Lateral knee pain refers to the discomfort felt on the outer part of the knee. One common cause of this pain is the ITB syndrome, sometimes associated with a meniscal tear or other knee injury. The ITB (iliotibial band) is a thick band of soft tissue that runs outside your thigh, extending from your anterior superior iliac spine to your knee. It helps with leg movements like walking and running.

Sometimes, the ITB can tighten or become inflamed due to overuse, poor form, or muscle imbalances, causing pain outside the knee. This problem is frequent in runners and cyclists and can be attributed to wear and tear from their intense activities.

ITB Friction Syndrome

ITB Friction Syndrome (Iliotibial friction syndrome) is one of the most common causes of "Runner's Knee" and can account for up to 22% of overuse injuries in runners. This condition isn't typically linked to a specific incident but rather to repeated trauma, often a result of sudden twisting movements or prolonged stress on the knee joint.

The ITB attaches to a bony protuberance (femoral condyle) on the outside of the knee. It slides forwards and backwards across this bony point with movement. This repetitive sliding can create excess friction, especially when the knee is bent at 30 degrees, which commonly happens just as your foot strikes the ground in the running. This region of 30 degrees of knee flexion is called an “Impingement Zone” or pinching of irritated structures over the outer side of the knee, thereby producing ITB Friction Syndrome.

What is the Iliotibial Band?

The ITB, or iliotibial band, is a long, thin band of fascia that runs down the outside of your thigh. At the top of your thigh it is attached to your tensor fasciae latae muscle, and Gluteus Maximus, and at the bottom, it attaches to your tibia (lower leg bone or shin bone) and femoral condyle on the lower outside portion of the thigh bone.

What Causes ITB Syndrome?

Essentially Iliotibial band syndrome is caused by altered running biomechanics due to underlying muscular imbalances. Your biomechanics can alter due to a muscle imbalance (weakness or tightness), fatigue and ground impact issues.

The most common causes of lateral knee include:

• Poor biomechanics (running technique); particularly inwards rolling knees and hips

• Weak hip / gluteal muscles

• Weak hip rotators

• Weak inner quadriceps

• Weak core muscles

• Poor foot arch control

• Worn-out or unsuitable runners

• Sudden increase in mileage for training

• Excessive hill training (particularly downhill)

• Endurance running (training for ½. and full marathons, ultra-marathons)

The syndrome can also be brought on by lcl sprain, sudden twisting of the knee, possibly leading to ligament tears. Meniscus tear, another potential cause of outer knee pain, may also result from sudden twisting motions.

What are the Symptoms of ITB Syndrome?

There are varying degrees of severity of ITB Friction Syndrome. The most common symptoms include:

• Sharp or burning pain just above the outer part of the knee

• Pain that worsens with continuance of running or other repetitive activities

• Swelling over the outside of the knee.

• Pain during early knee bending

• If the pain started persistently lasting for more than 4 weeks, it could cause significant interference in sports or other activities.

How is ITB Syndrome Diagnosed?

On examination, your physiotherapist or sports doctor will look for signs of ITB Friction Syndrome. The important diagnosis is discovering “what is causing” the problem. If this isn’t determined ITB friction syndrome will persist on a return to running. With a thorough assessment, further investigations, such as scans are not required.

ITB Syndrome Treatment

Many patients with ITB Friction Syndrome start to feel better within a few weeks of the injury. Your physiotherapy treatment will aim to:

• Diagnosis the actual cause of your ITB friction syndrome.

• Reduce acute pain and inflammation.

• De-load your IT band.

• Assist you with modifying your exercise or training regime to reduce pain and prevent recurrence.

• Normalise joint range of motion or your hip.

• Strengthen your knee, hip and leg muscles

• Normalise your lower limb muscle lengths.

• Improve your proprioception, agility and balance.

• Correct your running and landing technique and function.

If you are experiencing any of the above symptoms call our clinic on +61289709166 to organise an assessment with one of our experienced physios.

Lateral knee pain whilst running? Is it ITB Friction Syndrome?