If you have experienced pain during and after running in the outer knee that makes you limp, wince and stop in your tracks, chances are you have ilio-tibial band (ITB) syndrome. The iliotibial band runs down the outside of the leg, from the outside of the pelvis to the outer knee and the top of the tibia. Not many structures in the outer knee which can cause pain. Pain in this area, especially if associated with a rapid increase in running distance and running on gradients, is often from the ITB. However, it’s important to rule out kneecap or knee joint pain and dysfunction, a stress fracture of the distal femur and referral from the lumbar spine or gluteals, as they can also cause pain here.
It’s common in newer runners or experienced runners increasing distance and speed quickly. Trail runners often experience this too, as running downhill a lot, sometimes the narrow step width, can increase load on the outside of the knee.
So is it ‘iliotibial band friction’? No! It’s compression. As knee extends, it compresses the structures on the outer knee. This is important because some of the ‘quick fix’ treatments such as foam rolling actually increase force and compression on the outer structures. It therefore doesn’t make much sense to foam roll the outer leg if you have this problem. If you enjoy it, can continue, but avoid compressing the distal third of the femur and near the knee. The same applies to stretching, as some resilience is needed in the band to store and release energy as we walk and run. Instead, to eliminate pain and get back to sport, you need to get used to taking load on the ITB.
Firstly, you need to consider that this is often a training ‘error’ – where the running load is greater than what the body can take. You may need to reduce the amount you do and amount of downhill walking and running you do. As physios, we want to keep you moving, so will give exercises and ways to keep you active. Uphill walking on a treadmill can be really useful in keeping you going and retraining the muscles to take a higher load, whilst not putting too much pressure on the ITB. Strengthening the hip and knee, usually in weight bearing and with the guidance of a Physio will also help. Split squats – with a trailing leg on a chair, and walking against the resistance of an elastic band, can help. Plyometrics (rapid, explosive exercises, such as jumping), are useful at a later stage when you are increasing your running again. Softer running surfaces can also reduce load. Avoid downhill and trails initially and add them in at the end of your rehab, when pain is much improved.
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