The most common cause of lateral knee pain in runners is Illiotibial Band Syndrome, or IT band syndrome (“ITBS”).
ITBS most often presents as pain over the lateral knee, which appears during or after running. The pain often subsides immediately or within a few hours after running, but it returns with every run.
Anatomy of the IT Band
Anatomically, the IT band is a long, thick structure running along the lateral portion of the thigh, from the hip to just below the knee. It essentially acts as a long tendon of the gluteal muscles involved in moving the thigh out and back (hip abduction and extension).
Structurally, the IT band is extremely dense. It is more akin to a leather belt than a spring. Like a tendon, it has very little give, and for all practical purposes, it does not stretch. One can place a stretch on it, but that does not mean it will give.
For eons, athletes with ITBS have tried to statically stretch the IT band with little, if any, lasting effects. Treating symptoms rather than causes has little value when dealing with this syndrome.
IT Band Syndrome
In runners, abnormal tension develops within the IT band due to weakness of the hip abductors (gluteal muscles). That’s right. Your knee pain is rooted in your buttock, not your knee.
If the gluteal muscles are not strong enough or are not firing properly, the knee will drift inward after footstrike, placing additional stress on the IT band. The resulting compression of the soft tissues over the lateral knee eventually leads to inflammation, myofascial adhesions, scar tissue and pain, otherwise known as ITBS.
Research has shed much light on gluteal weakness as one of the primary causes of ITBS. In 2000, a pivotal study was done by Michael Frederickson, MD, and his colleagues at the Stanford Department of Functional Restoration. In the study, athletes with ITBS had significantly weaker hip abductors than their uninjured counterparts.
After completing a strengthening program targeting the hip abductors, the injured runners showed significant improvement in their symptoms. In fact, symptom improvement paralleled the improvement in hip abductor strength.
Activities That Can Cause IT Band Syndrome
This is somewhat consistent with what we see clinically. Athletes with ITBS almost always display relative weakness of the hip abductors. Strengthening the gluteal muscles and treating the soft-tissue fallout generally results in a functional cure. Treating the weakness or the soft-tissue alone only provides short-term relief. Both problems must be addressed in order to effect lasting change.
Clinically speaking, along with exercise, soft-tissue therapies designed to flush edema and break up scar and adhesions (e.g., Active Release Techniques, Graston Technique, etc.) are very effective.
Besides gluteal weakness, there are certain activities that can cause acute ITBS:
- Too much volume or distance, too soon (overtraining)
- Running downhill
- Running on cambered roads
- Extreme muscle development of the quadriceps (muscle bulk adds to the compression of the soft tissues sandwiched between the muscle and the IT band).
Preventing IT Band Syndrome
Common self-employed techniques for treating and preventing ITBS include regular use of the foam roller over the quadriceps, IT band and gluteal muscles; dynamic (not static) stretching of the gluteal muscles and strengthening exercises involving the gluteal muscles involved in hip abduction.
Lateral knee pain should always be evaluated by a physician. Many other knee problems can mimic ITBS, including injuries to the lateral meniscus, lateral collateral ligament, tumors, infections and cysts.
Further, hip abductor weakness can cause numerous other injuries that may need to be evaluated. Consult with your physician before embarking on any exercise program.
ITBS is a common condition. Many of the effects can be prevented or diminished by focused strengthening of the gluteal/hip muscles. Hip stabilization exercise should be a regular part of every athlete’s training.