Diagnosis and symptoms6 min read
Runner's knee: what is pain on the outer side of the knee?
The iliotibial band is a thick strip of connective tissue running from the hip to the outer knee. When it repeatedly rubs against the bony prominence at the knee during running it becomes irritated, and it is the most common cause of outer knee pain in runners.
Typical symptoms
Pain is felt on the outer knee, slightly above the joint line, at a point limited enough to indicate with a finger.
There is no pain at the start of a run; it appears after a certain distance and steadily intensifies. Patients usually know that distance quite precisely.
Pain reduces quickly on stopping. This distance-dependent pattern is the most characteristic feature separating it from other knee problems.
What increases it
Downhill running is the strongest trigger. On descent the knee spends longer in the range where the band rubs.
Descending stairs and long-distance running increase symptoms. Fast running usually causes fewer problems than slow running, a finding that surprises patients.
Running the same direction on a track and walking on the cambered side of a road create asymmetric load and trigger the picture on one side.
Differential diagnosis
In a lateral meniscus tear pain is on the joint line and sharpens with twisting; locking can occur. Locking is not expected in the iliotibial picture.
A lateral collateral ligament injury follows trauma and pain increases when force is applied to the outside of the knee. The iliotibial picture starts gradually without trauma.
In patellofemoral pain, symptoms are around the kneecap and increase with prolonged sitting. Sitting does not increase pain here; running distance is what matters.
Key points
- Pain is felt at a point on the outer knee.
- There is no pain at the start of a run; it appears after a set distance.
- Rapid reduction on stopping is characteristic.
- Downhill running is the strongest trigger.
- Locking is not expected here.
Frequently asked questions
Does it only affect runners?
No. It also occurs in cyclists and long-distance walkers. What they share is repetitive knee flexion and extension under load over long periods.
Does stretching the band fix it?
The iliotibial band is too strong a tissue to be lengthened by stretching. Stretching can give temporary relief, but the solution lies in hip strengthening.
How long does it take to resolve?
With load management and a hip programme, most patients improve markedly within four to eight weeks. Long-standing cases can take longer.
Related articles
- Treatment course· 6 min readTreating iliotibial band syndrome and returning to running
- Exercise· 6 min readThe exercise programme in iliotibial band syndrome
- Treatment decision· 6 min readOuter knee pain that persists: what to do next
- Daily living· 6 min readLoad management and injury prevention in runners
Other topics in the same region
- Diagnosis and symptoms· 6 min readMeniscus tear symptoms: which findings distinguish it
- Diagnosis and symptoms· 6 min readWhat is a Baker's cyst and what are its symptoms?
- Diagnosis and symptoms· 6 min readKneecap pain: what is patellofemoral pain syndrome?
- Diagnosis and symptoms· 6 min readJumper's knee: what is pain below the kneecap?
Articles of a similar kind
- Diagnosis and symptoms· 6 min readLumbar disc herniation symptoms: which pain points to a disc?
- Diagnosis and symptoms· 6 min readCervical disc herniation symptoms: what arm pain means
- Diagnosis and symptoms· 6 min readWhat is cervical flattening and what does it mean on an X-ray?
- Diagnosis and symptoms· 6 min readWhat is scoliosis and how is it noticed?
This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.