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Runner's Knee: Causes, Symptoms & Treatment

Runner's knee is a pain syndrome on the outer knee, common in endurance athletes. It is caused by irritation of the iliotibial band. Learn about causes, symptoms, and treatment.

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Things worth knowing about "Runner's knee"

Runner's knee is a pain syndrome on the outer knee, common in endurance athletes. It is caused by irritation of the iliotibial band. Learn about causes, symptoms, and treatment.

What is Runner's Knee?

Runner's knee (medically known as iliotibial band syndrome, or ITBS) is a painful overuse injury affecting the outer part of the knee. It occurs when the iliotibial band – a thick band of connective tissue running from the hip to the shinbone – repeatedly rubs over the bony prominence on the outer thigh bone (lateral femoral epicondyle), causing friction and irritation.

Causes

Runner's knee typically develops due to repetitive bending and straightening of the knee, as seen in running, cycling, or hiking. Common contributing factors include:

Rapid increases in training volume or intensity
Running on uneven, sloped, or hard surfaces
Weakness in the hip abductor and gluteal muscles
Biomechanical issues such as bowlegs or overpronation
Worn-out or inappropriate footwear
Insufficient recovery time between training sessions

Symptoms

The hallmark symptom of runner's knee is a sharp or burning pain on the outside of the knee, which typically appears after a certain distance of running and worsens with continued activity. Other common symptoms include:

Pain when climbing stairs or running downhill
Tenderness when pressing on the lateral femoral epicondyle
Occasional mild swelling or warmth on the outer knee
Symptoms that ease with rest but quickly return upon resuming activity

Diagnosis

Runner's knee is usually diagnosed clinically, based on a physical examination and medical history. Common diagnostic procedures include:

Noble compression test: Pressure pain at the epicondyle with the knee bent at 30 degrees
Ober test: Assessment of iliotibial band flexibility and tightness
MRI (Magnetic Resonance Imaging): Used in unclear cases to rule out other conditions such as meniscus tears or ligament injuries

Treatment

Conservative Management

The majority of runner's knee cases respond well to conservative treatment without surgery. Key treatment components include:

Reduction or temporary cessation of training: Rest is the most important first step
Physiotherapy: Targeted stretching and strengthening exercises for the hip, gluteal, and thigh muscles
Foam rolling: Self-massage techniques to release tension in the iliotibial band
Anti-inflammatory medication (NSAIDs): Such as ibuprofen for short-term pain relief
Ice therapy: Application of ice to reduce pain and swelling
Gait analysis and footwear assessment: Adjustments to stride length and running shoes

Additional Treatment Options

Corticosteroid injections for persistent symptoms
Extracorporeal shock wave therapy (ESWT)
Surgical intervention in rare, treatment-resistant cases

Prevention

Recurrence of runner's knee can be effectively prevented through regular strengthening of the hip and gluteal muscles, gradual increases in training load, adequate rest periods, and choosing appropriate footwear.

References

Louw, M. & Deary, C. (2014): The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners. In: Physical Therapy in Sport, 15(1), 64–75.
Strauss, E.J. et al. (2011): Iliotibial band syndrome: Evaluation and management. In: Journal of the American Academy of Orthopaedic Surgeons, 19(12), 728–736.
van der Worp, M.P. et al. (2012): Iliotibial band syndrome in runners: A systematic review. In: Sports Medicine, 42(11), 969–992.

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