Although exercise is the number one cause of iliotibial band syndrome, other factors can also contribute. Atypical physical anatomy can predispose a person to IT band problems. If the pelvis is not straight, or if a person has unequal leg lengths, one leg may compensate with extra movement. This can cause increased irritation to the IT band on one side, increasing the risk of developing IT band syndrome. Runners who always run on the same side of the road can replicate the posture of a discrepancy in leg length due to uneven road surfaces. Weak quadriceps and a lack of flexibility may also be contributing factors.

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