A Runner's knee - Never again! (5 tips & 5 exercises)

Nothing is worse than having to stop running due to aches, pains and injuries. A very common running injury that we see at our practice AmstelFysio is the runner’s knee, which is characterized by pain on the outside of your knee. This type of pain can happen to every runner, whether you’re a novice runner or an experienced one, and is one of the most frequently reported running injuries. Some of our physios have experienced the Runner’s knee themselves and we know that it can be a tough pill to swallow. In this blog you’ll read everything you need to know about the cause of this injury, the recovery time and how you can decrease your chances of ever getting it in the first place!

Iliotibial band Friction Syndrome / Runner’s knee

The Iliotibial band friction syndrome (ITBFS), also known as a runner’s knee, is the most common cause of pain on the outside of your knee during and after running.

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The ITB is a fascia, which is sort of a big, tendon-like sheet that runs from your hip down to your knee on the outside of your thigh. At the hip it connects to 2 buttock muscles (gluteus maximus and medius) and a muscle on the side of your hip (Tensor Fascia Lata). It then extends down along the side of your thigh and attaches to one of your quadriceps muscles (vastus lateralis), a ridge on your lower leg bone and the knee tendon (patella tendon).

The ITB is very important to ensure stability in your knee during running and is extremely important with its function to transfer energy from your hip to your foot during both the suspension and propulsion phase.

In the past we used to think that the pain you feel when you experience a runner’s knee was caused by friction of the ITB and the bony ridge on the outside of your knee. By doing a lot of repetitive movements this friction was thought to be too much, which would cause irritation and pain. However, recent anatomical studies that there is no forward and backward movement of the ITB during knee bending, and thus the friction theory seems to be outdated.

What causes the pain in a runner’s knee?

Recent studies have shown that the pain is most likely caused by compression of a fatpad and sometimes a bursa. A fatpad and bursa function as shock-absorbers and little bumpers around a joint to protect the joint from sudden impact. Due to an increased compression of these structures and their highly vascularised and innervated nature, this then causes the pain on the outside of the knee.

Symptoms of a Runner’s knee:

• Pain is located on the outside of the knee;
• Initial pain is often only felt during running;
• Pain often starts at a certain moment during running, often starts at the same moment during your training and disappears as soon as your stop running;
• The pain generally gets worse over time, to the point where you can also experience pain in walking, going up and down the stairs etc.

Causes of the Runner’s Knee

A lot of factors can influence the development of a runner’s knee. Earlier in this blog you read that the pain is most likely due to compression forces of a fatpad on the outside of the knee. These compression forces can be caused by a variety of reasons, such as running technique, training load, muscular strength and running shoes. The most common causes are:

  1. You’ve ramped up your volume or training intensity too fast. A lot of downhill running can also be a big contributing factor.
  2. Weakness in the hip muscles, specifically the stabilizing buttock muscles (gluteus medius and minimus). Due to lack of strength and control the hip will drop slightly, which causes a pelvic drop and kneeing-in. This causes more tension on the ITB and an increase of the compression forces to the fatpad and bursa on the outside of the knee.
  3. Insufficient core stability. Having a strong core helps in maximising your running performance and assists in stability and control of your hips and legs during running.
  4. Tightness of the gluteal (buttock) muscles, quadriceps (thigh) muscles or ITB itself.
  5. Poor running technique, for example low cadence, passive running technique, poor foot strike or fully extending the knee at footstrike, which massively increases peak breaking force.

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Tips for a fast recovery of a runner’s knee

If you recognize the symptoms of a runner’s knee, you’re best of checking in with a physio to confirm the diagnosis. Your physio can also help you determining what underlying factors are contributing to the injury and will the propose a treatment plan.

An example of a treatment plan could be:

  1. Decrease your training volume and intensity with roughly 50%. Does this not give the desired effect? Then take a full week’s rest.
  2. Strengthening exercises for your buttock and thigh muscles (see the examples at the bottom of this blog).
  3. Core stability training - see one of our previous blogs for training inspiration.
  4. Daily Foamrolling of your thigh and buttock muscles, check our foamroling blog for your instructions.
  5. Discuss your training schedule and running technique with your physio (or make an appointment with us) and make adjustments where necessary. At AmstelFysio, we’re specialized in running technique analysis and technique training, so contact us for an appointment if you’re looking for the right place to go!
  6. Has the pain decreased? Be smart in ramping up you training so that your body has the time to adjust to the new load. Keep your cadence in mind, make sure you run in proper form and continue your strengthening exercises.

Train your glutes and prevent a runnersknee!

The following 5 exercises are highly recommended to strengthen your glutes and fix your runnersknee.

Crab Walks

Step Down

Sidelying Abduction

Sideplank variations - 1

Sideplank variations - 2

Single Leg Deadlift


Hadeed A, Tapscott DC. Iliotibial Band Friction Syndrome. [Updated 2019 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542185/

Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M.
Is iliotibial band syndrome really a friction syndrome?
J Sci Med Sport. 2007 Apr;10(2):74-6; discussion 77-8. Epub 2006 Sep 22.

Ellis R, Hing W, Reid D.
Iliotibial band friction syndrome–a systematic review.
Man Ther. 2007 Aug;12(3):200-8. Epub 2007 Jan 8.

Lees verder - Tips voor het instellen van je (thuis)werkplek

Om gelijk maar met de deur in huis te vallen. Langdurig zitten is erg slecht! Zitten wordt inmiddels gezien als ‘het nieuwe roken’. In onderstaande blog geven we je 6 tips die te maken hebben met het instellen van je werkplek, hoe je de negatieve gevolgen van een lange werkdag kunt verminderen. Lees de 5 tips.