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Pickleball - Pain in the Outer Leg

Have you ever had pain around the outer leg, somewhere between the outer hip and the knee? It’s possible that the iliotibial band (or IT band, for those acronym lovers out there) may have something to do with it. Pain around the iliotibial band is actually a pretty common issue for pickleball players.

If you’ve never heard of the IT band, run your hand down the outside of your upper leg. If you feel some little bumps (which may or may not be painful) you’re likely feeling some tight spots in the iliotibial band.

But…what even is the iliotibial band, anyways?

I’ve heard many people speak about the iliotibial band as though it is a muscle, but in fact, it isn’t. It’s actually made up of connective tissue, and serves more of a supportive/protective function. Thus, the iliotibial band is not designed to stretch or lengthen in the way that we would expect a muscle to do.

Muscle…Connective tissue…Why does it even matter?

It matters because, in fact, connective tissue is incredibly tough and dense material. In fact, it’s so tough that studies have shown that it takes approximately 2000 lbs of force to create a 1% change in the length or form of the iliotibial band!

I don’t know about you, but I’m not capable of generating 2000 lbs of force with my hands. Neither is a foam roller, massager, or that other fancy gadget you see on a late night infomercial. This creates something of a conundrum, as massaging out the iliotibial band is one of the most common things that people attempt to do in order to address pain around the iliotibial band.

What to do, what to do…

Well, the good news is that issues in the iliotibial band are typically not caused by the iliotibial band itself. Once you figure out what is causing the iliotibial band to become tight and adequately address it, that pain in the outer leg tends to clear right up.

The common culprits?

First off, there is a little muscle called the tensor fascia latae that blends in with the upper iliotibial band. When this little muscle with a big name becomes overused and tight, it tends to cause irritation to the iliotibial band. If this is your culprit, the primary goal is to discern what part of the body the tensor fascia latae is overworking for, and improve function in those areas to reduce the stress placed upon the tensor fascia latae and iliotibial band. It’s a little like detective work!

Another common cause stems from the low back. In this instance, it’s possible that tightness around the low back is causing a person to move differently, causing more stress to be placed on the iliotibial band. Alternatively, nerve issues around the low back (such as sciatica) can also mimic iliotibial band syndrome symptoms.

Abnormal movement patterns, such as walking with a limp, can also place additional strain on the iliotibial band. In this case, anything contributing to the abnormal movement needs to be addressed and persisting habits must be retrained. Contributing factors may range from pain in other areas, weakness, and joint or muscle stiffness.

Ultimately, once the root cause of the iliotibial band pain is addressed, symptoms typically alleviate fully, and people are able to resume pickleball play without long term problems. Invasive procedures such as surgery are not necessary for iliotibial band issues the majority of the time.

Now…what about pickleball? The most important things you can do to protect your iliotibial band involve being vigilant of how you move, and ensuring that you have adequate endurance and strength around your hips. Make sure that you’re using good form with your footwork (especially when going side to side), and using proper lunge/squat techniques when the game makes you have to bend for the ball.

It sounds easy, but body mechanics are a challenging thing, especially since your opponents are always going to be trying to outfox you with tough returns. Practice makes perfect, and if you need a hand I’m happy to be a resource!

Need help with an issue such as pain in the outer leg? Or do you just want to make sure that your legs are as strong and flexible as they should be to keep you playing your best pickleball game? As a doctor of physical therapy and owner of Serendipity Physical Therapy and Wellness, I’m happy to work with you to help with all of these kinds of needs. (I do house calls around the general Naples area!)


I help pickleball players with a wide variety of issues, from injury rehab to improving flexibility and reducing the likelihood of getting hurt on the courts.

If you’re new, you can check out more of my advice and content here:

If there is anything I can help you with, or you have questions, please give me a call at (239) 232-8155, or send me an email at I would love to see how I can help get you moving at your best!

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