Iliotibial Band Syndrome (Runner’s Knee)

Nov 9, 2019

Runner’s knee (Iliotibial Band Syndrome) is a common term used in the athletic and physically active population and is a common injury in runners, hence the name. It can also be referred to as Condromalacia patella, anterior knee pain syndrome, patellofemoral malalignment or iliotibial band syndrome.

Some anatomy before getting to the real issue at hand…

Iliotibial band (ITB)The Iliotibial band (ITB) is located on the lateral (outside) aspect of the thigh, starting at the hip joint and inserting just below the knee joint. The ITB is not a muscle, but a thick fibrous band that’s made up of the Gluteus Maximus and Tensor Fascia Latea, which are both muscles that act on the pelvis.

According to Harvard Medical School, ITB syndrome occurs more in females than in males, especially females in middle age. Overweight and obese individuals are also at a greater risk for developing this injury.

What can cause Runner’s Knee?

Runner’s knee is mainly an overuse injury, which means that constant use/overuse of this fibrous band, especially during running (downhill or for prolonged periods) can cause irritation of the surrounding soft tissue or lining of the knee joint. Other contributors could be worn out cartilage at the knee joint, incorrect alignment of the kneecap, weak or tight thigh muscles or trauma to the kneecap, from a direct blow to it, for example. Improper biomechanics during running could be one of the major causes of runner’s knee, running on curbed road or incorrect or worn out running shoes.

What are the symptoms of Runner’s Knee?

The hallmark symptom of runner’s knee is a dull, aching pain at the outside of the knee that may limit activity. Pain usually start after the individual has run a certain distance and may then increase so much that the individual has to stop with the activity. During rest, the pain may disappear and return again when activity resumes. Runner’s knee is also usually described as a ‘referred pain’, meaning that the pain can start at the hip or lower back and travel down the outside of the thigh into the knee.

Another symptom is tenderness when palpating or touching along the iliotibial band. The runner may experience pain when:

  • Stair climbing, especially going down stairs
  • Walking, more so when running
  • Sitting down or standing up
  • Sitting for long periods of time and then standing up.

Prevention of Runner’s Knee

The best prevention strategies are explained below:

  1. Stay in shape: Overall health and conditioning needs to be main priority, doesn’t matter what sport or physical activity you partake in.
  2. Stretch: This is one component of exercise that is mainly overlooked by most runners. Doing 5 minutes of stretching before and after running can help to reduce the load placed on the knee joints during running, improve blood circulation to prepare and warm the muscles for the expected exercise.
  3. Gradual progression: NEVER abruptly increase the frequency or intensity of your running regime; make sure to make these changes gradually and incrementally as your body needs time to adapt to the new training load.
  4. Use proper running shoes: Buy shoes of good quality that helps to absorb the shock from the tar road or treadmill and make sure that it fits properly. If the shoes are old and worn out, rather invest in a new pair of shoes, even though the old ones might feel comfortable.
  5. Use proper running form: Do core activation exercises at least 3 times a week to ensure upright posture during running. Try to run on a smooth and even surface where possible. When running downhill, it’s a good idea to run a zigzag pattern, as it will take the pressure off the knees.

How can Runner’s Knee be treated?

One of the best practices to treat runner’s knee is to lengthen the iliotibial band through either stretching the surrounding musculature or releasing the ITB through foam rolling.

ITB StretchITB stretch

Stand close to a wall and keep hand against the wall. Place the leg closer to the wall behind the other leg and keep most body weight on that leg. Push your hip towards the wall as much as possible until a stretch is felt on the outside of the hip and thigh.

Sets: Do the stretch 2 times on each leg

Time: Hold the position for 20-30 seconds

ITB/Glute stretch

ITB/Glute stretchSit on floor with one leg bend over the other leg, keeping it straight down on the floor. Place opposite elbow on knee for leverage and push the knee towards the opposite shoulder. Turn upper body away from knee to intensify the stretch.

Sets: Do the stretch 2 times on each leg

Time: Hold the position for 20-30 seconds

ITB foam roll

ITB foam rollPlace the foam roller directly under the hip joint, bottom leg remains straight and top leg bent over. Control amount of body weight on the foam roller by assisting with the top leg. Roll from the hip joint to the knee joint along the outer thigh.

Sets: When starting off, only do 1-2 sets

Reps: 8-10 repetitions on each leg.


Simonè Ferreira

Simonè is a registered Biokineticist, currently lecturing at the University of Johannesburg. She also has a private practice in Boksburg. Her specific interests in the field of Biokinetics include sports Injuries, preventative rehabilitation & orthopeadic rehabilitation, with a keen interest in balance-related issues. She is also a keen runner.

Please note that information found in these articles does not constitute medical advice. If you are experiencing an injury or condition of any kind, it is always advisable to contact a medical professional for advice on your specific symptoms.

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