iliotibial band “hang” from a “hook” on the front of the pelvis, the anterior superior iliac spine, or ASIS for short. If you want to stretch anything attached to the ASIS, you need to hold it in place.

Elementary, right? The easiest way to do this is simply to lean your torso away from that corner of the pelvis. This takes up the slack in the lateral and anterior abdominal muscles, and pulls up on the pelvis. The anchoring is also greatly facilitated by raising the arms as well, because that takes up a lot of slack in the very long latissimus dorsi muscle, which tightens the broad thoracolumbar fascia and, again, significantly helps to anchor the pelvis.8

Much ado about nothing

But this is all mucho ado about almost literally nothing, and it’s time for the shocking punchline. Suppose you did everything right: how much would you actually change the length of your IT band? How far would it move?

About 2 millimeters — an overall change in length of less than half a percent.

In 2010, Irish researcher Dr. Eanna Falvey and her colleagues measured the mechanical effect of a basic IT band stretch (like the standard one illustrated at right) plus a more sophisticated stretch, and found virtually no difference: the IT band was effectively unaffected, making it one of the unstretchables. And that was including knee flexion, in a stretch carefully applied to corpses by anatomists!9 If that doesn’t move the IT band, certainly runners don’t stand a chance.

And so, unfortunately, conventional iliotibial band stretches, prescribed and described practically everywhere — even the better ones — are simply not able to do the job. Assuming it’s even a job worth doing.

Schematic of the change in length fo the ITB band with stretch: <0.5%.

Better stretches, better solutions

So there are better stretches. But, more importantly, there are also better options for IT band syndrome than any stretch!

In my experience, practically everyone who is looking for IT band stretching information would be better off learning much more about IT band syndrome first, because the subejct is a minefield of myths and misconceptions (not just about stretching):

Some health professionals have taken the time to study ITB syndrome properly, of course. But it’s usually impossible to luck out and find one before your training schedule is blown to smithereens.

There are no miracle cures for IT band syndrome

This is an excerpt from a much larger tutorial for both patients and professionals. It will teach you basically everything there is to know about ITB syndrome. There is no foolproof system for beating iliotibial band syndrome (and please do not believe anyone who offers one). But if you read the full tutorial, I can guarantee that you will know the condition better than most doctors, and you will know your options inside and out.

Full access to the ITBS tutorial is available immediately for USD$1995, or you can start by reading several free introductory sections.

read on any device, no passwords
refund at any time, in a week or a year
call 778-968-0930 for purchase help

Plus …

If you choose to buy, thanks in advance for your business, and please feel free to write to me about something unusual or interesting about your case. I routinely make improvements to the tutorial as a result of feedback from runners and readers and health care professionals around the world.

Paul Ingraham, Publisher
778-968-0930 (Vancouver)

Mildly amusing humorous definition of IT Band Friction Syndrome. aArows pointing to the different parts of the term and whimsically translate them to create “ITBS is a weird hip to shin police problem?”


  1. Not universally, of course. Some therapists will know this stuff. But let me put it this way: I worked with ITBS patients routinely for a decade, and in that time the number of patients I saw who’d been taught to stretch properly by another therapist … I can count them on one hand. The huge majority were given the standard, inadequate stretch. BACK TO TEXT
  2. Brushøj C, Larsen K, Albrecht-Beste E, et al. Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: a randomized controlled trial of 1020 army recruits. Am J Sports Med. 2008 Apr;36(4):663–670. PubMed #18337359. This study showed “no significant differences in incidence of injury” in soldiers doing preventative exercises for commmon overuse knee injuries, especially iliotibial band syndrome and patellofemoral pain syndrome (two kinds of runner’s knee). The authors concluded that the exercises “did not influence the risk of developing overuse knee injuries or medial tibial stress syndrome in subjects undergoing an increase in physical activity.” The exercise regimen certainly included static stretching, and it certainly did not work any prevention miracles for iliotibial band syndrome. BACK TO TEXT
  3. Khaund R, Flynn S. Iliotibial Band Syndrome: A Common Source of Knee Pain. Am Fam Physician. 2005 Apr 15;71(8). PainSci #56763. From the article: “…studies have not demonstrated that stretching hastens recovery from [iliotibial band] syndrome.” BACK TO TEXT
  4. Stretching without clearer goals than “injury prevention” or “flexibility” is usually a waste of time that could be better spent on more effective healing strategies. Many recent studies have clearly shown that conventional stretching isn’t good for much, possibly nothing at all, but people tend to ignore the evidence even when they are aware of it. To be deprogrammed, see Quite a Stretch. Well-planned and specific therapeutic stretching is helpful for some injuries — evidence strongly supports the use of stretching for plantar fasciitis, for instance — but I usually do not recommend stretching as self-treatment, because its applications are too few and too specific. The most useful thing you can do with your stretching routine is to stop bothering. BACK TO TEXT
  5. Consider the quadriceps, for instance: only the smallest portion, the rectus femoris, can be stretched. The vastus medialis, vastus lateralis, and vastus intermedius are all mechanically impossible to stretch, because the calf and the hamstrings are thick body parts that meet and prevent complete knee flexion. For more information, see Massage Therapy for Your Quads. BACK TO TEXT
  6. Many therapists don’t believe this at first — it doesn’t jibe with the anatomy they learned in school. But it’s a great example of why therapists need to keep up with their scientific reading, because this anchoring arrangement was actually discovered (or clarified) by researchers quite recently, in 2006 (see Fairclough et al). The attachment is not through the big thigh muscles, but behind them. Attachment is more direct in the distal femur. Here's the relevant sentence from the paper: “This layer of deep fascia completely ensheathed the thigh and was continuous with the strong lateral intermuscular septum, which was firmly anchored to the linea aspera of the femur.” BACK TO TEXT
  7. As early 1979, Noble wrote that, “Tenderness over the lateral epicondyle associated with pain at 30 degrees of flexion on compressing the iliotibial band against the lateral epicondyle is diagnostic.” In 1996 Orchard shows the practical, painful reality of this in the biomechanics of running. Just last year, Fairclough confirmed that tension on the iliotibial band is greatest at 30˚ of flexion. BACK TO TEXT
  8. Fredericson M, White JJ, Macmahon JM, Andriacchi TP. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Arch Phys Med Rehabil. 2002;83(5):589–592. From the abstract: “Adding an overhead arm extension to the most common standing ITB stretch may increase average ITB length change and average external adduction moments in elite-level distance runners.” BACK TO TEXT
  9. Falvey EC, Clark RA, Franklyn-Miller A, et al. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010 Aug;20(4):580–7. PubMed #19706004. BACK TO TEXT