Knee Pain - ITB Syndrome

Physiotherapy is highly effective for running injuries.  ITB syndrome is one such injury and manifests in pain on the outside of the knee. 

 It is commonly associated with running and can be a very difficult condition to treat.  The Iliotibial band (ITB) is the fascial connection on the side of the leg extending from the hip all the way down the side of the thigh and onto the bone just below the knee (Gurdy's Tubercle). Historically pain was thought to be due to friction (ITB Friction Syndrome) with the band rubbing on the tubercle. This is not the case, the band doesn’t rub and instead it compresses against the bone causing irritation of the structures in that area (fascia, bone, bursa).  The cause is typically biomechanical, weakness of the muscles around the hip and poor training or running technique.  The originating and aggravating factors are thought to be 'over use' and over training – ie when there is an increase in mileage during marathon training or when someone is new to an activity. It seems to affect women in greater numbers with biomechanical differences between sexes deemed to be the likely underlying cause.


“my knee hurts when I’m running – starts off ok and then worsens. Seems to go away when I stop”

  • Pain on lower thigh and over outer knee
  • Increases with activity
  • Worse on hill running
  • Sometimes on stairs, descending 
  • Worsens with increased activity but rest allows recovery
  • May have no pain until running
  • May not occur until some miles into the run


There are quite a few treatments that can be applied:  you can massage, roll on a foam roller, apply dry needling, use tape, or ultrasound and all help to ease pain – but this seldom solves the causative factors.  As Physiotherapists we will always focus on style, pattern and frquesncy of training, if there are weak muscles (particularly the gluteal muscles), and we will look at exercise or running technique.    

Local and manual techniques are great for keeping you training while managing your symptoms.  However, as physiotherapists we are experts in movement dysfunction and understand that the key to symptom resolution is to correct dysfunction and KEEP YOU ACTIVE!  If you fail to treat the casue, it will return in the latter stages of exercise or when increasing your program for marathon training.


A list of treatments include:

Sports Massage

Trigger point therapy

Dry Needling


Foam Rolling



Core Stability

Training advice



Find and resolve the issues contributing to the ITB Syndrome and you are on the right track.  Pain often persists because the clinician has failed to isolate the issues causing the pain or the patient has not listened and just carried on running the same intensity.


Unsure if physiotherapy can help? Get in touch and ask the experts.