Proactive Physio | Knee Injuries

Pain on the outside of your knee?

Are you a runner making the most of the fine weather recently? Noticing pain on the outside of the knee? We have seen an increase in runners presenting to the clinic with this complaint. One of the causes of this can be iliotibial band syndrome.

The Iliotibial (IT) band is commonly injured in such sport like running and cycling where there is repeated motion in bending and straightening the knee. In fact, it is the one of the most common complaints among runners. Pain develops on the outside of the knee and along the outside of the leg. It is often felt initially when running and can progress to pain being felt in daily activities such as walking and stairs climbing.

The Iliotibial band is made up of connective tissue. This type of tissue is made up of strong material to provide support to the outside of the leg as you run, walk and cycle. It also provides an attachment point for two muscles at the hip, the TFL and the gluteus maximus.

What contributes to the development of this syndrome?

Suggested risk factors include; impingement or “friction” but most likely due to irritation of the lateral soft tissue structures of the knee.  

Is it the way I run?

Not always! The development of this syndrome may be linked with certain techniques of running. In some runners with IT band syndrome we have noticed that they become flexed in the trunk at the painful side and show patterns such as knee valgus (knees coming towards the midline of the body). If you tend to strike the ground toward the midline of the body instead of under the hip this may make you more prone to developing the syndrome. A very important factor to consider is your training programme. Any sudden spikes in training volume, type or intensity may lead to irritation of the tissues around the knee.

What can I do to prevent this?

Rest and recovery are important. Ensure you are getting adequate rest in between each session. Increase the volume of your training sensibly. If you are increasing your mileage it’s often good to avoid increasing your pace at the same time. Aim to increase distance first (~ 10% weekly) and then work on increasing your pace within that distance.

What if I already have this?

It makes sense that if we feel tightness in an area we would want to stretch it out. However, there is little evidence to support the stretching of the ITB. There is a lack of research in this area and so the advice we give is based on expert opinion. What we do know that helps is strengthening around the hip and the calf complex improves the body’s ability to cope with the load placed on it during running. We’ve added a couple of exercises to the post to help set you in the right direction.

If this is something you have been struggling with come and book in with one of our chartered physiotherapists. We will go through a comprehensive assessment of all the factors above and come up with a plan that is tailored to you.


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  1. Aderem, J. and Louw, Q.A., 2015. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC musculoskeletal disorders16(1), p.356.
  2. Falvey, E.C., Clark, R.A., Franklyn‐Miller, A., Bryant, A.L., Briggs, C. and McCrory, P.R., 2010. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scandinavian journal of medicine & science in sports20(4), pp.580-587.