Part of IT band syndrome
Can IT band syndrome cause hip pain?
Warning signs, and when to get help
Can IT band syndrome cause hip pain, or is that the wrong name?
Yes and no, and the trouble starts when someone hears only half of that.
The band is genuinely involved at the hip, because that is where it comes from. Geisler's 2021 clinical review describes the iliotibial band as the fused tendon of the tensor fasciae latae and the gluteus maximus, arising from the iliac crest and the bony point at the front of the pelvis, taking all of the tensor fasciae latae fibers and most of those from the gluteus maximus. So a sore or overworked muscle at the top of that chain is felt as a tight, aching strap down the outside of the thigh. That part of the story is real.
What is not real is the label. IT band syndrome is a knee diagnosis. It names pain where the band is compressed against the bony bump just above the outside of the knee, and the IT band syndrome program is written for that problem. Calling hip pain IT band syndrome sends the reader toward the wrong program and, more often, toward the one treatment the sore structure at the hip handles worst.
One more piece of anatomy settles a lot of arguments in clinic. Geisler is specific that neither the gluteus medius nor the gluteus minimus inserts into the band. Those are the two tendons that most often hurt at the bony point of the hip, and they are not part of the band at all.
Where the band starts, and what sits under it at the hip
Run your hand down the outside of your thigh and you are following one continuous sheet from the pelvis to below the knee. At the top it is muscle and tendon. Lower down it is a flat band that Fairclough and colleagues (2006) found anchored to the lower thighbone by fibrous strands, which is why it does not slide or roll the way a tendon over a pulley does.
Underneath the band at the hip end sit the gluteal tendons and the bony point they attach to (the greater trochanter). This used to be called trochanteric bursitis, and most of what you will read about hip pain still explains it that way. Grimaldi and colleagues (2015) describe tendinopathy of the gluteus medius and minimus tendons instead as a recognized primary local source of pain on the outside of the hip, which is the reason our own greater trochanteric pain program uses that name. The same review names excessive compression and high tensile loads as the loads thought to do the most damage to a tendon, and excessive hip adduction, meaning the thigh crossing toward the midline, as a key joint position.
That matters because the bursa story and the tendon story lead to opposite advice about pressing on the sore spot. Researchers went looking for a bursa at the knee end too, and did not find one. Muhle and colleagues (1999) imaged six donated knees at full extension, 30 degrees and 60 degrees and found no primary bursa between the bony bump and the band in any specimen, checked against sections under the microscope.
IT band syndrome or gluteal tendinopathy: which end is sore?
Put a fingertip on the sorest point and notice where it lands. It is the most useful thing you can do before an appointment. You are not testing yourself, you are finding a location you can describe to someone.
The bony point at the side of the hip. If that is the spot, and lying on that side at night is miserable, the gluteal tendons are the usual suspects rather than the band. Grimaldi and colleagues (2015) note that this problem disrupts sleep, particularly lying on the side, which fits what people describe. Outer hip pain is the symptom page for that area.
The bump just above the outside of the knee. If the sore point is there, roughly a thumb's width above the joint line, and it bites a predictable distance into a run, that is the pattern Geisler describes for the knee end: sharp, focal pain over the lateral femoral condyle after a period of running, with downhill running and stair descent among the usual aggravators. Outer knee pain covers everything else that can hurt in that spot.
A spread-out ache with no single sore point. Common in runners, and usually the muscles along the outside of the hip and thigh after work they were not ready for. It tends to ease over a few days when the training load eases.
Two things stop this from being a self-diagnosis. People have more than one problem at a time, especially runners, and the clinician's tests are not interchangeable with pressing on yourself. Geisler is explicit that the Ober test, the one often shown as a way to measure band tightness, should not be factored into the diagnostic process, because its ability to tell you anything about knee motion has been challenged.
Why your hip can ache when the problem is at your knee
Runners ask this one a lot, and the answer is more reassuring than it sounds.
One study is worth knowing here. Noehren and colleagues (2007) measured the running mechanics of healthy female recreational runners and then waited two years to see who got hurt. Eighteen of the women developed IT band syndrome, and set against controls matched for age and mileage, their original data showed significantly greater peak hip adduction and greater knee internal rotation before any of them had pain. The measurements usually blamed for this condition, rearfoot eversion and knee flexion at footstrike, came out no different, and neither did any of the joint moments.
Read that from the hip's point of view. The thigh is dropping further toward the midline on each step, and the muscles at the side of the hip are the ones holding that drift. Ask them for more than they can give, mile after mile, and they ache. That is work, not damage, and it explains why the hip and the knee so often start complaining in the same month.
It also explains why both programs include the same hip strength work. Our greater trochanteric pain program and the IT band syndrome program both build the muscles at the side and back of the hip, starting with lying exercises like the clamshell before anything is loaded in standing. Where the two part company is everything to do with stretching and pressure.
Pain at the front of the hip, the inner hip or the groin
People search for all three with the words IT band attached, so it is worth saying plainly that the band does not reach any of them.
Pain at the front of the hip or the top of the thigh, worse lifting the knee or driving the leg back in a stride, points more at the muscles that flex the hip than at anything on the outside, and hip flexor strain is the page for it. Deep groin or front-of-thigh pain, stiff in the morning and worse turning the leg in, points at the hip joint, where hip osteoarthritis is one of the usual explanations. Pain in the buttock that travels down the leg, with pins and needles or numbness, belongs to the back and the nerve, not to anything on the outside of the leg, and sciatica sets out that picture.
None of those is a conclusion you can reach from a web page. They are the structures a clinician will be sorting between, and knowing the names makes the appointment faster. The NHS puts hip pain in front of a GP when it stops you doing everyday things or disturbs your sleep, when it keeps coming back or getting worse, or when two weeks of looking after it at home has not helped.
Should you foam roll or stretch the side of your hip?
Here the two conditions want different things, and this is the one place where the wrong label does harm instead of just wasting time.
For the knee end, rolling the outer thigh is optional and never the treatment. Geisler's review puts stretching and deep friction massage of the lower band outside the intervention plan altogether. Our own IT band foam rolling page keeps it as a comfort measure for people who like it, with the rules that go with that: moderate pressure, outer thigh only, stop above the knee, off the sore spot.
For the bony point of the hip, the answer is firmer. If a compressed tendon is the problem, then pressing a roller into the compression is working against the tissue, and Grimaldi and colleagues name excessive compression among the loads thought to be most damaging. Exercises to avoid with outer hip pain goes through this properly, including the positions that take the thigh across the body and load the same tendons in the same way.
So the practical rule is short. Rolling the bony point of the hip is out. Rolling the outer thigh is optional either way, and it earns its place only if the hip and knee are no sorer that evening or the next morning.
What to do this week
None of this needs equipment.
Write down where the sore point is, as precisely as you can, and what you were doing when it started. A clinician can work with "a point I can cover with one finger, just above the knee, from mile three onward" in a way they cannot work with "my IT band".
Take the aggravating load down rather than out. For the knee end that usually means shorter and flatter running or riding, with downhill and camber left alone for now; the parent program sets out how to judge that. For the hip end, the positions matter more than the distance, and sitting with your legs crossed is worth dropping while things settle.
Keep the hip strength work going, because it is in both programs. Start where you can keep the sore spot quiet.
Two checks come first if you have had an operation on this leg. After a knee fracture or knee surgery, including a knee replacement, follow your surgeon's or physio's plan, and start these exercises only when they have cleared you. If you have had a hip replacement, get the go-ahead from your surgeon or physio before you try these exercises. Several of them take the leg out to the side or across the body, and many surgeons ask you to avoid that for the first months after some operations.
Leave the roller off the bony point of the hip, whichever end turns out to be the problem. Nothing is lost by waiting on that, and it is the one piece of common advice that can make a tendon at the hip worse.
When to see a physio or physical therapist
Book an assessment if the pain has lasted more than two or three weeks, if it is changing how you walk, or if it has stopped you doing something you want to do. A clinician can separate the hip end from the knee end in a few minutes with tests that mean something in context, and the right program follows from that. Both programs on this site are education, and they do not replace a plan written for your leg.
Some patterns are not a matter of waiting for an appointment at all. The warning list below is grouped by how soon each one needs attention, and the ones at the top need the same day or an emergency department: a hip that is hot and swollen or comes with a temperature, severe hip pain after a fall when you have low bone density, a knee that swelled within hours of a twist, a leg or foot that is getting weaker, or numbness around the genitals or new trouble passing urine. Read it before you read anything else on this page if any of that sounds like you.
If you have had a hip replacement or any hip surgery, your surgical team's own instructions come first, and outer hip pain carries the post-operative warning signs with the timing each one needs.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: pain, tingling, numbness or weakness in both legs, numbness or altered feeling around your genitals or bottom, or new trouble peeing or controlling your bladder or bowels. The same applies if you lose feeling in one leg. Call emergency services or go to an emergency department straight away. These can be signs of pressure on the nerves at the base of the spine (cauda equina syndrome).
- Emergency: you have had a fall or an injury and now have severe hip pain, or you cannot walk or put weight on the leg. Call emergency services or go to an emergency department. This can be a sign of a broken hip (hip fracture).
- Emergency: tingling or loss of feeling in the hip or leg after a fall or injury. Call emergency services or go to an emergency department.
- Emergency: the knee has moved out of place, looks misshapen or is pointing at an odd angle, or you have tingling or no feeling in the knee, leg or toes, or your foot turns cold, pale or blue. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
- Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
Get help today
- Same day: severe hip pain that came on suddenly without a fall, or pain that is getting worse quickly over a few days. Get medical advice the same day.
- Same day: new hip or groin pain after a fall, even a small one, if you are older, have low bone density (osteoporosis) or have taken steroid tablets for a long time, even if you can still walk. Get medical advice the same day. A broken hip is not always obvious at first.
- Same day: the pain started with a fall, a twist or a blow to the knee, and now the knee is very painful or swollen, or you cannot put weight on the leg or move the knee. Get medical advice the same day, and go to an emergency department if the pain is severe. This points to an injury, not IT band syndrome.
- Same day: the knee swells up, locks so you cannot straighten it, gives way under you, or clicks painfully. These can be signs of a problem inside the joint, such as a torn meniscus (the cartilage cushion in the knee) or a ligament injury. Get medical advice the same day and stop running and riding until it has been checked.
- Same day: the hip is hot and swollen, the skin around it has changed color, or you have hip pain with a high temperature or feel hot, cold or shivery. Get medical help the same day, and go to an emergency department if you feel very unwell. A joint infection needs treatment quickly. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: the knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- Same day: you are a teenager who is still growing and you have a limp, or pain in the hip, groin or thigh as well as the knee. Get an urgent appointment with a doctor the same day, and stay off sport and these exercises until you have been checked. If you cannot put weight on the leg, have a high temperature or feel very unwell, go to an emergency department. Some hip problems in growing teenagers, such as a slipped growth plate at the top of the thigh bone (slipped capital femoral epiphysis), are felt in the knee and need checking quickly.
- Same day: a leg or foot that is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop). Get medical advice the same day. If the weakness is getting worse by the hour, go to an emergency department.
- Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Same day: pain at night or at rest that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: pain at night or at rest that keeps getting worse. If you have had cancer, now or in the past, or are losing weight without trying, see your doctor sooner, within a day or two, and mention it. This applies even if the pain is not getting worse.
- Within a few days: pain at night or at rest that keeps getting worse. See your doctor within a few days.
- Within a few days: new pain in the groin or buttock, and you take steroid tablets long term, or have in the past, or you regularly drink a lot of alcohol. This can be a sign of a problem with the blood supply to the top of the thighbone (avascular necrosis). Book an appointment with your doctor within a few days and mention the steroids or alcohol.
- Within 2 weeks: pain that spreads from your lower back or buttock down the outside of the thigh or below the knee, especially with numbness, tingling or pins and needles in the leg or foot. The pain may be coming from your back rather than the knee. Book an appointment with a doctor or physio. If your leg or foot is getting weaker, for example your foot drags, catches on the ground or slaps down when you walk (foot drop), get medical advice the same day, and if the weakness is getting worse by the hour, go to an emergency department.
Common questions
Can a tight IT band cause hip pain?
The tight feeling and the pain usually have the same cause rather than one causing the other. The band at the hip end is the shared tendon of the tensor fasciae latae and most of the gluteus maximus (Geisler 2021), so when those muscles are working hard or guarding, the whole outer thigh feels like a tight strap. Treating the tightness as the problem is where people go wrong, because the band does not behave like a muscle that can be lengthened: Fairclough and colleagues (2006) found it anchored to the lower thighbone by fibrous strands. The useful question is which structure is sore when you press it, and the IT band syndrome program sets out what the knee end needs.
Where is IT band hip pain felt?
Most often over the bony point at the side of the hip, or in a band spreading from there down the outside of the thigh. That is also where the gluteal tendons attach, which is why the location on its own does not tell you which structure is involved, and why the exact sore spot is worth more than the general area. Where outer hip pain is felt, and where it travels maps the pattern in detail. Pain that starts in the lower back or buttock and runs down the leg is a different story, and sciatica is the page for that.
Can IT band syndrome cause groin pain?
Not in any direct way. The band runs down the outside of the thigh and its attachments at the knee end sit on the outer side of the joint (Geisler 2021), so it does not reach the groin. Pain felt in the groin or deep in the front of the hip points at other structures, and the hip joint itself is a common one: hip osteoarthritis often shows up as groin or front-of-thigh pain rather than pain on the outside. Groin pain with a limp, after a fall, or with a temperature has its own lines on the warning list at the foot of this page, and a growing teenager with hip, groin or thigh pain needs seeing the same day.
Can you have IT band hip pain and knee pain at the same time?
Yes, and in runners it is common enough that it is worth expecting. Noehren and colleagues (2007) followed healthy female recreational runners for two years and found that the 18 who went on to develop IT band syndrome had already been running with more hip adduction and more knee internal rotation than matched controls, which means the hip muscles on that side are being asked for more than they are giving. A hip that aches after a run in that situation is usually muscle work rather than a second lesion. What makes it worth checking anyway is that the two conditions want different things done to the outer hip, which the foam rolling section above explains.
References
- Geisler PR. Current Clinical Concepts: Synthesizing the Available Evidence for Improved Clinical Outcomes in Iliotibial Band Impingement Syndrome. Journal of Athletic Training. 2021;56(8):805-815. https://doi.org/10.4085/1062-6050-548-19
- Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of Anatomy. 2006;208(3):309-316. https://doi.org/10.1111/j.1469-7580.2006.00531.x
- Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine. 2015;45(8):1107-1119. https://doi.org/10.1007/s40279-015-0336-5
- Noehren B, Davis I, Hamill J. ASB clinical biomechanics award winner 2006: prospective study of the biomechanical factors associated with iliotibial band syndrome. Clinical Biomechanics. 2007;22(9):951-956. https://doi.org/10.1016/j.clinbiomech.2007.07.001
- Muhle C, Ahn JM, Yeh L, Bergman GA, Boutin RD, Schweitzer M, Jacobson JA, Haghighi P, Trudell DJ, Resnick D. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. 1999;212(1):103-110. https://doi.org/10.1148/radiology.212.1.r99jl29103
- NHS. Hip pain in adults. Page last reviewed 20 November 2025. https://www.nhs.uk/symptoms/hip-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.