This post may contain affiliate links.

Understanding Hiking and Iliotibial Band Syndrome

Hiking and ITB

Iliotibial band syndrome, often abbreviated as ITB or ITBS, is an ailment common to hikers and backpackers, in addition to cyclists. It usually manifests itself as knee pain or pain along the side of your leg from your hip down to your knee. It occurs when the fibrous connective tissue on the outside of your leg, called the iliotibial band gets “tight” and rubs against your hip or knee bones. If you experience knee pain when hiking, it may very well be iliotibial band syndrome and not a knee injury.

What causes Iliotibial Band Syndrome?

There are many possible causes of ITB ranging from poor hydration to shoe soles that have worn down and cause your inner foot and ankle to roll inward. Another common cause is weak hip muscles as the result of sitting too much or crossing your legs over your knees when you sit: in other words, something that’s difficult to avoid if you sit for work.

The gluteus medius is the muscle on the outside of your hips, just below the iliac crest.
The gluteus medius is the muscle on the outside of your hips, just below the iliac crest.

How do you treat Iliotibial Band Syndrome?

ITB will go eventually away with rest or by taking anti-inflammatory medication. But if you hike and backpack a lot, it pays to do some remedial bodywork to prevent an occurrence.

Rolling your leg with a foam roller used to be recommended to loosen the IT band. But that fibrous connective tissue, also known as fascia, is very resistant to stretching (like don’t even bother trying) and the net result is that you can inflame the muscles surrounding it, which can also be quite painful.

One reason the IT Band gets tight is to compensate for weak muscles that surround it, especially the gluteus medius, which is the muscle on the outside of your hips, just below the iliac crest, which is what your backpack hip belt rests on and may partially cover.

How can you strengthen the Gluteus Medius?

You can strengthen your gluteus medius with a few simple exercises that are easy to do at home without any special equipment. You can make these more difficult as you get stronger using some simple elastic exercise bands or light hand weights. The following video illustrates the top exercises very well even though the narrator sounds like a certain Austrian weightlifter.

These exercises include:

  • Side-lying leg abduction
  • Pelvic drop
  • Single leg deadlift
  • Single leg squat
  • Side planks

They’ve been shown to achieve the best muscle activation: in other words, the best bang for the buck.

Can you still hike with Iliotibial Band Syndrome?

You can continue to hike and backpack although the pain usually gets more intense the longer you hike or exercise. But you can prevent the IT band from snapping against the knee bones by using an IT band wrap. This is a neoprene band with velcro at the ends that you tighten above your knee. It provides enough compression to provide some, if not total relief.

But wearing an IT band for days at a time can irritate the skin on your leg and gets pretty gross if you perspire a lot in hot weather. You really are better off doing leg strengthening exercises to prevent a recurrence. They really do work.

See also:

SectionHiker is reader-supported. We only make money if you purchase a product through our affiliate links. Help us continue to test and write unsponsored and independent gear reviews, beginner FAQs, and free hiking guides.


  1. Please add me to your mailing list.

  2. I can’t tell you how much I appreciate this article. I suffer from ITS around the knee and the elastic/velcro band I purchased really helps. I’m trying those exercises. Thanks again!

  3. Spot on advice, especially the stretches. Before I knew what ITBS was, I thought my knee was the problem. It’s astonishing how much relief regular stretching and some pressure point foam rolling of the hip area can accomplish.

  4. Gah! I’ve had/have it and have tried for years to remedy it – lots of physio, strengthening exercises, foam rolling the glutes and hips, and searching for good information. You nicely compiled some of the good info I’ve found over the years, so hats off to you for that. It usually only happens for me during 2 hour or longer cycling sessions and it killed my long distance cycling (randonneuring) hobby when I made it 75km into my first attempt at a 1000km ride. I’m pretty sure dehydration played a role in the last time I was stopped on a century ride. Now I’m experimenting with seat height and pedal/cleat placement (Q-factor) and I’ve found that a wider stance and lower saddle height is working so far. But oh man, am I ever afraid of trying to go too far on the bike. The silver lining is that, because I’ve been afraid of cycling over the last 5-6 years, I’ve got much more into trail running and from there I got really into canoe tripping and hiking, which is why I now follow and subscribe to Section Hiker. I absolutely love canoeing and portaging to an overnight camp spot or day tripping to a trail and then running or hiking the next morning, or that day if it’s a short trip. I’m glad you wrote about this because anything that helps people deal with ITBS, especially the more stubborn cases, is a very good thing.

  5. I’m wondering if this is the ailment I have? I can be hiking along, and all of a sudden, out of nowhere, my left knee and outer thigh start to hobble up on me. Even walking up a set if stairs, can set it off . Its not an excruciating pain, but really uncomfortable. The discomfort always subsides with rest. Years ago I got a ChoPat strap on knee brace that puts mild pressure above and below the back of the leg at the knee. It helped somewhatt. I call it the old term “trick knee ” I will try some of your recommendations to see if it is the ITBS, and if that helps.

  6. After 44 years of practice, I can say an essential element of correcting a persistent ITB problem is Chiropractic care, specifically with someone who uses a Thompson or Pierce Drop Table. This is a painless adjustment to correct a pelvic rotation at the SI joint (where the ilium joins to the sacrum.) Typically, I find 2-3 treatments is enough to get things going IF the patient is advised on what their “perpetuating factors” are and how to avoid them. Here’s a very simple tip to check that this may be a problem: If you sit with the same leg habitually crossed over the other and if you tend to always sleep on the same side with the same leg drawn up, that’s a sign of a rotated ilium. By doing these things, you are subconsciously trying to accommodate the weakness and, in doing so, just perpetuate it.

    In addition, when your pelvis is “rotated” it also tilts when you’re standing which will obviously affect your gait, energy use and balance. All the things you need for hiking. Check this by standing in front of a mirror and have someone put a finger on each iliac crest and see if one finger appears higher/lower. A difference of only 1/4″ is plenty to cause a problem. While many are told “we all have one leg shorter than other”, it’s been my consistent experience most are due to the SI joint rotation, which is usually correctable. (There’s a difference between an anatomically short leg and a functionally short one.) BTW, if you have this condition and simply use a heel lift, once again, you are only accommodating/perpetuating.
    Good luck!

Leave a Reply

Your email address will not be published. Required fields are marked *