From the Guidelines
Lateral knee pain in runners is most commonly caused by iliotibial band syndrome (ITBS), and the initial treatment should focus on rest, activity modification, and anti-inflammatory medications. The causes of lateral knee pain in runners can be multifaceted, including ITBS, lateral meniscus tears, patellofemoral pain syndrome, or lateral collateral ligament injuries. ITBS is the most frequent cause, occurring when the iliotibial band becomes inflamed from repetitive friction against the lateral femoral condyle during running 1.
Common Causes of Lateral Knee Pain
- Iliotibial band syndrome (ITBS)
- Lateral meniscus tears
- Patellofemoral pain syndrome
- Lateral collateral ligament injuries
Treatment Approach
Treatment typically begins with:
- Rest and activity modification, reducing running volume by 50% or temporarily switching to low-impact exercises like swimming or cycling for 1-2 weeks
- Anti-inflammatory medications such as ibuprofen (400-600mg three times daily with food) or naproxen (220-440mg twice daily with food) for 7-10 days to manage pain and inflammation
- Ice application for 15-20 minutes several times daily, particularly after activity, to reduce inflammation
- Foam rolling the IT band and lateral thigh for 1-2 minutes daily, along with targeted stretching of the IT band, glutes, and hip muscles held for 30 seconds and repeated 3-5 times, to improve flexibility
- Strengthening exercises focusing on hip abductors, particularly the gluteus medius with clamshells, side-lying leg raises, and single-leg squats (3 sets of 10-15 repetitions every other day), to address biomechanical issues
Prevention and Further Evaluation
Running gait analysis and proper footwear can prevent recurrence. However, persistent pain beyond 2-3 weeks warrants professional evaluation to rule out more serious conditions requiring advanced interventions like physical therapy, cortisone injections, or rarely, surgery. The progression of running load should be individualized based on risk and grade of the injury, as well as the level of the athlete, with females potentially benefiting from a slower progression due to higher tibial bone stresses 1.
From the Research
Common Causes of Lateral Knee Pain in Runners
- Lateral knee pain, also known as outer knee pain, is a common issue among runners, often caused by overuse or poor running mechanics 2.
- A sudden increase in mileage or intensity can lead to musculoskeletal injuries, including lateral knee pain 3.
- Running more than 40 miles a week can increase the risk of injury, including knee problems 3.
Treatments for Lateral Knee Pain in Runners
- The RICE protocol (rest, ice, compression, and elevation) is a useful treatment for most running-related injuries, including lateral knee pain 3.
- Running technique retraining, such as landing softer, can reduce the risk of knee injury and manage patellofemoral pain 4.
- Multicomponent exercise therapy, medial-wedged foot orthoses, and osteopathic manipulation can also help reduce knee pain in runners with patellofemoral pain 4.
- Sustained Acoustic Medicine (SAM) has been shown to improve clinical outcomes, reduce pain, and increase function in athletes with musculoskeletal injuries, including knee injuries 5.
Prevention Strategies
- Gradually increasing mileage and intensity can help prevent overuse injuries, including lateral knee pain 3.
- Running technique retraining and multicomponent exercise therapy can help prevent knee injuries in runners 4.
- Wearing proper footwear and using foot orthoses can also help prevent knee problems in runners 4.