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Runners knee: The Iliotibial Band Friction Syndrome, a cause of outside knee pain

by Jane Hodgson 28 September 2009


Iliotibial band friction syndrome is commonly termed runners knee because its occurrence in endurance runners is common. Causing outside knee pain, it has been estimated to account for 7% of all running injuries in middle aged men. The term runners knee is however misleading as a broad range of sports people can be affected by iliotibial band syndrome including bowlers, cyclists and racquet sports.

The iliotibial band is a thick band of fibre that goes from the outside of the pelvis down the outside of the thigh and joins onto the bone on the outside of the shin just below the knee joint.

What Causes Iliotibial Band Friction Syndrome/ Runners Knee?

When the knee is straight the iliotibial band lies to the front of the axis of movement of the knee. With the knee bent it lies behind the axis of movement of the knee. Therefore every time the knee is bent or straightened the band moves backwards and forwards over a prominence of bone on the femur (thighbone) just above the knee. With repeated movement the band can become irritated, inflamed and sore at this point.

What are the Symptoms of Iliotibial Band Friction Syndrome/ Runners Knee?

  • Pain on the outside of the knee just above the knee joint.
  • Occasionally lateral hip pain. Because the iliotibial band comes from the outside of the pelvis sometimes the pain can be felt on the outside of the hip, but it is much more common to get knee pain.
  • The pain is worse when doing any activity and decreases on rest. Going up and down stairs will often bring on the pain.
  • No one incident caused the problem, it built up over time. If the outside knee pain came on after a specific accident it is more likely to be damage to a ligament or muscle than runners knee
  • Iliotibial band syndrome usually affects only one side i.e. the pain will generally be felt in one knee only
  • Sometimes there is an audible popping as the knee bends and straightens, or sometimes the band can be felt flicking over the prominence at the bottom of the thighbone just above the knee

Who is More Likely to get Iliotibial Band Friction Syndrome / Runners Knee?

  • Endurance athletes - especially runners and cyclists. A sudden change in training often precipitates it, for instance rapidly increasing hill reps.
  • Sports people whose sports involve cutting movements for instance racquet sports
  • Sportspeople whose activity involves frequent squatting movements, for instance bowling
  • Having a bow legged position increases the tendency to iliotibial band syndrome as the band has further to stretch and this increases the tension on it
  • Over pronation at the foot increases rotation at the shin bone and consequently increases stresses on the iliotibial band
  • Men have a higher incidence of runners knee than women. It is especially prevalant in men aged 20 - 40

What is the Treatment for Iliotibial Band Syndrome/ Runners Knee?

  • A regime of specific stretching, strengthening and core stability exercises. We can offer a personal programme of exercises
  • The use of ice and anti inflammatory medication to reduce inflammation.
  • Relative rest: avoidance of the aggravating activity for a period of time to allow healing. Cross training may be used during this time
  • Address underlying causes: This may include looking at the underlying biomechanics (way movement occurs) of the whole leg
  • Cyclists can often benefit from altering their saddle height. Often cyclists with iliotibial band syndrome have the saddle too high. Have a look at our basic bike set up article.
  • Runners should look at their running shoes. Are the shoes correct for their running style - a gait assessment is useful. Are the running shoes worn out?
  • Assess training methods - frequent problems include track runners who don't alternate the direction they run on the track and fell runners who have a sudden increase in numbers of hill reps.
  • Orthotics - assessment by a podiatrist will determine if orthotics are needed. These go inside the shoe and alter its relationship to the ground on every footfall.
  • For resistant episodes a cortico - steroid injection may be considered, surgery is rarely of benefit.
  • The use of a foam roller to release tight points.



Disclaimer: The information on this page is written to help you understand your injury. There are many possible causes for pain on the outside of the knee and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.

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About the author

Jane Hodgson - Chartered Physiotherapist Jane Hodgson Jane specialises in lower body injuries and has raced competitively in running, orienteering and adventure racing.

Did you know

Iliotibial band friction syndrome is a common injury that causes outside knee pain. It accounts for 7% of running injuries in men who run middle to long distance (Cooper 2008)

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