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Recognizing and Rehabilitating Runner's Knee

Posted by Douglas W. Stoddard MD, M Sp Med, Dip Sport Med, ES on 26 June 2015
Recognizing and Rehabilitating Runner's Knee

Iliotibial Band Syndrome, also known as "IT Band Syndrome", refers to pain and inflammation experienced over the lateral aspect of the knee during flexion and extension. The iliotibial band (ITB) is a thick band of tissue which originates from the pelvis and inserts into the lower leg (tibia), and indirectly into the knee cap (patella). During flexion and extension of the knee, the ITB slides over a bony protrusion of the upper leg bone (lateral femoral epicondyle).

Irritation of the ITB occurs when from excessive friction of the ITB over the upper leg bone. Tightness of the ITB increases the friction of the band as it passes over the leg bone. Excessive friction eventually will cause pain, and start an inflammatory reaction. The inflammation may result in scar tissue formation, adhering the ITB to surrounding structures, which in turn causes further dysfunction and exacerbation of the problem. ITB syndrome is a common injury among runners and cyclists due to the repetitive knee flexion and extension performed during each sport. IT Band Syndrome is also commonly referred to as "Runner's Knee".


The IT Band connects the pelvis (ilium), upper leg (femur) and lower leg (tibia and fibula). It is soft tissue called fascia that originates from the waist and the lateral tubercle of the ilium, and extends down the side of the leg, attaching to the outside of the tibia and fibula. Closer to the knee joint, the ITB blends with fascia that inserts into the patella and influences tracking of the knee cap. The ITB also blends with the gluteus maximus and tensor fascia lata muscles in the pelvis.

An imbalance in strength of these two muscle groups can cause the resting position of the ITB to shift forward or backward, predisposing the athlete to injury.


  •     Pain or aching along the length of the IT Band on the outside of the hip, the greater trochanter, thigh, upper leg and/or more commonly, the knee
  •     Pain may occur during or shortly after a run or activity
  •     Crepitus over the lateral knee
  •     Tenderness in surrounding muscles as a result of abnormal compensation of the body to protect the injured structure.


  •     Running
  •     Cycling
  •     Incorrect training
  •     Lack of stretching
  •     Muscle spasms in surrounding areas
  •     Weak surrounding muscles
  •     Altered biomechanics of any joint of the lower extremity
  •     Leg length discrepancies
  •     Bow legs
  •     Foot pronation
  •     Occupation - prolonged sitting, heavy lifting and carrying


Assessing the area to determine the factors contributing to the syndrome will determine the focus of the treatment. Specific tests may indicate decreased tissue length of the IT Band, weakness of surrounding musculature, and altered joint mechanics. Tenderness at specific locations will also aid in determining the focus of treatment. Treatment focus may be the origin of the ITB at the hip, its insertion into the knee, surrounding musculature of the ITB, or a combination of the three.


  •     Increase the length of the IT Band along the thigh, regaining lost range of motion
  •     Increase circulation, flushing out built up toxins and any metabolic wastes that occur within the tissues before and after treatment
  •     Decrease hypertonicity spasm or tightness in muscles surrounding the area
  •     Promote tissue health
  •     Return to daily activities without pain


  •     Restore normal joint biomechanics (mobility) of the lower extremity
  •     Develop an exercise program to address muscle imbalances of the lower extremity and pelvis
  •     Decrease pain
  •     Decrease inflammation
  •     Promote gradual safe return to sport


Prevent future reoccurrence of symptoms by providing patient education towards early identification of symptoms, the importance of proper warm up / stretching, and safe training progression.


If you're experiencing one of the symptoms of runner's knee, SEMI's sports physiotherapy and massage teams can devise a treatment plan to reduce pain, inflammation, and restore joint mechanics and range of motion in the leg. To learn more about our sport massage therapy and sport physiotherapy treatments, contact us today! 



    Rattray, Fiona S. "Iliotibial Band Syndrome." Massage Therapy, An Approach to Treatments. 1995; 171-76.
    "2 Iliotibial Band Syndrome Illustrations" Sports Medicine Advisor, 2004.

Tonia Trentadue,  BA, RMT
Massage Therapist

Printed: October 2005
Copyright ©2005 SEMI
Author: Douglas W. Stoddard MD, M Sp Med, Dip Sport Med, ES
About: Dr. Douglas Stoddard is a sports medicine physician and is the Medical Director of the Sports & Exercise Medicine Institute (SEMI). After receiving his medical degree from the University of Toronto, he trained in Australia at the Australian Institute of Sport in Canberra, obtaining his Master Degree in Sports Medicine. He is also a diplomat of the Canadian Academy of Sport and Exercise Medicine and has his focussed practice designation in Sport Medicine from the Ontario Medical Association. Dr. Stoddard is a consultant to the Canadian Military and has consulted with well over 30,000 unique patients in his career. Dr. Stoddard is constantly searching for new and promising therapies to help SEMI patients, and is responsible for developing the RegenerVate Medical Injection Therapy Program. He is married and the proud father of two boys, is an avid triathlete and occasional guitar player.
Tags: Lower body Treatment options


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