If you have pain on the outside of your knee while running, it is likely that you are suffering from one of the most common running injuries: iliotibial band friction syndrome. The iliotibial band (ITB) is a thick band of fascia spanning from the hip to the knee. At the hip it attaches to the guteal and Tensor Fascial Latae muscles and at the knee it attaches to the outside of the knee cap (patella) and the lower leg bone (tibia). Its primary function is as a hip and knee lateral stabilizer, but with training errors and abnormal biomechanics, the ITB becomes tight and will rub on the outside part of the knee while running. This results in pain and inflammation on the outside of the knee. Without proper treatment, the pain will be sharp and debilitating, necessitating a break from running.

How Do I Know if I Have It?
The most common symptom is pain on the outside (lateral side) of your knee. The pain usually begins in the first ten minutes of a run and will gradually worsen as the run continues especially if running downhill or on a slightly cambered road (i.e. running around the sea wall). In the initial stages, the pain will subside when you stop running, but as the injury progresses lateral knee pain will present with walking, especially downhill or down stairs, standing after a period of sitting, and at the beginning of a run.

Causes
ITB friction syndrome can be caused by anything that puts pressure on the outside of the knee. These include overpronating feet, a tight ITB and its connecting hip muscles, weak hip stabilizers, a rotated or upsliped pelvis, or a true leg length discrepancy.

What Can I Do About It?
Stop running!! An injury will only get worse if the aggravating factor (running) is not taken away. There are two possible courses of action.

1. The first is icing and stretching until the inflammation settles down (usually a couple days) and then getting back to running gradually over a couple of weeks. If the injury is caught in the initial stages and the body has time to adapt to the new running load, then the pain may subside.
  Here are a few pointers for getting back in to running:
    • Alter your stride length (trail running helps to do this automatically)
    • Run a little faster
    • Begin on a walk run program (1 min run : 5 min walk)
2. If the injury continues, it is likely caused by biomechanical factors (i.e. over pronation, tight muscles, weak muscles, or abnormal joints). The factors at the root of the problem must be treated before beginning a running program. If your problem is due to overpronating feet, the first step is to make sure that your running shoes provide the correct amount of support. You may need to consult your physiotherapist to see if orthotics are necessary to correct poor foot mechanics.

A visit to your physiotherapist will help direct your rehabilitation in the right direction, but here are a few exercises to get you going!
1. ITB roller. The first few times you roll on a foam roller it may seem like it will be doing more harm than good, but I guarantee that it gets easier and it is very important for loosening your ITB.

2. The hip flexor and lateral hip stretch achieves two goals. First, most runners have tight hip flexors, which limits your running stride causes the ITB and the muscle it attaches to (the TFL) at the hip to be overused. Secondly, the top of the ITB (the TFL muscle) will be stretched out if the hip flexor stretch is done correctly.


3. Weak hip stabilizers are the cause of many injuries from lower back pain to knee and foot pain. Strengthening your hip stabilizers will keep your pelvis level while running so the ITB is not stressed as much as well as keep your ITB/TFL from being overused.

Written by:
Jennifer Keefer BSc(PT), BHK, RCAMT, CGIMS
Registered Physiotherapist
Village Physiotherapy (604) 985-2629
Hollyburn Country Club Physiotherapy (604) 913-4563