Are You Experiencing Lateral Knee Pain?


A common complaint amongst active patients, especially long distance runners, cyclists and triathletes is lateral knee pain, and the most common cause of that pain is Iliotibial Band Syndrome (ITBS).  Have you ever experienced lateral knee pain during the beginning of a run, or about 30 minutes after completing a long run?  Have you ever experienced sharp lateral knee pain that gets progressively worse as you increase your mileage? 


Unfortunately ITBS gets in the way of people reaching their fitness and competitive goals, but this doesn’t have to be the case at all.  Knowing how to avoid ITBS, how to recognize it, and how to treat it can allow athletes to continue to train and make it to race day. 


The Iliotibial Band (ITB) is a tendon, which originates just above the lateral hip and inserts just below the joint line on the lateral knee.  It helps with knee stabilization while running as it constantly moves slightly forward and backward with knee flexion and extension.  A disruption of the forward and backward movement, or an increase in tension can lead to irritation and eventually inflammation anywhere along the ITB.  Things that can cause these changes in the movement and tension to the ITB include excessive adduction of the hip and increased rotation of the knee. 




During the normal gate cycle of running, when one foot is planted on the ground, the other foot is swinging forward.  If the hip on the side of the swinging foot dips down toward the ground this is a sign of weak abductor muscles causing excessive adduction on the plant foot side.  Similar biomechanics are utilized while cycling.  If the pushing leg has week abductors the hip on the pulling leg can dip down toward the ground.  This causes increased tension along the ITB and it will likely lead to ITBS.  Several things cause this abnormal movement, including running on an uneven surface, weak gluteal muscles, uneven leg length and misalignment of the pelvis. 


Excessive knee rotation will also cause increased tension on the ITB leading to ITBS.  Hyper-pronation and low/weak arches of the foot will cause medial rotation of the knee.  Wide hips and a weakness in the medial quad muscle will also cause excessive medial rotation of the knee.




With all of the causes of ITBS it’s amazing that everyone doesn’t have it.  However it can be easy to avoid.  One of the most important and easiest things to do is to be properly equipped with the right shoe and to make sure the bike being used is properly fitted for the rider.  Another simple solution is a proper warm up and stretching after activity.  Finally never increase your mileage or training intensity too quickly, giving your muscles time to strengthen as you spend more time on your feet. 


Fortunately, getting ITBS does not mean you won’t be able to continue to train.  The key to success is seeking help early.  The longer you wait, the longer it takes to heal.  Your health care provider must identify what caused the ITBS and not only treat the symptoms, but fix the root of the problem.  Painkillers and anti-inflammatory medication will not do the trick.  The fibers of the ITB need to be manipulated stretched, iced and stabilized.  At ESSM we utilize Active Release Technique™, Graston, Kinesio-taping, dry needling, acupuncture and deep tissue massage.  Often times the joints above and below the area of pain need to be adjusted to restore normal mobility, and finally rehabilitation and strengthening of the areas of weakness will keep the ITBS from reoccurring.  You can continue to train as long as the pain is continuing to decrease and you are able to move without modifying your biomechanics.  If running is not an option then a good alternative is finding another way to get your heart rate up for the same amount of time that you would be spending running. 



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