Runner's Knee


Runners knee or iliotibial band friction syndrome is an injury to the side of the knee that commonly occurs in runners.

To understand how this syndrome works you have to look at the structure of the iliotibial band or ITB as it is commonly known.
The ITB attaches high in the pelvis and runs down the outside of the leg where it attaches into the outside of the knee. The ITB band is recruited to help stabilise the pelvis. When the gluteal muscles are not functioning properly the ITB takes on more of a stabilising role and over time can become excessively tight.

Tightness of the ITB band causes friction and compressive forces on the outside of the knee.  These forces cause pain as the tissues beneath the distal end of the ITB to become compressed. The majority of these forces occur during foot strike, the part of the running stride where the foot comes into contact with the ground. Downhill running is particularly bad for this syndrome as the leg is significantly straighter at foot contact causing more stress from the ITB on the lateral femoral condyle.


Signs and symptoms of ITB friction syndrome or runners knee:

  • An ache on the outside of the knee aggravated by running.
  • Aggravated with downhill running.
  • Aggravated with longer runs.
  • Aggravated with walking up and down stairs.
  • Aggravated with squatting movements.
  • Uncomfortable to push on the outside of your knee.
  • Knee stiffness.
  • You may develop a limp.
  • You may have a grinding or clicking sound as you flex and extend your knee.

Ignoring the symptoms is likely to cause your symptoms to become worse and become chronic.  Once chronic the healing time is significantly longer and the treatments will be much more intensive and possibly uncomfortable.


In order to treat ITB band friction syndrome or runners knee correctly an assessment of the lower back, hips, legs and feet needs to be completed by a physiotherapist. This assessment will diagnose why it is that your ITB is tight show you what to do to correct your dysfunctions to ensure you gain relief, train unaffected and don’t have this troublesome syndrome returning.

Treatment may consist of:

  • Avoiding aggravation activities to allow the inflammation to settle down.
  • Icing the knee.
  • Stretching the ITB band and any other restricted muscles.
  • Correcting any faulty running biomechanics, we will assess your lumbar/pelvis stability and strength; your footwear.
  • Soft tissue massage to release tight muscles.
  • Mobilisations or manipulations to the lower back/Sacroiliac joints if they are restricted.
  • Strengthening for your lower back, hips or knees.
  • Revision of current exercise program and alter accordingly to ensure a complete recovery.