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What’s that knee pain I get when I run?


It’s called Ilio-Tibial-Band Friction Syndrome (ITBFS) and it is quite common.

The knee is the most commonly injured body part in runners, making up 25% of all running injuries. That is quite a lot, considering around 50% of all runners can expect to sustain a running injury over a 12-month period.

Various structures around the knee can be affected; quite frequently, runners develop pain on the outside of the knee which can be caused by an irritation of the Ilio-Tibial-Band (ITB), a band of connective tissue that runs from the pelvis to the outside of the knee.  The injury is called Ilio-Tibial-Band Friction Syndrome (ITBFS).

So what exactly is ITBFS?

ITBFS is an overuse injury that generally builds up gradually, so it is not an acute strain or tear.  Repetitive friction of the tissue of the ITB rubbing over a bony prominence along the outer thigh can result in pain and localised inflammation at the friction site.

Initially, the pain may only occur during a run but it can quickly progress with each run, to the point where the pain may linger after a run and even basic activities such as bending and straightening of the knee or lying on the affected side at night can be sore.

What are the causes?

A range of factors can contribute to the development of ITBFS, for example:

  • Training errors, such as a sudden increase in training intensity
  • Hip muscle deficiencies, e.g. weak gluteal muscles and reduced core strength
  • Poor ankle and foot mechanics
  • Running inefficiencies, such as a reduced cadence (running too slow), which often results in overstriding. This can put an increased load on the knee, causing ITBFS over time, especially when running long distances.
  • Poor footwear

So what can be done?

Reducing the load by changing the running program is absolutely essential in the acute stages. A course of anti-inflammatories and application of ice to the painful area may also be beneficial.

Foam rolling, as well as dry needling and deep tissue work to the ITB, quadriceps and gluteal muscles can help reduce symptoms.

In the long run, it is important to look at the underlying causes, addressing any issues related to running mechanics, footwear and, of course, muscular imbalances.  It is also important to return to running gradually and monitor your symptoms closely.

Below we have put together some exercises to strengthen your glutes, thigh and core muscles and help set you up for a better running performance.


Imagine you are sitting down on a chair behind you, slightly moving your pelvis forward and your buttocks back. Keep your knees aligned with your hips and ankles, avoiding excessive forward or inward movement of your knees. Use your buttock muscles to push up again.

Start with double leg squats; once you have mastered the technique, you can increase the speed of the movement, stand on an unstable base and finally progress to single leg squats.

















Glute med against wall

(Note: this can also be done without a ball)

Stand close to a wall, making sure your hip, knee and ankle of the standing leg are in a straight line. The other leg sits up against the ball (or wall). Make sure your pelvis is level and your trunk is upright.

Now push this leg into the ball as hard as you can whilst maintaining good alignment. You should start to feel your glute muscles (especially of the supporting leg) starting to fatigue after a few seconds.

  1. Hold for 10-15 seconds; repeat 10 x (2 sets)
  2. Progress to a single leg squat while maintaining good leg and trunk alignment


















Pelvic hitching

Stand on a step (side on) with your feet slightly apart; one leg is off the step, the other one on the step. Slowly hitch and then lower your pelvis (on the side of the unsupported leg) moving only the pelvis. Make sure that the movement comes from your abdominals (on that side), and your leg muscles are relaxed. Keep the knee of the standing leg stable and the knee straight.

























Side planks

Note: If you find the exercise with straight legs too difficult you can start with bent knees.

Resting on your forearm and the bottom foot, lift your pelvis until your body is in a straight line; then slowly lower your pelvis down towards the floor before lifting up again to the starting position. Make sure your body stays straight throughout the entire movement.

To progress, increase the speed when lowering and lifting the pelvis.






















We hope that this information has been helpful and wish you good luck with your running, whatever your goals may be.

BETTINA RUHL Physiotherapist

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