Runner's Knee (ITB Syndrome)

_Iliotibial Band Syndrome_

Summary

Overuse condition where the ITB and the innervated fat beneath it are compressed against the lateral femoral condyle near 30° of knee flexion. Driven by training-load spikes and glute-medius weakness. Offload plus glute-medius strengthening.

Pathology. ITB syndrome is an overuse compression/friction condition where the ITB and the richly innervated fat beneath it are compressed against the lateral femoral condyle near 30° of knee flexion. It is driven by training-load spikes and hip-abductor (glute-medius) weakness causing hip adduction/internal rotation. Management offloads the lateral structures and, crucially, strengthens the glute medius.

Clinical presentation (signs & symptoms)

Lateral knee pain, sharp/burning over the lateral femoral condyle; worse with repetitive knee flexion/extension (running, descending), often near 30° flexion; eases with rest; gradual onset with load.

Assessment (Examination & Assessment)

Subjective

Lateral knee pain, worse with running (esp. downhill) and repetitive knee flexion/extension; pain around ~30° flexion (foot strike). Training-load spike. Pain scale.

Objective

Palpation over the lateral femoral condyle (~2–3 cm above joint line — key finding); Noble compression test; Ober's test (ITB tightness); assess glute-medius strength; single-leg squat (dynamic valgus); running biomechanics.

Differentiate from

Lateral meniscus, patellofemoral pain, biceps femoris tendinopathy, lateral collateral ligament.

Key special tests

| Test | What a positive result indicates | |---|---| | Palpation of the lateral femoral condyle (~2–3 cm above joint line) | localises the site | | Noble compression test | reproduces pain near 30° flexion | | Ober's test | ITB tightness | | Single-leg squat | dynamic valgus / glute-medius control | | Glute-medius strength test | identifies hip-abductor weakness |

Red flags & when to refer

• Lateral meniscus or joint pathology (locking, joint-line signs)
• Lateral collateral ligament injury
• Biceps femoris tendinopathy (posterolateral)

Contraindications & precautions

• Rule out lateral meniscal/joint pathology (locking, joint-line signs) — refer if suspected.
• Dry needling: standard contraindications (infection, anticoagulants, needle phobia); consent & hygiene.
• Avoid aggressive direct compression over the acutely irritable condyle.

Treatment protocol

Session structure & time scales

• Pre-assessment + prep (10 min): palpation, Noble, Ober's, glute-med strength.
• Soft tissue — TFL/ITB, glutes, vastus lateralis (12–15 min).
• Hip mobilisations (5 min).
• Dry needling — glute-med/TFL/VL trigger points (8 min).
• Electrotherapy — US (8 min).
• Glute-medius loading demo (5–8 min).
• Reassessment + home programme (5 min).

Modalities & rationale

| Modality / technique | Rationale (why it is used for this pathology) | |---|---| | Soft tissue (TFL/ITB/glutes/VL) | reduces tension in the ITB complex and lateral chain, easing compression at the condyle. | | Hip mobilisations | improve hip mechanics contributing to load (Banks, 2013). | | Dry needling (glute-med/TFL/VL) | relieves trigger points perpetuating pain (Sharkey, 2017). | | Therapeutic ultrasound | parameter-dependent symptom support (Watson, 2008). | | Glute-medius strengthening | corrects hip abductor weakness/dynamic valgus — the key evidence-based driver. |

Loading & exercise progression

Glute-medius strengthening (side-lying abduction, hip hitch, single-leg control) → running-specific. Running load/cadence management (reduce downhill and volume).

Home care / self-management

Glute-medius strengthening (side-lying abduction, hip hitch, single-leg control), running load management (reduce downhill/volume, cadence advice), lateral-chain flexibility, gradual return.

Outcome measures & re-assessment

• Pain scale (NPRS 0–10) pre/post; running tolerance over sessions.
• Repeat Noble compression & lateral-condyle palpation.
• Reassess single-leg squat control.
• Reassess glute-medius strength.

Anatomy reference

| Structure | Origin | Insertion | Action | |---|---|---|---| | Tensor fasciae latae (TFL) | ASIS & anterior iliac crest | ITB → Gerdy's tubercle | hip flexion, abduction, internal rotation | | Gluteus maximus | posterior ilium, sacrum, coccyx | ITB & gluteal tuberosity | hip extension, external rotation | | Gluteus medius | ilium between anterior & posterior gluteal lines | lateral greater trochanter | hip abduction; pelvic stabilisation | | Iliotibial band (ITB) | thickened fascia lata (from TFL/glute max) | Gerdy's tubercle (lateral tibia) | — lateral stabiliser |

Clinical reasoning (Q&A for the system)

_These question–answer pairs encode the expected clinical reasoning for this condition. Use them to justify decisions and to check generated plans._

Q: Where and when is the pain in ITB syndrome? A: Lateral knee pain over the lateral femoral condyle, typically around 30° of knee flexion, worse with running (especially downhill) and repetitive flexion/extension.

Q: Which tests would you use and what do they show? A: Noble compression test and palpation over the lateral femoral condyle reproduce the pain; Ober's assesses ITB tightness; assess glute-medius strength and single-leg squat control.

Q: Why is strengthening the glute medius central to the plan? A: Glute-medius weakness allows hip adduction/internal rotation (dynamic valgus), which increases ITB compression at the condyle — so it's the key driver, not just soft-tissue work.

Q: What forms the ITB and where does it insert? A: It is a thickening of the fascia lata receiving TFL (O: ASIS) and gluteus maximus, inserting at Gerdy's tubercle on the lateral tibia.

Q: What differentials would you consider? A: Lateral meniscus pathology, patellofemoral pain and biceps femoris tendinopathy.

References

• Banks, K. (2013) _Maitland's Peripheral Manipulation Management._ Elsevier.
• Banks, K. (2013) _Maitland's Vertebral Manipulation Management._ Elsevier.
• Sharkey, J. (2017) _The Concise Book of Dry Needling._ Lotus Publishing.
• Watson, T. (2008) _Electrotherapy: Evidence Based Practice._ Elsevier.
• Clarkson, H. M. (2013) _Musculoskeletal Assessment._ 3rd edn. Lippincott.
• TODO: add a condition-specific loading-protocol reference (from module notes), Harvard format.