Runner's Knee, or ITBS, is one of the most common runnng injuries.

What Is Runner’s Knee and How to Prevent It

Knee pain is one of the most common issues for runners and anyone who is active, but how to distinguish between different types of knee pain? If you feel a sharp or burning pain when your knee bends, it may be ITB Syndrome or ITBS, otherwise known as “Runner’s Knee.” An overuse injury, ITBS doesn’t occur because of a specific incident or injury, but develops gradually from over-training. By some counts, ITBS accounts for up to 22 percent of overuse injuries in runners.

The Iliotibial band is a thick, dense, band of connective tissue or fascia, which extends from the outside of your hip to down just past your knee joint, attaching to your knee to help stabilize the joint. Running at approximately the same line as the seam of your pants, it’s the longest tendon of your body.

The problem is that the IT band can easily become inflamed when the knee joint is not moving properly. The IT band passes over a bony prominence just above the knee joint, and this movement can cause friction, leading to irritation and eventually to inflammation. It also attaches to a very short muscle, which is just there to take up the slack when you move.

Symptoms of IT Band Syndrome

People often confuse ITBS with a knee joint injury. To help differentiate, feel for a little bump on the end of your thigh bone, just up from the outside of your knee joint. As you bend your knee back and forth past 30 degrees, you will likely reproduce your ITBS symptoms.

Risk Factors for IT Band Syndrome

ITBS is most commonly an overuse issue and often related to poor running form and/or simply running too much. Other contributing factors may be running in the same direction on a cambered road or trail or poor stability of your hip or ankle joints, causing the knee to be caught in the middle dealing with the stresses. Adding core and hip strengthening exercises to your regimen and refreshing your running and non-running footwear may help mitigate your symptoms.

Steps to Take If You Develop IT Band Syndrome

Many doctors will tell you to stop running if you develop ITBS, but this can leave out out of condition and prone to exacerbating the problem when you return to running. So, I say take active rest, while maintaining your strength and aerobic fitness.

I recommend cross training with another aerobic sport, such as swimming, riding the elliptical trainer, or cycling, and possibly adding some weight and core training to enhance your balance when your feet hit the ground again.

The Truth About Stretching

As the IT band is thick and dense, stretching it may have little effect. More beneficial is stretching adjacent tissues such as your quadriceps, hamstrings, and hip muscles. Doing this may  loosen connecting fascia and decrease tension on the IT band. I don’t go into a rigorous stretching routine before I start my run, but I make sure I get a good warmup.

The best warmup for your sport is actually doing the sport itself, possibly at a slower pace or less vigorously. A baseball player would take a few swings in the on-deck circle before walking up to the plate, a tennis player would hit a few balls before the match, and a seasoned runner would do some running at different speeds before the sound of the starting gun. For any run, start off a little slower and see if you can build your speed to maintain or exceed your starting pace.

Brian Soo is a senior physical therapist at the Kaiser Permanente San Francisco Medical Center who works inpatient, outpatient, and in sports medicine.  A recreational runner for many years, Brian also bicycles, plays racquetball, and most importantly, paddles on a 20-person Dragon Boat team that competes internationally and practices three times a week. He also enjoys active video games and believes they can be an excellent complement to an overall fitness regime.