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There are many causes of “runners knee”

  • Tight ITB

  • Poor foot biomechanics e.g over pronation

  • Weak and lengthened stabilising hip abductor muscles

  • Leg length discrepancy

  • Tight muscles such as gluteus maximus, TFL, and adductors

  • Poor core stability

  • Overtraining Incorrect footwear


The Iliotibial band (ITB) is a fibrous band extending from the hip to the outside of the knee. Its purpose is to straighten the knee and move the hip sideways. It is also involved in stabilising the hip and knee, particularly in activities such as running.


The ITB arises from the pelvis and continues down to the bony part on the outside of the knee (the lateral epicondyle of the femur). It is here where it is prone to friction. At an angle of about 30 degrees the IT band flicks back behind the lateral epicondyle, when the knee is straightened it flicks in front of the epicondyle. It is approximately this angle when the foot strikes the ground during running. This can cause pain down the side of the leg and cause friction on the outside of the knee joint. In people who run regularly this may lead to irritation of the ITB – this is termed ITB Friction Syndrome, also known as ‘runners knee’


Signs and symptoms

  • Ache on the outside of the knee.  Made worse or brought on by running.  Worse on going down slopes or stairs and getting up from a seated position. Tender to touch on the outside of the knee.

  • R.I.C.E

  • Analgesia

  • Rest from aggravating activities




Return to running or sports activity can be attempted once pain and tenderness have dramatically reduced, strength has improved and any contributing biomechanical factors have been addressed.


If the pain persists it is worth having a physiotherapist accurately diagnose and assess the area. Physio treatment may include:

  • Deep friction massage and myofacial release to the ITB and other tight muscles

  • Dry needling techniques

  • Biomechanical assessment possibly using video analysis

  • Advise on strengthening and stretching program

  • Shoe advice and or orthoses referral.

  • Lower limb alignment assessment




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