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Lateral knee pain


Lateral Knee Pain

Lateral knee pain on the outside of the knee is most often ITB Friction Syndrome, however the rarer types of lateral knee pain should not be missed as the optimum treatment will differ between them.  Lateral knee pain is one of the most common injuries for runners.


The Illiotibial band (ITB) is a long tendon of a small muscle from the hip – the Tensor Fascia Latae.  Gluteus Maximus also partially attaches to the ITB but at an oblique angle so that it has less mechanical advantage then the Tensor Fascia Latae.

The purpose of the ITB is to add to the lateral stability of the knee.  Through most of its length the ITB is a flat thickening of the deep fascia that holds the muscles in place.  However it becomes more like a thick cord as it approaches and passes the knee joint to attach to the main lower leg bone, the Tibia.


The pain in ITB friction syndrome is rarely within the ITB itself.  It is more commonly caused by inflammation or irritation of a bursa on a bump on the thigh Bone (femur). Bursa’s are lubricating sacks that help to reduce the friction between a tendon and the bone.

Excessive compression force from the ITB as it slides past the bursa during gait can cause trauma to the Bursa triggering the injury.  This usually happens just after footstrike at about 20 degrees of flexion.  The pain from ITBFS can be sharp and intense or aching.  It will usually not warm up as you run but get worse the longer you go.  Downhill running with its increased impact forces are more painful than running on the flat.

Are you experiencing ITBFS? Click here to see one of our podiatrists at intraining Running Injury Clinic


One interesting factor in ITBFS is that it can be caused by two opposite motions.  Excessive pronation or rolling in of the foot causes a stretching strain of the ITB as the pronation results in internal rotation of the knee.  Lateral instability and rolling out of the foot also puts tension and strain on the ITB.  It is critical that the biomechanics that is causing the tension be identified as any orthotic or footwear intervention can make the problem worse if misdiagnosed.

Foam rolling

Tightness of the ITB or adhesion’s to the deeper muscle are a factor in the risk of ITBFS.  Stretching of the ITB has not been shown to be effective.  Mechanically stretching the ITB with massage is much more effective at increasing flexibility and reducing adhesion’s.  Regular use of ITB rollers will reduce recovery time and the risk of recurrence of the injury.  Icing and anti-inflammatory gel will quickly reduce the severity of symptoms.


One injury often misdiagnosed as ITBFS is tendinopathy of Biceps Femoris one of the hamstring muscles.  It usually hurts just before its insertion on the head of the smaller leg bone the Fibula.  The symptoms can be very similar to ITBFS however the location of pain is distinctly different being more posterior.  Sometimes tension from Biceps Femoris affects the fibrous joint between the two lower leg bones requiring mobilisation.


Pain on the knee joint is often from trauma or degeneration to the lateral meniscus.  The knee sometimes gives way when there is a tear in the meniscus.  It is sore along the joint line crossing under the ITB and below where the ITB usually hurts.  Clinical tests can often identify meniscal abnormality but an MRI may be needed.  Osteoarthritis in the lateral knee compartment can also cause joint line pain.

Lateral knee pain is one of the most common injuries for runners.  It is important that you have an accurate diagnosis in order to recover from the injury and reduce risk of it recurring.

Article by: Steve Manning – Podiatrist and coach at intraining Running Injury Clinic
Article by: Steve Manning – Podiatrist and coach at intraining Running Injury Clinic

The podiatrists at the intraining Running Injury Clinic are experienced at treating lateral knee pain. All of our clinicians are runners and share your passion. Our team of clinicians can help plan a safe return to running with a specifically designed rehabilitation training program to get you back running, sooner.

If you have had lateral knee pain that lasts longer than two weeks or is severe enough to make you limp then you should make an appointment to see one of the podiatrists at the intraining Running Injury Clinic – Milton and Indooroopilly.

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