Iliotibial Band Pain: Why Your Outer Knee Hurts When You Run

If you’ve ever felt a sharp or burning pain on the outside of your knee while running, especially downhills? If the answer is yes, then you might be dealing with Iliotibial Band Pain (ITB pain).

It’s one of the most common causes of outer knee pain in runners, cyclists and active people.

What Is ITB Pain?

The iliotibial band (ITB) is a thick band of connective tissue that runs down the outside of your thigh. It starts at your hip and attaches just below your knee.

Its functions include:

• Helping stabilise your knee

• Assisting with hip movement

• Supporting your leg during walking and running

When irritated, it can cause pain on the outside of the knee, usually just above the joint line.

Why Does ITB Pain Happen?

ITB pain is considered an overuse injury. It’s common in:

• Runners

• Cyclists

• Hikers

• Sports involving repetitive knee bending, straightening and pivoting

During running, your knee bends to about 30 degrees when your foot hits the ground. At this angle, the ITB experiences the most compression against the outside of the thigh bone.

If there is:

• Weakness in the hip muscles (especially glute medius)

• Weakness in knee flexors and extensors (e.g. quads and hamstrings)

• Poor control of hip movement

• Sudden increase in training load

• Excess downhill running

Common Symptoms

• Sharp or burning pain on the outside of the knee that can radiate into the outer thigh or calf

• Pain that starts after a certain distance while running

• Worse pain when running downhill or going downstairs

• Tenderness when pressing on the outside of the knee

• Occasionally a snapping sensation

• Swelling on the outer side of the knee

Early on, pain may settle when you stop doing the aggravating activity. If untreated, it can become persistent and sharper.

Who Is at Risk?

ITB pain is more common in runners, and some contributing factors may include:

• Changes in running volume or intensity

• Hip abductor weakness

• Reduced hip strength or control

• Biomechanical factors (such as hip adduction, rotation patterns or poor rearfoot mechanics)

It’s usually caused by several factors listed above rather than one single factor.

How Is ITB Pain Treated?

Most cases improve with conservative management. Surgery is rarely needed.

It is essential to address both the irritated tissue and the underlying strength and load issues.'

1. Load Management

   Reducing aggravating activities temporarily (e.g. cutting back running distance or avoiding downhill running) helps calm symptoms.

   Complete rest is usually not necessary. Active rest is recommended as you stay active while working below your pain threshold. Some activities to maintain fitness can include swimming and upper-body training. The goal here is to reduce irritation without completely deconditioning.

2. Strengthening the Hip Muscles

   Once symptoms are settling, strengthening becomes the next priority. Research consistently shows that strengthening the hip abductors is important.

   Common rehab exercises include:

   • Glute bridge (with resistance band)

   • Side-lying hip abduction

   • Lateral band walks

   • Side plank

   • Hip hikes

   • Single-leg step-downs

   • Single-leg deadlifts

3. Myofascial Release & Foam Rolling

   Foam rolling the outer thigh and surrounding muscles (like glutes and tensor fascia latae) may help reduce pain, especially in the early phase.

   This can help manage symptoms while building strength.

4. Pain Relief Strategies

• Ice

• Heat

5. Individualised Rehab

The most effective program depends on:

• Your strength

• Your running style

• Your weekly training load

• Your goals

This is why a tailored assessment and rehabilitation plan can make recovery faster and safer.

Alternative Treatment Options

1. Therapeutic ultrasound

2. Iontophoresis or phonophoresis

1. It aims to deliver anti-inflammatory medication through the skin using electrical current or ultrasound.

3. Radial shockwave therapy

1. It works by stimulating tissue healing, reducing pain sensitivity and improving circulation.

How Long Does It Take to Recover?

With appropriate management, many people improve within weeks to a few months.

At 6 months, research shows that conservative treatment is effective for most people.

The key is to:

• Not to ignore early symptoms

• Address the underlying strength deficits

• Gradual return to running

When Should You See a Physio?

You should seek help if:

• Pain doesn’t settle despite rest

• It keeps coming back

• It’s limiting your training

• You’re unsure whether it’s ITB pain or something else

Lateral knee pain can sometimes mimic other conditions, so proper diagnosis is important.

Conclusion:

ITB pain is common, but very manageable. It’s not about the band being too tight. It’s more often about load, strength, and control.

If you’re struggling with outer knee pain, a tailored rehab program can get you back to running stronger and more confidently.