Outer Knee Pain Running: Causes And Treatment, Prevention

Outer Knee Pain Running: Causes And Treatment, Prevention


Your knees sustain an impact from each running stride you take. You can help keep your knees healthy by building your mileage over time and knowing when to rest. If your knees start to hurt, it's important to know what's causing your pain so you can properly treat it. Iliotibial Band syndrome, or IT band syndrome, is a common cause of outer knee pain for runners.

Outer Knee Pain Running: Causes And Treatment, Prevention

What’s causing my knee pain if the problem is in my hip?


The IT band starts at the hip as a wide tendon where it attaches to the hip bone (Ilium), the glutes and a small muscle called the tensor facia lata (TFL).  It runs down the outside of your thigh to just below the knee, attaching to the tibia.  This is why it’s called the “IT band.”  It connects the ilium to the tibia.  As the IT band approaches the knee, it rubs against the lateral condyle of the femur (see small image).  I like to use the car front-end alignment analogy to explain this:  If the alignment is off in a car, the tires wear more quickly.  The problem is not the tires, it’s the parts that align the tires.  In our knees, the IT band pain is the same as the worn tires, just a symptom of the root problem.

How is this related to running?


Think of your knees as simple hinge joints, similar to a door hinge.  They can only go forward and back.  Our kneecaps point in the direction that the hinge is facing.  So if you’re running forward you want your knees to flex straight forward and back, not at an angle.  If your knee is rotated inward, the friction of the IT band on the lateral condyle is greater and things become irritated, especially during repetitive movements like running.  When you see runner’s with their feet kicking out to the sides when they push off, you’re seeing the poor biomechanics of hip internal rotation in action.  They probably have painful knees.

How did this muscle weakness happen?


The short answer is sitting.  When we sit for hours at a time, the muscles are not active.  The use-it-or-lose-it philosophy rings very true here.  Over time, the muscles become more accustomed to being at rest and lose their strength.  I’ve noticed a trend when I talk to people about this subject.  The knee pain usually starts after about 5-6 years of working at a desk job.  Unfortunately, you can count graduate school as a sit-down job.  Incidentally, sit-stand work stations are becoming more popular and I strongly encourage people to consider those if they’re stuck behind a desk work.

Treatment for Outer Knee Pain Running


Taking a break from running helps your IT band heal. Icing your knee and taking an anti-inflammatory reduces pain and inflammation. Ice your hip if you experience pain there. Stretching your IT band and hips helps reduce the tension that contributes to IT band knee pain.

Prevention for Outer Knee Pain Running


Exercises and stretches that target the IT band and hip abductors will keep your muscles and connective tissue strong and flexible. Muscular strength supports joints and connective tissue so you're less likely to put excess strain on your IT band. Keeping your hips and IT band flexible reduces the chances of strain.