Pain Outside of Knee (ITB Pain or Frictional Syndrome)

Also known as or related to:

Illiotibial band frictional syndrome. ITB frictional syndrome, ITB Pain, pain outside of knee, lateral knee pain


Pain outside of knee (ITB pain or Frictional Syndrome) is that pesky pain experienced around the lateral (outside) part of the knee that commonly affects runners of all levels of experience. The ITB is a long band of connective tissue or fascia that originates on the outside of the pelvis and extends down the outside of the leg to insert just past the knee joint.  Its main function is to assist in stabilisation of the knee during weight bearing activities.


ITB pain most commonly presents on the outside of the knee around the bony prominence called the lateral femoral epicondyle. The pain may not initially present at the beginning of a run, however will usually intensify as the run progresses. Flexion of the knee through a range of motion past 30 degrees has been found to exacerbate the problem. Flexion of the knee to 30 degree causes the fascial band to rub across the bony prominence. Thickening and swelling around the outside of the knee are also common symptoms.


There are many potential causes of Illiotibial band frictional syndrome.

Causes associated with overuse or poor training habits:
  • Running regularly on a cambered /sloping roads or paths
  • Always running the same direction around a running track
  • Excessive hill or stair running.
  • Failure to warm up, cool down adequately
  • Triathletes who have increased their cycling may tighten up through their quadriceps and gluteal muscle groups, failure to stretch and loosen these muscle groups may contribute to ITBFS.
  • A rapid increase in training load or intensity.
Causes associated with anatomical alignment or biomechanical function:
  • Significant leg length difference
  • A stiff supinated foot type, leading to a lack of normal pronation
  • An excessively pronated foot type leading to excessive internal rotation of the Tibia and consequently increased tension through the ITB.
  • Bow Legs (Genu Varum) 
  • Gluteal weakness and/or inactivity leading to poor hip stability.


Treatment usually involves attacking the problem from several angles to ensure a speedy return to running. Below is an outline of where to begin:

ITB friction syndrome responds well when acted upon as soon as symptoms arise.  If runners rest or decrease their mileage as soon as they start to feel a niggle on the outside of their knee most cases will settle and resolve. If decreasing running load does not work, rest from running is recommended. Remember you can cross train by cycling, swimming and rowing, just avoid, squats and stair climbing and breaststroke.

While resting, normal anti-inflammatory treatments such as ice and ibuprofen can help to decrease the pain and inflammation in the tissue.  Massage, stretching and myofascial release are also very helpful for ironing out the knots and trigger points in the fascia and connective tissue of the ITB. This can be done at home with the use of a foam roller or for a deeper more specific treatment a massage therapist should be utilised on a regular basis.

If the initial treatment detailed above does not work or if the problem is long standing, than engaging the help of a health professional is recommended.

A Sports Podiatrist will be able to assess your running biomechanics to determine if poor running form or lower limb alignment has been contributing to your ITB friction syndrome. If required a change in running shoes and/or custom designed orthotics may be recommended to help decrease the mechanical load being placed on the ITB.

If hip stability and gluteal strength is identified as an issue, specific strengthening exercises may be prescribed. Our Sports Podiatrists ensure you are performing the right exercises with correct form at the right level.

Management of training principles such as load, intensity, duration and frequency should not be neglected when treating ITB syndrome.  Joining a running club or consulting with a technical run coach is a good way to educate yourself about how best to structure your training to achieve the results and goals you’re aiming for while helping to minimise the likelihood of overuse injuries.

The majority of cases respond well to treatment, however if conservative care fails corticosteroid injections or surgical management could be considered.


With the right approach ITB Friction Syndrome can be controlled quickly.  Once it has settled it can be prevented by managing your running training to ensure adequate rest and appropriate progression.  Acting quickly as soon as symptoms arise will also hasten return to pain free running.  Finally, remember not to neglect your running shoes, replace them as soon as you feel that they are wearing out or if your pain starts to return.

Shoes Feet Gear's Brisbane Podiatrists can help you with all lower limb complaints. Make an appointment today to see a Brisbane Podiatrist.