Are you a runner who has been experiencing lateral (outside) knee pain? Have you recently been increasing how much you run? Whether you run for fun, fitness, or competition, pay attention to knee pain should it appear.

Ilio-Tibial Band Syndrome is the most common cause of knee pain in runners. The ilio-tibial band (ITB) is a thickening of superficial tissue that runs from your pelvis down the outside of your thigh, passing over the hip and knee before finally inserting on the outside of your leg below the knee (see pic).

The ITB helps to stabilize the knee during the continuous flexion and extension of the knee during running activities. During these knee motions, the ITB slides back and forth across a normal bump on your thigh bone (femur), called the lateral femoral condyle. This continuous rubbing can lead to ITB syndrome, which is a sharp or stinging pain above and on the outside of your knee due to inflammation of the ITB.  While the area may be tender to touch, you likely will not see redness or swelling usually associated with inflammation.

The most common cause of ITB syndrome is overtraining, whether that means adding too much to your normal exercise regimen or perhaps starting out with too much too fast if you are a new to running. Other physical factors also play a role, such as hip abductor weakness, one leg being shorter than the other, or a cavus (very high arched) foot structure. Other factors can be related to the exercise itself, including always running on the same side of uneven or banked surfaces, inadequate warm-up or cool-down, or too much running up or down hills. All of these things put more strain on the ITB, causing it to become tight and inflamed.

Treatment for ITB Syndrome starts initially with rest, ice and anti-inflammatory medication, but this is usually not enough. Physical therapy modalities such as ultrasound, electrical stimulation, massage therapy and hip abductor strengthening may also be useful in not only calming down the inflammation, but also in preventing further injury. Once the pain is controlled, it is very important to stretch the ITB (and the hamstrings, calf muscles, and quadriceps to maintain proper balance between muscle groups). One way to do this is to use a foam roller on the ground and roll the outside of your hip and thigh across the roller.

Custom orthoses and a change in shoe gear may also be warranted to prevent chronic pain from ITB syndrome. Supportive, properly fitting shoes are important for running, and shoes tend to lose their valuable properties (and should be replaced) every 300-500 miles of use. It is usually necessary to make a change in the exercise itself. Once you return to running after getting rid of the pain, start slow and gradually increase your frequency and intensity. Minimize the amount of up and down hill running if possible. If you run on a sloped/banked running surface, make sure you switch which side of your body is dropping down lower (ie – if you run on the right side of the path going one direction, run on the left side coming back).

When in doubt about your pain, stop running and call for an appointment at 206.358.7000 or request an appointment through our website! Pain usually means something is wrong and should be fixed, not suffered through.

Rion A. Berg, DPM

Foot and Ankle Center of Lake City
2611 NE 125th St., Ste.130
Seattle, WA 98125

Keeping Feet Happy and Healthy In Seattle Since 1980



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