Runners Knee The ITB
Pain at the outside of the knee ITB

I often hear people in running and cycling clubs talk about pain at the outside of the knee that gets worse with exercise. The talk of the dreaded ITB that attaches at the outside of the knee that causes friction that produces inflammation and then pain. Many people that present in The Recovery Room sports injury clinic after running or cycling through the pain until it eventually prevents them from exercising.

Signs and symptoms of ITB friction syndrome include:

Gradual onset of pain at the outside of the knee made worse with exercise, can get progressively sharper.

Pain that is worse when running up and down hills-due to a shorter stride pattern increasing the friction and irritation.

Physical Therapist Assisting Patient


  • Poor mechanics while running as weak glute muscles allow the knee to fold inwards.
  • Poor saddle height causing increased irritation at the knee.
  • Tight hip abductors that increase tension of the ITB and pressure at the knee.
  • Over pronation (flat foot).
  • Sudden increase in duration and intensity of exercise.
  • Treatment and prevention:
  • Rest, Ice, Compression and Elevation
  • Soft tissue therapy into the glutes, TFL and ITB. OR use a foam roller on these muscles.
  • Correct faulty firing patterns of the glutes and strengthen using side lying clam or hip abduction exercises.
  • Correct saddle height.
  • Rest or modify running to reduce pain- walk up and down hills.
  • Correct poor foot mechanics using orthotics.
  • Running Technique case study:


Case Study: Running Injury

A female recreational runner presented with long term anterior knee pain. Over the years she has dealt with the pain and altered her running style accordingly. With no symptoms at rest, the subjective and objective assessment was suggesting patella femoral joint syndrome as prolonged sitting and walking downstairs aggravates the symptoms.

Objective assessment showed overactive hamstrings on leg extension and, poor firing patterns as well as weak glute medius and minimus. The patient experienced altered mechanics while running to the extent that the medial aspect of the foot brushed the contralateral side of the swing through phase of gait.

My assessment of the knee and hip was thorough, although the ankle assessment was only using active movements. No abnormalities were detected.

On the tread mill after the warm up, it was evident that I was looking for alterations of mechanics at the hip and knee. Weak gluteus medius and minimus was my rationale for the incorrect gait, but this was only half the cause. The gait analysis helped me elicit the problem was also due to tibialis anterior weakness at the ankle, causing the ‘chewing gum’ gait.

This use of functional equipment and technique is very important in thoroughly assessing athletes and the cause of injury or overload.

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If you would like any more help or advice please feel free to get in touch on 07748 483639 and ask for James.