Lateral knee pain with running? It may be ITB syndrome

Iliotibial band syndrome (ITBS) is an overuse injury resulting in pain on the outside of the knee. It is often seen in runners and usually develops gradually over time with symptoms often occurring at the same time in a run.
Women running on a treadmill.

Iliotibial band syndrome (ITBS) is an overuse injury resulting in pain on the outside of the knee. It is often seen in runners and usually develops gradually over time with symptoms often occurring at the same time in a run. In a clinical setting the pain is located at the knee, however the injury management needs to target the hip region. It is commonly associated with an underlying weakness of the hip abductor muscles.

The iliotibial band (ITB) is composed of dense fibrous connective tissue that runs from the hip region particularly, the tensor fasciae latae (TFL) and gluteus maximus muscles that tend to pull the ITB fibres upward where is connects to the lateral aspect of the knee.

The main symptom of ITBS is a sharp pain on the lateral aspect of the knee, particularly when the heel strikes the floor at slightly below 30° of knee flexion. The pain tends to be worse when running, walking downstairs and distance cycling. There may be an audible snapping sensation when the knee bends due to the band flicks over the bony tubercle. There may also be some swelling on the outer side of the knee.

To self-assess for ITBS, a positive Renne’s test will show pain with a standing single leg squat movement. This can indicate ITBS. (Video: https://www.physio-pedia.com/Renne_test)

The aim of ITBS treatment is to reduce pain and inflammation not only at the pain site of the lateral knee, but also to reduce muscular tightness of the whole gluteal region. This includes cold therapy, rest, taping, bracing, and sports massage that needs to target the TFL, ITB, calf, and gluteal muscles.

After a period of rest, symptoms disappear only to return when the patient returns to normal training. Therefore, the other things to consider with ITBS injury management which are.

1) Orthotic devices to help correct and stabilise foot and ankle biomechanics.

2) Prescribed gluteal stability exercises such as side lying banded clam and single leg exercises which focus on strengthening the hip abductor and lumbopelvic musculature.

3) Warm up with foam rolling along the ITB to help reduced muscular tightness.

4) Individualised running program to help prevent poor running form with fatigue.

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