Pain on Outside of Knee During Running & Cycling

By Tomás Ryan BSc.(AHS), Ph.Th. MIAPT, Registered Physical Therapist based in Thurles

Pain on the outside of the knee is the 3rd most frequent injury for Road Runners and Cyclists. The condition most commonly responsible for this outside Knee pain is Illiotibial Band syndrome or ITB syndrome. The Illiotibial Band runs from outer area of the Hip joint and attached to the outside area of the Knee joint. To treat this condition we need to know what exactly is causing the pain. The pain caused is by compression of Fatty Tissue, that sits underneath the Illiotbial Band, against the outside bone of the knee known as the Lateral femoral epicondyle, see the illustration below.

Signs & Symptoms

  • Sore pain located on the Outside of the Knee joint during running, cycling and even long walks.

  • Knee Pain occurs at 30 degrees of a knee bending, such as a Heel strike during running or fast walking.

  • With running, the knee pain appears within a few kilometres of running and becomes worse.

  • Pain is relieved by rest or stopping aggravating activity

  • There is no history of a fall or injury.

Causes of Illiotibial Band Syndrome

When the Hip and thigh move inwards excessively during running, this leads to excessive inward rotation of the tibia or shin bone. Remember the bottom end of the Illiotibial Band attaches to the tibia. If the tibia is turning in too much then this will cause a strain or excessive pull on the Illiotibial Band. This straining causes compression of the ITB attachment against the outer knee bone known as the Lateral Femoral condyle.


There is no recent evidence in research studies that shows that a stretching program of the ITB helps stretch the ITB. The focus needs to be on reducing the excessive inward swing motion of the Hip and thigh during running. This is achieved through a strengthening program for the gluteal hip muscles while also focusing on patient’s running mechanics and incorporating verbal aids to help improve Hip and Knee alignment. The athlete should not cease running entirely but instead reduce running times to non-painful levels, this helps to reduce the load and irritation of the ITB. Massage or stretching of the ITB leads to further compression so it is a waste of time!

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672

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Physiotherapy & Injury Rehabilitation Clinic in Tipperary

0504 26672


The Surgery, Fianna Road, Thurles


Riverside Medical Centre, 7 Upper

Irishtown, Clonmel

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