By Noah Stierli, physiotherapist at Kineo Seefeld
Pain on the outside of the knee when running
The first kilometres go well, then a stabbing pain starts on the outside of the knee. It gets worse going downhill or climbing stairs, and at some point you cannot go on. That is the typical picture of runner's knee, medically known as iliotibial band syndrome (ITBS).
The iliotibial tract is a strong band of connective tissue on the outside of the thigh. It runs from the hip to below the knee. With repeated bending and straightening, pressure builds up on the outer thigh bone against the tissue underneath, which becomes irritated.
Typical causes
- A rapid increase in volume or pace
- Many downhill runs or always running on the same side of the road
- Weak hip muscles, especially the gluteus medius
- The knee collapsing inwards on landing
- Worn-out or unsuitable shoes
Symptoms
- Stabbing or burning pain on the outside of the knee
- Often starts after a certain distance and then quickly gets stronger
- Worse going downhill and climbing stairs
- Usually pain-free at rest
What you can do yourself
- Reduce your volume, but do not stop completely: only run as far as you can without pain
- Avoid downhill runs until the pain eases
- Strengthen your hips: side leg raises, clamshells, single-leg squats
- Shorten your stride: A slightly higher step rate takes load off the knee
Simply stretching or rolling the tract usually achieves little on its own. What matters is why it is being overloaded.
How we treat runner's knee
In runner's knee, tissue on the outside of the knee is irritated between the iliotibial tract and the thigh bone. The cause usually lies higher up, at the hip, or in how the training was built up.
1. Assessment: what we examine in your first session
- Noble test: We press on the outside just above the knee joint line and bend the knee. Pain at around 30 degrees of bending is typical.
- Hip strength: strength of the lateral hip muscles, compared side to side
- Single-leg squat and step-down: Does the pelvis drop towards the opposite side, or does the knee move inwards?
- Differentiation: Pain at the kneecap or at the joint line points more towards patellar tendinopathy or the meniscus.
- Running pattern: Do your feet land almost on one line, as on a tightrope? A very narrow step width and a lot of downhill running increase the pressure on the outside of the knee.
2. Treatment in phases
- Phase 1: Calming the irritation (1–2 weeks). Only run as far as you can without pain, on the flat instead of downhill, shorter sessions. Alternatively bike or aqua jogging.
- Phase 2: Strengthening the hip (from week 1). Side plank with leg raise, single-leg deadlift, step-downs. Two to three times per week, with increasing load.
- Phase 3: Adapting your running style. A slightly wider step width and a step rate that is 5 to 10 percent higher reduce the load on the outside of the knee.
- Phase 4: Volume returns. Intervals of running and walking, then continuous running. Downhill and intervals come last.
3. Kineo services we use
- Runners Physio: physiotherapy with a focus on runners, in Seefeld right next to the Runners Lab
- Currex 5D running analysis to assess step width, pelvic movement and shoes
- Fascial therapy and dry needling for hip muscles such as the tensor fasciae latae and the gluteus medius
- Medical training therapy for strength building of the hip
Stretching the tract alone achieves little: the band itself is very firm. Strength, running style and a smart increase in load are more effective.
Three exercises for the hip
- Clamshells: Lying on your side, knees bent, open the top knee without rotating the pelvis. 3 x 15.
- Side plank with leg raise: In a side plank, slowly lift the top leg. 3 x 10 per side.
- Single-leg squat: In front of a mirror, the knee stays over the foot. 3 x 8 per side.
What matters is not the perfect exercise, but that you do it regularly over weeks.
Getting back into running
- Run on the flat and only as far as the point where the pain begins, then stop.
- Split the run up: better twice 15 minutes than once 30.
- Only increase the duration once three runs have been pain-free.
- Downhill runs and long runs come back last.
What the running analysis shows in runner's knee
In runner's knee, we often see a typical pattern in the running analysis. It helps us choose the exercises in a targeted way:
- Pelvis drops: On the stance leg, the pelvis tilts towards the opposite side. This is a sign of too little strength in the gluteus medius and puts additional tension on the tract
- Knee falls inwards: On landing, the knee moves towards the midline
- Narrow track: Some runners place their feet almost on one line or even cross them. This increases the tension on the outside of the leg. A slightly wider step, as if you were running on two rails, can already relieve it
- Long strides downhill: Going downhill, the braking load rises. Shorter, quicker steps help
Because we film you from all sides with 3D cameras in the Runners Lab, we see these patterns even when they are barely noticeable to the naked eye. At the retest after a few weeks, you can see whether your running style has changed.
From our practice
Many people come with a foam roller that they use daily and wonder why the knee still hurts. Usually the hip is too weak. As soon as we strengthen the hip and adjust the stride length, most people are running pain-free again after a few weeks.
Runners Lab and physio under one roof
At Kineo Seefeld at Seefeldstrasse 83, we analyse your running style in the Runners Lab on the ground floor and treat on the first floor. Especially with runner's knee, this look at leg alignment, stride length and shoes helps to find the cause. Feldeggstrasse stop, trams 2 and 4.
Frequently asked questions
Does the foam roller help with runner's knee?
It can feel pleasant, but rarely solves the problem on its own. Hip strength and adapted loading are what matter.
How long does runner's knee last?
With targeted training, often four to eight weeks. If you carry on running as if nothing were wrong, it takes longer.
Is it down to my shoes?
Sometimes. More often, training volume and hip strength play a bigger role. The running analysis shows both.
How long does an appointment take?
A physiotherapy appointment at Kineo lasts 30 minutes. In your first session, we clarify the cause and start straight away with treatment and first exercises.
You might also like
- Runner's knee: pain at the front of the knee
- Strength training for runners
- Preparing for a marathon without injury
Book an appointment
Do you want to run pain-free again? Book your appointment at Kineo Seefeld or a running analysis in the Runners Lab.
