Eight weeks out from race day, the BYD Singapore International Marathon (4–6 December 2026) is well within sight. Long runs are getting longer, weekly mileage is climbing — and for many runners, a familiar ache is starting to appear on the outer side of the knee. If that sounds familiar, you may be dealing with IT band syndrome: the single most common overuse injury among distance runners, and the one most likely to derail final-block training.
This guide covers what the IT band actually is, why it becomes painful, how to keep training safely through it, and what chiropractic care can offer runners who want to make it to the start line healthy.
Dr Kelvin Ng with a marathon finisher at the Singapore Marathon — FHC has supported Singapore runners for over a decade.
What Is the IT Band?
The iliotibial band (IT band) is a thick band of connective tissue — not a muscle — that runs along the outside of your thigh from the hip (ilium) to just below the knee (tibia). It helps stabilise the knee during the stance phase of running and works closely with the gluteus maximus and tensor fasciae latae (TFL) muscles at the hip.
Because the IT band crosses both the hip and the knee, problems at either end — or in the structures that feed into it — can contribute to pain along its length.
What Is IT Band Syndrome?
IT band syndrome (ITBS) refers to pain on the outer side of the knee caused by repetitive friction or compression of the IT band as it passes over the lateral femoral epicondyle — a bony prominence on the outside of the thigh bone, just above the knee joint. With each running stride, the band repeatedly slides forward and back across this point; once the surrounding tissue becomes irritated, every step aggravates it.
ITBS accounts for up to 12% of all running-related injuries and is the leading cause of lateral knee pain in runners. It is most common in people who have recently increased their weekly mileage — precisely the training phase most Singapore Marathon runners are in right now.
Symptoms: How to Recognise IT Band Syndrome
The hallmark of ITBS is a sharp or burning pain on the outer side of the knee, typically appearing after a predictable distance into a run (often 3–5 km) and easing when you stop. Unlike a joint injury, the pain is rarely present first thing in the morning or when walking normally — it is activity-provoked and repetitive-load-specific.
Common signs include:
- Aching or burning on the outer knee during or after running
- Pain that appears at a consistent point in a run and worsens if you push through
- Tenderness when pressing directly on the outer knee just above the joint line
- Occasional swelling or warmth over the lateral knee
- Pain going down stairs or sitting with the knee at 90° in more severe cases
- A feeling of tightness along the outer thigh
What ITBS is not: it is not a sharp pain inside the knee joint, not pain with twisting, and not swelling within the joint itself. Those patterns suggest a different structure — meniscus, ligament, or cartilage — and warrant different assessment.
Why Does IT Band Syndrome Happen?
ITBS is almost always a load management problem combined with one or more biomechanical risk factors. The most common contributing causes include:
Rapid mileage increase
The most reliable predictor of overuse injury in runners is a mileage spike that exceeds the tissue’s capacity to adapt. Jumping your long run from 18 km to 26 km in a single week, or adding a second long run without adequate recovery, is the textbook trigger for ITBS during marathon build-up.
Weak or inhibited hip abductors
The gluteus medius and minimus control the position of the pelvis and femur during single-leg stance. When they are weak or not firing efficiently, the thigh drops inward (hip adduction) on each stride, increasing the tension on the IT band as it passes over the lateral femoral epicondyle. This is the single most important biomechanical factor in ITBS — and one that is frequently overlooked.
Pelvic and lumbar dysfunction
The IT band originates partly from the gluteus maximus, which itself is influenced by how the pelvis and lumbar spine move during gait. Asymmetry in pelvic rotation, restricted sacroiliac joint movement, or altered lumbar mechanics can change how load is distributed through the hip and thigh — contributing to IT band overload even when the runner’s training volume appears reasonable.
Foot strike and running form
A pronounced crossover gait (feet landing near or across the midline), excessive knee varus (bow-leg alignment), or running in heavily worn shoes can each increase lateral knee stress. Hill running — particularly prolonged downhill — is a known aggravating factor because the knee spends more time near the 30° flexion angle where IT band compression is greatest.
Insufficient recovery
Singapore’s heat and humidity mean that even well-paced long runs carry a significant physiological cost. Inadequate sleep, compressed recovery between sessions, and insufficient nutrition all reduce the rate at which soft tissue adapts to load — making overuse injuries more likely at any given mileage.
Can You Keep Running With IT Band Syndrome?
In most cases, yes — but not without modification. The key principle is load management: reducing the volume and intensity of running to a level the IT band can tolerate, while addressing the underlying cause so that the threshold gradually rises.
In practice this often means:
- Cutting the next one or two long runs by 30–40% in distance
- Avoiding back-to-back running days while the band is acutely sore
- Substituting pool running or cycling to maintain aerobic fitness without repetitive knee flexion
- Reducing or avoiding hill running, especially long downhill sections
Complete rest is rarely necessary and is often counterproductive — tendons and soft tissue respond better to graduated loading than to prolonged unloading. The goal is to find a volume you can run pain-free, and build from there.
How Chiropractic Care Can Help With IT Band Syndrome
Chiropractic care for IT band syndrome focuses on the structures that feed into the problem rather than just the point of pain. At Family Health Chiropractic, Dr Kelvin Ng and Dr Ashley Liew assess the full kinetic chain — pelvis, sacroiliac joints, lumbar spine, and hip — because restriction or asymmetry in any of these areas can alter how load passes through the IT band during running.
Pelvis and sacroiliac joint assessment
One of the most common findings in runners with ITBS is altered pelvic mechanics — either a functional leg length difference from sacroiliac joint restriction, or asymmetric rotation of the pelvis during gait. Either pattern can increase the demand on the IT band on the affected side. Restoring normal joint movement in the pelvis and lower lumbar spine often produces a noticeable reduction in lateral knee tension within a few sessions.
ArthroStim instrument adjusting
Both Dr Kelvin and Dr Ashley use ArthroStim instrument adjusting — a low-force, high-frequency technique that delivers precise impulses to restricted joints without the twisting or high-velocity thrust associated with traditional manual manipulation. This makes it particularly well-suited for runners still in active training: there is no soreness or recovery time after a session, and the effect on joint mechanoreceptors is rapid. The ArthroStim can address restriction at the hip, SI joint, lumbar spine, and the knee itself within a single visit.
Soft tissue care
Direct work on the TFL and lateral hip musculature — which often become hypertonic in runners with ITBS — can reduce the tension feeding into the IT band. It is worth noting that aggressive foam rolling of the IT band itself has limited evidence of benefit, as the band is too dense to be meaningfully deformed by surface pressure; the more productive targets are the muscles that attach to and tension it.
Gait and load guidance
Beyond in-clinic care, Dr Kelvin and Dr Ashley provide practical guidance on training modification, return-to-volume timelines, and the hip strengthening exercises — glute medius loading in particular — that have the strongest evidence for ITBS prevention and rehabilitation. The aim is not to stop you running. It is to get you to the BYD Singapore Marathon start line in better shape than when you walked in.
What to Expect at Your First Visit
The first appointment at Family Health Chiropractic runs about 45–60 minutes and includes a detailed history of your training, symptom pattern, and running background. Your chiropractor will assess your lumbar spine and pelvis, hip mobility and strength, and the knee itself to build a clear picture of what is driving the problem.
There are no packages at FHC — every visit is charged individually (standard fee $100–$130 for adults), and you decide after each appointment whether to continue. Many runners with ITBS notice meaningful improvement within two to four sessions, though this depends on how long the problem has been present and whether training load is modified alongside the care.
How Many Sessions Will I Need?
For a runner who catches ITBS early and is willing to adjust training load, four to six sessions over three to four weeks is a reasonable expectation. Runners who have been pushing through pain for several weeks, or whose hip strength deficit is significant, may require longer. Either way, the goal is always the shortest course of care that achieves a durable result — not an extended programme.
With the Singapore Marathon on 4–6 December, there is still time to address ITBS effectively if you act in the next two to three weeks. Waiting until the taper is unlikely to resolve the underlying mechanics.
Evidence: Does Chiropractic Help IT Band Syndrome?
The research base for chiropractic management of ITBS is consistent with the broader evidence on lateral knee pain in runners. A 2012 case series in the Journal of Chiropractic Medicine reported significant pain reduction and return to full running in runners with ITBS following chiropractic care targeting the pelvis and lower extremity. The evidence on hip abductor strengthening for ITBS is strong — a 2010 systematic review in the British Journal of Sports Medicine identified hip weakness as the most modifiable risk factor — and the role of lumbopelvic mechanics in lower limb overuse injury is well established in the sports physiology literature.
What the evidence consistently shows is that ITBS is not purely a local problem. Interventions that address only the lateral knee tend to produce slower and less durable outcomes than those that assess and correct the full kinetic chain.
Frequently Asked Questions — IT Band Syndrome Singapore
Is IT band syndrome serious?
ITBS is not a structural injury — it does not involve torn ligaments, damaged cartilage, or bone stress. However, it can become a persistent, training-limiting problem if the underlying cause is not addressed. Runners who push through ITBS without modification often find the pain-free distance shortens progressively until running becomes impossible. Identifying and correcting the cause early gives the best outcome.
Does stretching the IT band help?
The IT band cannot be meaningfully stretched — it is a dense fibrous structure with very little elasticity. Studies using ultrasound have shown that standard IT band stretches produce minimal change in band length or tension. Stretching the TFL at the hip and addressing hip mobility restrictions are more productive. The most evidence-based approach is strengthening the hip abductors.
Will I be able to run the Singapore Marathon with IT band syndrome?
That depends on how far along the injury is and how much time remains. With eight weeks until race day and early-stage ITBS, most runners can successfully get to the start line with appropriate load management and targeted care. Pain that is already limiting your runs to under 10 km requires more urgent attention. The sooner you seek an assessment, the more options you have.
Should I see a chiropractor or physiotherapist for IT band syndrome?
Both can help. Chiropractic care tends to focus on the spinal and pelvic mechanics that feed into the problem, while physiotherapy focuses more on exercise rehabilitation. For many runners, a combination of both produces the best outcome. If pelvic asymmetry, lumbar restriction, or altered gait mechanics are contributing — which is common — chiropractic assessment adds significant value. See our guide on chiropractor vs physiotherapist Singapore for a fuller comparison.
How much does a chiropractor cost for IT band syndrome in Singapore?
At Family Health Chiropractic, the standard fee is $100–$130 per visit for adults. There are no packages — you pay per visit and decide at each appointment whether to continue. Medisave cannot currently be used for chiropractic care in Singapore.
Book a Running Injury Assessment at Family Health Chiropractic
Family Health Chiropractic is located at 1 Grange Road, #09-01 Orchard Building, Singapore 239693 — a short walk from Somerset MRT. Dr Kelvin Ng (clinic director) and Dr Ashley Liew (senior associate) both see runners throughout marathon training season and are familiar with the specific demands of Singapore’s heat and the BYD Marathon course.
If lateral knee pain is starting to affect your training, book an assessment early. Eight weeks is enough time to address ITBS properly — but not enough time to keep ignoring it.
Related reading: For a broader overview of common marathon training injuries, see our guide: Running Injuries Singapore: The Complete 2026 Guide.