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The Dangers of Running

Many people enjoy running as a great form of exercise.  Some people have been running for years and yearn for the next “runner’s high,” while others are simply just trying to get in shape.  Seeing as how we live in America’s Finest City, we are given the opportunity to enjoy going out for a jog or train year-round.  I wish everyone was immune to injury, but often times there are injuries or ailments that can come with the territory.  One of the most commonly associated injuries with running is knee pain.  Knee pain can come in various forms as it can affect all aspects of the knee, from the front, to the sides, or the back.  If not treated early or properly, it can lead to other areas of abnormal wear and tear and further pain.  This can result in new injuries at either the foot or hip, other knee, or even low back pain.  This article is going to focus on knee pain at the outside of the knee, or lateral knee and a condition called “IT Band Friction Syndrome.”

There are several key structures located at the lateral knee.  These are the lateral meniscus, lateral collateral ligament, and the iliotibial band.  The lateral meniscus is the cushion between the femur of the thigh and the tibia of the shin.  This structure can become irritated, or possibly torn, resulting in lateral knee pain.  The next is the LCL, otherwise known as the Lateral Collateral Ligament.  This stabilizes the knee via a ligamentous attachment connecting the lowest portion of the femur and the highest portion of the fibula of the lateral lower leg.  Last major structure, and the one of importance for this article, is the Iliotibial Band.  The IT Band connects to the Tensor Fascia Latae muscle at the pelvis and the Gluteus Maximus at the hip and spans all the way down the lateral thigh to the tibia.  This band is made of dense fibrous connective tissue that works to stabilize the knee and hip.  When irritated, it can cause pain which can be detrimental to your training and even stop you from running.

Pain during running, associated with ITB Friction Syndrome, is most commonly felt at the lateral knee or even to about 1/3 of the way up the lateral thigh.  The friction is the result of undue stress on the IT Band at the bony prominence of the lateral femur called the lateral condyle.  When you bend your knee, the IT Band moves behind the lateral condyle, and when you straighten it, the IT Band moves in front.  Normally when producing the motion there is no pain, but the tension placed on the IT Band while running and the repetitive sliding forward and backward can wear and irritate the IT Band.  Below is a list of several things that you can do to address IT Band Friction Syndrome:

  • Start at the feet:  Your feet are the only portion of your body in contact with the ground when running and the position of them matters most.  If you look down at your feet, what do you see?  Flat feet or high arches?  If your arch does not appear to “arch” off the ground, then you may have flat feet.  When your feet flatten out too much, it can affect the biomechanics of the entire leg, and be one possible contributing factor to the development of IT Band Friction Syndrome.  Some good running shoes, with some good arch support or orthotics, can help decrease the amount of pronation and keep the foot in a more neutral alignment.  It is this neutral alignment that will lead to the friction being removed from the IT Band.
  • Look where you are running:  Many people get in the habit of running one way and usually in a loop.  The loop may minimize the boredom for those who don’t want to see the same thing twice, but it will most likely lead to more stress on one leg or the other.  Whether running through the neighborhood, down to the beach and home, or around the office complex, one leg will always be on the outside the other on the inside, and that will never change.  This will produce asymmetrical forces at the knees and may lead to IT Band friction.  Quick fix for this is to simply alternate the direction of the loop with every session, or just run out and back.  This way the forces remain symmetrical and one leg does not bear all.  Ideally, you should be running on a level, flat surface, and avoiding the driveways and slopes of the street and shoreline.
  • Make your hips stronger:  The gluteal muscles of the backside of the hip help to keep the knee in better alignment by outwardly rotating the femur, which will decrease stress on the IT Band at the knee.  When running, these muscles, and the IT Band, are subjected to greater forces than just plain walking, and thus, need to be stronger than what is needed for just plain walking.  If the gluteal muscles, otherwise known as hip abductors, are not strong enough to support the hip then the IT Band will bear most forces and lead to increased stress.  One simple exercise for hip abductor strengthening is a hip dip exercise.  Standing on a step sideways, so one foot is on the step and the other off the step floating in the air, dip the floating leg down as if to touch the ground with the toes without bending the knee of the leg on the step.  Only pelvic and hip motion should be occurring, no knee bending or straightening.  The leg attempting to touch the ground will never touch the ground, but the main goal of the exercise is to dip and raise that hip in order to work the hip muscles of the leg standing on the step.  A couple of sets of high numbers of repetitions can increase muscle endurance and strength.  By increasing the endurance and strength of the hip abductors, the tension can be decreased on the IT Band.
  • Increase flexibility:  Tight muscles can alter the positioning of the foot, leg, thigh, and hip during running, and lead to greater force placed on the IT Band.  Stretching commonly tight muscles can help alleviate tension on the IT Band.  Starting at the foot and ankle, stretching of the calf with the knee straight and knee bent, will allow for better motion at the ankle.  Piriformis stretching can also be beneficial to stretch the hips in outward rotation.  This can be done seated with your ankle on the other knee, and leaning forward to stretch the muscle of the back of the hip.  Lastly, loosening of the IT Band can result in better mobility and decrease tightness at the lateral knee.  Using a foam roll, roll the side of the thigh.  Starting from the hip and rolling down to the knee and back can help improve mobility of the fascial band and decrease stress and tension on the IT Band while running.  Now, rolling of the ITB can most likely be a sore subject but it will get better as time goes on and the fascial band is allowed to move more freely.


The best course of treatment is to listen to your body and act early if you detect some knee pain.  A physical therapist or orthopedist is trained to evaluate these types of injuries.    Physical therapists are movement specialists, and evaluate human body mechanics and musculoskeletal disorders.  IT Band Friction Syndrome can be treated easily by a Physical Therapist.  The above suggestions are merely suggestions and should not be viewed as the full treatment or encompassing all available options for lateral knee pain.  There are many causes of lateral knee pain and depending on the origin, treatments will vary.  If you have been dealing with running related or other lateral knee pain and the symptoms are not improving see a physical therapist or orthopedist for advice.

Brandon Irons, MPT is a Director of Physical Therapy for Water and Sports Physical Therapy and specializes in orthopedic manual therapy, sports rehabilitation, and aquatic therapy.  Brandon can be reached at Water and Sports Physical Therapy at (858) 488-3597 or at  Brandon is part of the rehab team at Fitness Quest 10.

Disclaimer: No information presented in this article can replace medical advice. Before beginning any program consult a physician. The author and publisher of this article are not responsible for any injury sustained from advice contained in this article.

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