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Natural Awakenings Boston

When Running Creates Side Knee Pain

Jun 30, 2012 11:36PM ● By Alfred Roncarati


Many regular runners can find themselves troubled by injuries to the Iliotibial Band (ITB) as a result of repeated small micro traumas in the front and side of the knee. In some cases, these runners will end up with a disorder known as Iliotibial Band Friction Syndrome (ITBFS).

The ITB is a thick band of tissue that begins at the iliac crest (what most people call their hip bone). From there it extends down and eventually attaches to the shinbone. When functioning normally, the ITB acts as a stabilizing band between these bones and helps to lock the knee during extension. It moves forward when the knee is flexed and backwards when the knee is extended.

Activity such as running, aerobics, bicycling and even weight lifting can irritate the ITB tendon as it slides repetitively over the lower extremities. ITBFS is the result. Signs and symptoms of this problem can include pain and tenderness over the outside of the knee (where the ITB attaches) and radiating pain above or below the ITB attachment. ITBFS can also be signaled by pain that is aggravated by repetitive flexing and extension of the knee in such activities as walking and sitting for long periods of time.

As with any overuse injury, the main factors leading to ITBFS are training errors. Runners who increase their mileage excessively, run too frequently or expand the intensity of their running too abruptly are at risk for ITBFS. A runner’s footwear may also contribute to side knee pain, when training shoes wear out and fail to provide the heel stability that’s needed to protect from the repetitive shocks of running. Anatomical and biomechanical misalignments are frequently responsible for overuse injuries as well. Examples include bowed and knock knees, high or low arches, and ankles that roll inward or outward.

Treating ITBFS begins with rest, and the amount depends on the severity of the knee symptoms. Ice should also be applied to reduce inflammation. To prevent future overuse injuries, runners should follow sensible training habits, such as never increasing the distance, speed, intensity or frequency of their runs by more than 10 percent a week. Shortening the stride length can also help, as can orthotics to help neutralize the inward and outward rolling of the ankles.

Alfred Roncarati is a Licensed Physical Therapist at Cambridge PT & Sports Medicine, located at 1000A Cambridge Street in Cambridge. For more information call 617-492-6600 or visit