Runner’s knee (ITBS): symptoms, causes and treatment

Ifyou’re a runner, play football or take part in another running-intensive sportand you’re experiencing stabbing knee pain, a diagnosis of runner’s knee (ITBS) is likely.

Stabbing pain on the outside of the knee joint is typical of what’s known as runner’s knee, also called jumper’s knee or ITBS. The medical term for runner’s knee is ‘iliotibial band syndrome (ITBS)’ or ‘tractus iliotibialis syndrome’.

The pain usually starts during a run and may progress to walking. ITBS often appears when you increase the volume or intensity of your training. We recommend conventional methods such as muscle–fascia training to help manage your symptoms.

01. What is runner’s knee?

The broad, tough fascial band (iliotibial tract) is important when running because of its stabilising function for the hip and knee. It runs from the iliac crest along the side of the thigh, over the outside of the knee to the lateral condyle of the tibia below the knee and also connects the gluteal muscles to a muscle called the tensor fasciae latae. Together, they help stabilise your leg axis.

03. What causes runner’s knee?

It's an overuse injury triggered by a combination of myofascial shortening and tightness, restricted movement, strength deficits and the resulting imbalances.

Reduced mobility of the tensor fasciae latae as a cause of ITBS
The tensor fasciae latae and the gluteal muscles both insert into the ITB and pre-tension the band for its stabilising function. If the tensor fasciae latae becomes too tight (which can be caused by excessive sitting), the thigh rotates inwards and is pulled into a position of increased hip flexion. This also increases the tension across the entire iliotibial tract – resulting in increased friction on the outside of the knee. You can imagine this as a woollen cord rubbing repeatedly against a sharp stone edge. Sooner or later, irritation sets in

Lack of activity and weakness in the gluteal muscles as a cause of ITBS
Their main job is to extend the hip, keeping your body upright and aligning thighs, pelvis and upper body in a straight line. It's precisely our gluteal muscles that suffer from the seemingly comfortable conditions of constant sitting. This constant compression severely restricts both the mobility and the neuromuscular activity of these muscles. Once the gluteal muscles have weakened, they can no longer adequately maintain the balance with the tensor fasciae latae.

Inward rolling of the foot (overpronation) as a cause of ITBS
The biomechanics of the feet form the foundation of a healthy running style. Feet that roll inwards trigger a chain reaction: the knees and thighs follow suit. The iliotibial band on the outside of the thigh responds by becoming highly tense in order to stabilise the movement as effectively as possible and compensate for the inward roll of the foot.

Weak pelvic stabilisers as a cause of ITBS
Many runners show a pronounced inward roll of the lower leg, and while a slight roll is natural, excessive movement can indicate weak hip stabilisers. However, if the lower leg tilts excessively inwards, this may indicate that the pelvic stabilisers are too weak. When weakened, these muscles can no longer fulfil their role of keeping the outer thigh within a stable leg axis. This also increases the tension on the outer thigh and can lead to runner’s knee (ITBS).

When running, the lower limb chain functions as a single unit, so loosening tight calf muscles is also important for the knee: if the calves lack flexibility, the push-off phase during the running stride changes — and the load shifts upwards.

04. How long does runner’s knee last?

With targeted treatment for runner’s knee, you can quickly relieve your symptoms. However, it can take up to 12 wk for tendons, fascia and ligaments to heal completely. This is particularly important when it comes to managing your workload: increase your running distances and intensity gradually in the first few weeks, even if the runner’s knee (ITBS) appears to have disappeared and you’re pain-free. Follow our advice on rest and running shoes and do the exercises consistently to prevent and relieve runner’s knee.

05. How long should you rest?

Stick to the rest period while you work through the corrective exercises. Fresh irritation will delay long-term recovery and undo your training. Remember, your ITBS arose from the one-sided strain of running. If you return to running too soon you’ll simply go round in circles. Give your body the time it needs to recover before your runner’s knee and the pain become chronic. Take the break and you’ll usually see a rapid improvement.

06. Which running shoes/knee brace for runner’s knee (ITBS)?

A brace can help stabilise theknee and provide some relief. In some cases — and this depends both on the individual and the brace — it can lead to increased pain due to additional pressure. Try it yourself to see if a knee brace is right for you. Remember, a brace can only support; it can’t remedy the causes of runner’s knee described above.

Which running shoes should you use? It's difficult to give a general answer to this question. The choice depends on factors such as body mechanics, muscle tension, running style and running volume. Sometimes, in cases of overpronation of the foot as described above, appropriate insoles can help. In general, we recommend using the following exercises and adjusting your running style to utilise the arch of the foot and the ascending muscle-fascia chains as actively working and shock-absorbing structures, rather than relying on the bone-joint chain. This approach corresponds to a healthy barefoot running technique and effectively amounts to a recommendation for barefoot running shoes. Please note: making the transition takes time.

‘Runner’s knee is one of the most common diagnoses for knee pain, particularly among young and active people. Tissue changes such as shortened muscles and stuck fascia often lead to joint misalignment caused by a counter-rotation of the thigh and lower leg, as well as to unphysiological pressure and tension on the outer knee joint. Runner’s knee can be effectively treated by taking appropriate measures to correct these imbalances and by adjusting one’s activity levels.’ Dr Torsten Pfitzer, holistic pain therapist and health coach

08. Iliotibial band syndrome

It’s a common problem among runners and is often linked to runner’s knee. It’s a band of connective tissue that runs along the outside of your thigh and attaches to your knee, and when it’s overused or irritated it can cause pain from the hip down to the outer knee.

It’s common among runners, especially those covering long distances or training intensively. Causes often include biomechanical issues such as overpronation (the foot rolling inwards upon landing), weak hip or leg muscles and excessive running on hard surfaces.

You'll feel pain on the outside of the knee that worsens when you run or climb stairs; it can be dull and aching or a burning sensation, and you might notice swelling or irritation around the outer knee.

Rest, avoid activities that worsen symptoms and complete physiotherapy exercises to strengthen your hip and leg muscles. Stretch the iliotibial band to reduce tension.

09. Tensor fasciae latae pain

The tensor fasciae latae is a muscle on the outer side of the thigh that plays an important role in running, particularly in stabilising the pelvis and hip whilst running. Pain in this area is often associated with runner’s knee.

The tensor fasciae latae can play a role in runner’s knee, as an imbalance or weakness in this muscle can impair the running motion, leading to poor alignment of the kneecap. This can result in excessive friction and pressure on the kneecap, which in turn causes pain.

You may feel pain on the outside of the knee, stiffness or a sense of instability around the kneecap, symptoms that tend to worsen during running or other high-impact activities.

10. Physiotherapy and rehabilitation for runner’s knee

Physiotherapy and rehabilitation play a crucial role in the treatment of runner’s knee (ITBS). As part of a personalised programme, physiotherapists focus on strengthening and stretching the affected muscle groups, as well as on improving the movement patterns that led to overload. Targeted exercises strengthen the hip and gluteal muscles and stabilise the knee, which helps to reduce strain on the iliotibial tract and prevent future injuries. We also teach techniques for self-massage and fascia training that support recovery and improve tissue flexibility. Gradually resume running under professional supervision to avoid disrupting healing.

11. Various pain relief techniques

We use various pain relief techniques to manage the discomfort associated with runner’s knee (ITBS). In addition to cold or heat therapy, which can soothe inflamed areas and boost circulation, manual therapies such as trigger point treatment or gentle massage also play an important role. These help to release tension in the affected muscles and fascia, thereby reducing pain. Furthermore, targeted stretching exercises for the iliotibial tract and adjacent muscle groups can help with pain relief by reducing tension in the tissue. Another approach is taping techniques, which relieve pressure on the affected area whilst improving range of motion. Finally, anti-inflammatory medication may be considered; however, always consult a doctor so that the cause of the symptoms can be treated rather than merely alleviated.

15. How to prevent runner’s knee (ITBS)

Prevent runner’s knee (ITBS) by optimising your running style and incorporating more three-dimensional movements into your training, such as side steps, cross steps, running backwards and running on different surfaces. Wear well-fitted shoes and allow adequate recovery. Use ^BLACKROLL® products to maintain balanced myofascial tissue.