Lateral knee pain/Iliotibial band syndrome

Lateral, or outer, knee pain can be caused by various structures that lie around the outer side of the knee. Whilst pain may start suddenly, it is commonly as a result of overuse. The most frequent structure to cause pain is the Iliotibial band (ITB).

Causes

The Iliotibial band is a thick fibrous band of tissue that is attached to muscles at the front and back of the hip. It runs along the side of the thigh and attaches to the outer aspect at the top of the shin.

The ITB works in co-ordination with other muscles in the thigh and hip to provide stability and to help bend the knee. If the ITB becomes irritated, repeatedly bending and straightening the knee can become painful.

Common symptoms

  • Pain on the outer aspect of the knee with repeated movements, for example when the heel strikes the floor whilst walking.
  • Pain tends to be worse with running and coming down stairs.

Treatment

Activity modification

Resting your knee and avoiding painful movements or activities is often very useful in settling pain down. If you had increased your activity levels before the onset of the pain try to reduce back to your baseline level of activity to help settle your symptoms.

Ice

If symptoms do not settle with relative rest it may also be beneficial to ice the affected area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to three times a day.

You should be cautious using these treatments if you have altered skin sensation or circulatory problems. Check the skin regularly during and after the ice pack application. Stop if there is excessive pain, numbness or tingling. Do not put ice directly on to the skin as this may cause a burn.

Pain relief

Over the counter painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. A short course of anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.

https://www.nhs.uk/medicines/paracetamol-for-adults/
https://www.nhs.uk/medicines/ibuprofen-for-adults/

Exercise

Exercises to strengthen muscles in the hip that abduct (move outwards) your leg and take excess strain off your Iliotibial band.

Aim to perform 8-12 repetitions, for 2-4 sets with 1 minute rest between sets.

Side lying leg lifts

  1. Lie on your side with your affected leg on top.
  2. Slightly bend your bottom leg and straighten your top leg.
  3. Steady yourself with your hand on the bed/floor in front of you.
  4. Keeping your toes facing forward and thigh relaxed, lift your top leg as high as you can.
  5. Do not let your leg drift forwards or your waist drop into the bed/floor.
  6. Feel most of the effort in the back and side of your buttock – not in the front of your leg or your back.

lateral knee pain side lying leg lifts

Standing side lifts

  1. Stand straight, holding onto a support. Take your leg out to the side. Keep your pelvis level and still, and your trunk upright.
  2. Keep the front of your thigh relaxed. Feel most of the effort in the back and side of your buttock – not the front of your leg. Repeat on the other side.

lateral knee pain standing side lifts

Useful links & resources

Knee pain and other running injuries – NHS (www.nhs.uk)

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