ITB or Runners Knee

I've recently started running and I think I've got runner's knee (self diagnosed). I would really like to know if there is anything that can be done to prevent/treat this. Lots of pain involved and an inability to use stairs the day after a run. I've tried some stretches but it keeps coming back, especially after running hills. Any tips would be really appreciated.



  • If it's ITBS, try not calling it runner's knee. That term more usually describes a patella tracking problem.

    It's the outside of the knee, I take it? If so, there's a fair few other threads here - search for 'ITBS'. I won't repeat myself, but the best thing you can do is to get a physio (or even a running shop with video gait analysis) to see what you're doing wrong, and what you need in terms of footwear and/or orthotic inserts to correct it. I'm a big disbeliever in curing it solely by strengthening and stretching - it may be a part of recovery, but it's likely to be a colossal waste of time if you're still running funny.

    Oh, and in the short term REST! Don't run until the pain's gone, and stop immediately if it comes back.

    Best of luck.
  • You're right, the pain's on the outside of the knee. Will go and get everything looked at!!

    Thanks very much.
  • Good to read everyones comments on this, as i've been trying to self diagnose my knee problem, and i think ITBS could well be it.

    I had a two week training lay off over christmas due to illness, and second day back running i think i overstretched on a downhill section. I now have a pain on the outside of the knee when walking down steps / stairs, seems ok on flat and only very slightly noticable walking up steps.

    Haven't risked running since saturday, and have used ice pack every night. Seems to be improving 'very very' slowly.

    Interested to hear from anyone on their recovery times. I guess at this rate i can't see myself doing any sort of running for the best part of another week.

  • Hi swerve,

    Glad your around, I had a question to run passed you.

    Speaking in terms of ITB recovery, I am currently up to 15 mins of road running on flat fairly even surfaces. I am increasing my time out running by 5 mins a week only and going out 3 times a week. I stretch and stregthen muscles every day pretty much for about 10 mins.

    ok where's the question I hear you ask... What recovery 'plan' have you followed and how long has it taken you to get where you are today? How far/long are you running at moment?

    Does that make sense!!!

    Thanks, Rachael.
  • Rachael - out of interest, how long since you first had this knee problem ? and how long did it take (if it has) for the pain to subside and for you get back to doing some sort of running. ?

    i suppose it's going to be different for each person and dependent on the severity, but i'm just trying to get some sort of idea of the time involved.
  • Hi Gareth,

    My appointment with my physio looking back in my old diary was 18th Nov. So its taken me around 5 weeks to get where I am today. Having said that my band was very very tight and I suffered from severe pain at time of injury.

    It took me about 7 days to eliminate the knee pain when walking. The last 4 weeks I have been working on stregthening my stability and general causes of my over-pronation and muscle imbalances.

    The timings for me on a full recovery, will take some time as my previous message indicates!

    Does this help or hinder?
  • Hi Rachel. I'll do my best! Here's my life history......

    I've run into ITBS problems three times in all. First was March 2001 (the 17th!), when I was running on cheapo shoes (£10, no cushioning or strength) - gives me nightmares to think about how stupid that was. I had a hint of a niggle in my right knee, but set out on a five-miler anyway. It hurt after about 200 yards, but I tried to run through it. The upshot was that I could hardly walk for a week, and limped for a month or more.

    My recovery from that was to avoid activity for something like three months (yes, honestly!), including walking if at all possible. I invested in a more expensive pair of shoes, having (at this point) no idea that there was anything more to shoes than more expensive equals better. Over the summer I played a fair amount of cricket, which seemed to cause only a little pain, and built up the running gradually (I'm afraid I don't remember too well what my schedule was). I was aware it was ITBS, but thought it was just a case of being patient and building up slowly. Wrong! I got to about 2 or 3 miles with not much pain, then one day - ouch! Left knee this time. This would have been around October or November 2001 - 7 or 8 months after the first episode.

    Right, I thought. What had I done wrong? Had to be (according to the hopelessly contradictory info on the web) the lack of muscle-building. Signed up for a gym to strengthen my abductor muscles (those which move the leg sideways at the hip) and a lot of other muscle groups too for good measure. I also did the elliptical/strider thing (which I can very strongly recommend to keep the running fitness up), going onto the treadmill for maybe five minutes a time, stopping if it started to hurt. I rationed myself to one run a week at most. It took ages to get to ten minutes running (I actually found that I improved if I ran with my feet slightly further apart than usual!), then it was time for another cricket season, which took me away from serious running over the summer (and gave my ITBs a rest). After that I gradually, gradually increased treadmill time again, and the summer lay-off had done great things. I think I can say fairly confidently that this time the weights (and possibly the gait modification) delayed the onset of ITBS significantly, but DIDN'T cure it.

    [continued in next message]
  • [continued]

    By October 2002 I'd got up to occasionally an hour running, and maybe a couple of shorter runs (some treadmill, some not) a week before the ITBS started to come back (reverting to the right knee). BUT it was very mild, and I could still run through it without much discomfort. But after two previous rehab periods, I had to get it sorted. I was a bit more clued up about ITBS by now and went to get my gait analysed at a proper running shop (Advance Performance in Peterborough). The video showed that I overpronate enormously and have fallen arches - my foot kind-of collapsed inwards, causing my knee to move inwards and twist, rubbing the ITB. They sorted me for some shoes, and immediately the ITB symptoms became less and less significant. I went to a physio too, and she gave me exercises to do, but as a final try to clear up the last of the pain tried some cut-up paper (yellow pages) and duct tape under my insoles from big toe to arch region (i.e. inside edge of the shoe), and after a bit of adjustment by me, the aggravation went dramatically and instantly.

    Since then I've tried to build my mileage sensibly, but feel like I could run forever, so tend to do more than maybe I should. I now run four times a week. One long run on a Saturday which is currently 10 or 13 miles, probably a six-miler, a brisk 4-miler and a club session.

    Finally, just to illustrate the main point of my crusade, I did a 1 hour cricket practice recently, but took my old running shoes for reasons too dull to go into, thinking it'd be OK, as it was only cricket, and only one night. Guess what happened? The old feeling of mild ITB pain in that scarred old right knee.

    My gait is so different in my new shoes - looking in the mirror at the gym or even just feeling it whilst running, there's no collapse of the knee, and as far as I can see, no twanging of the ITB, so no pain. I remain very, very sensitive to anything happening in my knees, and I'm touching wood right now, but it's my firm belief that I've got past ITBS by eliminating the irritation, and that the strengthening and stretching (I DO still stretch) is important but very much secondary. I still have ITBs like steel bands!

    Hope that helps, but do please ask me if you have any other questions. But bear in mind that my experience doesn't necessarily match up with those of other people! Best of luck to all of you with ITBS - there's a LOT of us out there, many of whom just give up their beloved sport.
  • Swerve thanks for that. I find your current running a real inspiration and a feeling that I can really get over this!

    I have already noticed a huge difference in my stability and strength when running my short distances - espacially in my hip flexors and gluets.

    Again, I think you have highlighted the one point that has been nagging me for weeks now, I need to get my shoes sorted. I had my foot strike scanned the other day and was recommended Addidas Supernova Control for various reasons that all make sense to my problems - so it looks like another visit to the shop.

    I agree completely about the strider thing in the gym, it really has helped and a good 40 mins on that the other night reminded me of what it feels like to RUN!!!

    Thanks again and watch this space!
  • Thanks Rachel and Swerve for your comments.
    I admire your patience and persistance in overcoming this problem, it must of been / be very very frustrating.

    I think now having read your 'history', my problem really seems quite trivial in comparison, as i have no problem walking on the flat and uphill. The only pain experienced is when walking down steep hill / down stairs etc.. and this has slowly improved each day this week as i have not done any training.

    I have put ice pack on each evening, and this may of helped ?

    i'm hoping to see if i can jog on a flat section of road at the weekend to see if i get any reaction, i think i'll avoid any undulating routes for a bit longer.

    I suppose i've been lucky as this is the first setback i've had since i started running last april, but frustrating as just hitting some good times / form for events planned this month. but i suppose that is always the way ! i just suppose that i have to accept that if your running 5 / 6 days every week, sooner or later you'll pick up some sort of injury.

  • Ice is good for a more immediate thing. I would imagine Swerve would agree, by making ITB stretches part of your regular routine (stretching the band after any excerise) is key to recovery and keeping it at bay.

    Again like Swerve, I have had set backs, if you feel it coming on STOP! If you stop immediantly the niggle will go after a couple of days, rather than 6 or 7 days.

    Hills or steeply cambered roads play havoc with me - I can only at present run on flat sections of road.

    Good luck!
  • Yep, ice and ibuprofen for the immediate recovery. And yes, I'm a believer in stretching when you're warmed up or cooling down, not cold.

    The camber thing I found very important. My right knee was always the worst (and I overpronate worst on my right leg), so running on the right hand side of a crowned road was way preferable to running on the left. Never had the hill problem, but then I live in Cambridgeshire!

    And Gareth - do make sure your shoes are right for you. I can't emphasise too much that all the rest/ice/stretch business is probably not enough on its own.
  • Thanks Swerve.

    My right knee is the problem too, the left is fine. i'll take your advise on running on the right side of the road when i start back again !

    As for footwear, i was quite careful in buying the correct footwear for my weight / mileage, so i don't think that's the problem. They have slight wear on the outside of both heels but nothing excessive.

    They are light racer/trainers, and from looking back on my training record, i reckon to have done about 600 to 700 miles in them, although i'm not sure when i should be thinking of changing them - any idea ?

  • Gareth - some trainers are designed to limit pronation, some aren't. I believe (but I'm not certain) that racing shoes are generally 'neutral', i.e. they don't have pronation control. Weight and mileage are fine, but may not be all that important regarding ITBS (though worn shoes are often cited as a factor).

    People generally quote 600 miles as a limit, but I think (again, I don't know!) that as racers are light, they wear out quicker. I suggest you take the opportunity to go to a specialist running shop with a treadmill/video camera set-up (or maybe those footscan thingies I hear about) and get them to fit you with shoes to suit your gait. Or get a podiatrist to check you out.
  • Thanks. Once i'm back running i will try and find somewhere where they can do this. I work in London, so i'm sure there will be a specialist with this type of facility not too far away.

    I'll let you know how i get on.
  • Swerve

    grateful you comment on a couple of ITBS points re diagnosis:

    1) When it first arrives is it sudden/sharp/immediate or is it a dull ache that developes after a run?

    2) Can a tender spot be indentified by pressing on any part of the outside of the knee?

    thanks in advance
  • Hi sfh.

    Not wishing to set myself up as a self-appointed ITBS oracle, I'll give it a go!

    1) I think it really depends. Classically it's sharp, and brings you to a halt straight away. I've had warning aches though. It certainly shouldn't develop after a run, in fact it ought to fade vary drastically when you're at rest, though you'll feel the pain when you walk, especially down stairs.

    2) Yes, but blinking hard to describe! Kind of the bony bit that sticks out at the same height as the patella, but on the outside of the knee. If you apply pressure and flex the knee you'll get pain at something like 30 degrees away from straight. To be honest, that's a diagnosis that a physio would be best at!

    There's a lot of info at including diagnosis. But be careful! There's loads of rubbish advice there too, which cost me a huge amount of time.

    Any more questions, I'll give it a go.
  • You just gave me all the wrong (for me)answers, leading me to suspect ITBS I'll go read the the website
  • well after 11 days total rest, i managed to jog very slowly for 15 minutes last night on treadmill (about 10 min mile pace) without any major reaction, just a slight dull ache this morning which is subsiding gradually.

    hopefully i will be able to increase this time / speed very gradually over the next couple of weeks without any re-occurence.

    BTW, the ITB stretching exercises they tell you to do seem quite painful, unless i'm not doing them right ? so i've stopped doing these at the moment as was starting to get other minor tweaks/strains in my upper leg due to this.

    Rachael, hope your rehab is still going well.
    sfh legs - how are you getting on ?
  • Yes everything is going well at moment. Still building strength on the cross trainer thing in the gym - knee has been feeling good lately, so tonight will move on to 20 min run.

    I have noticed recently that my right leg seems to 'move about more' at the front (top) when running (a roll inwards/outwards feeling)- due to weaker hip flexor muscle?

    I guess thinking about it logically that would make sense, in terms of controling my leg movement and trying to keep it in a straighter more controlled movement.

    What does anyone think?
  • Rachael - yep, I agree with that theory. To keep the ITBS away, I need to be running with each leg moving in a vertical plane - when the knee moves inwards during the stride cycle, I'm in bother. My solution is currently to have my shoes prevent this motion, but it may very well be a good idea (as I've done also) to strengthen the abductor/adductor muscle groups to keep your leg in the vertical plane throughout.

    Gareth - yes, there'll be some tugging (which you'll feel at the hip and not the knee), but shouldn't be pain as such. Make sure you've warmed up before stretching. I do a 5-min jog, or you could walk briskly. I'm a bit doubtful about stretches (in my case at least), but I think that at the leat they're not (or shouldn't be) actively harmful.
  • Rachel - Glad things seem to be going well, and hope things continue this way.

    Swerve - yes, there is a bit of 'tugging' at the top of the leg beneath the hip, but it's not too bad.

    Like you said before, there seems to be loads of info flying around on this subject, and i'm sure not all of it beneficial. I have spoken to a physio who i think has given me some sound advice on recovery.

    Hopefully, my only problem now will be to stop myself trying to run too fast too soon especailly if i'm feeling ok, as i want to get back to my normal training asap. i will try and be patient.
  • Message for Swerve.

    I know you said it took a 'few months' for you to rid yourself of this injury. Sorry if you've already mentioned this before, but was that 3, 4 or 6 months ?? and are you now able to run to the same standard / training schedule prior to the knee problem. ? Any reocurrence and how long since you've been back to ' normal' running. ?

    i'm just trying to gauge how long i can expect this too take, and hopefully try to stay positive about returning to the same sort of amount training (about 35mpw) and race times as i have been doing up to now. ?

    Had a bit of a set back on saturday as i felt pain coming back after about 10 - 15 moins jogging. i stopped straight away, but suppose that'll be another week before i try any jogging again. Have staerted back up the stretch exercises and will try and stick to these.

  • Gareth - hard to tell exactly. the first occasion was severe, mostly because I limped (almost hopped!) five miles after the onset. I was barely able to walk for a couple of days afterwards and limped for at least two weeks, and got pain whilst walking for, ooh, putting a number on it.... 2-3 months. Thereafter I first managed to run 5 minutes something like five months after(?) the injury. But I had run about a bit playing cricket only three months after the injury. I'm guessing that I was up to the five minutes stage maybe 2-3 months after my second injury.

    I'm now doing about 25 miles a week or more - more than I've ever done consistently. And I'm doing single sessions at 10-13 mile range, having only been 5 miles prior to injury 1. I do get some very mild aches occasionally (feels like stiffness), but I'm biomechanically far more sound so the ITB's (presumably) barely rubbing at all, so in my opinion I'd have to go quite a lot further to cause any significant pain. I reckon my ITBs (especially my right) are pretty scarred from the earlier problems, and they're still tight, so I'm not surprised there's some residual niggle.

    You did the right thing to stop, by the way. Being optimistic, people do report that a two-week lay-off and gradual return are sufficient. I guess it's a combination of biomechanics and how bad the injury was in the first place.

    Any more questions.....?

    Do please, please get your gait checked out! You'll thank me for it! ;-)
  • Thanks Swerve.

    Hope you don’t mind being bombarded with questions. ! I’m glad to hear your training is going well. Just one more question !, are you able to run intervals like 400m 800m etc.. or do you have to be very careful about doing this type of training at the moment. ?

    Sounds like you injury at the outset was much more severe than mine, as i’ve not had a problem walking, and the initial discomfort when walking downstairs has disappeared already. I have tried a few more stretching exercises I found looking at the internet, as from reading the many articles on ITB, stretching seems to be the key to recovery in every case.

    I tried the XC ‘skier’ type machine at the gym last night, which is good as there is no impact / resistance on the knee, but you can still work at a high heart rate to maintain the aerobic base. I only did 15 mins to see if there was any reaction, but it was fine and feels ok this morning. Might attempt jogging again at the weekend for 10 to 15 mins.

    Once i’m up and running I will make that trip to a specialist to check my gait !

  • No worries - I'm happy to answer questions, as long as you realise I'm a complete amateur and can't guarantee my advice won't cripple/kill you!

    I might be worried about doing short (i.e. high-speed) intervals at your stage, but I've done some (but not much) myself, and don't seem to have a problem.

    Yeah, those skier/elliptical machines are fab. I used them to build endurance mainly (which can be a tad dull!), and had no problems at all. It would be a bit depressing to go to the gym just to do five minutes on the treadmill, so the guaranteed proper work-out is just the job. The ones at my gym have the option to lower the handles and just do lower body, which is what I generally did. Of course, my equestrian legs are in stark contrast to my feeble, flabby upper body, but who cares? :-)

    I guess you'll be back on the road a good bit quicker than me, but that's just half the battle - staying on the road's tricky too.
  • Thanks.

    yes, i don't think i'll be doing any interval sessions until i'm comfortably back into running some decent tempo runs of 5 to 6 miles, and that could be some time., especially as i'm pretty sure that the interval sesssion i did after the week or so lay off over christmas was the cause of the problem in the first place. !

    Thanks for the advice, and i'm sure it won't kill me !, it seems to be pretty sound to me, having also done a lot of reading on the subject and spoken to a physio etc..
  • Seems to be a mix up between Runners Knee( patella femoral pain) and ITBS, i have noticed on some threads.

    I have had two injuries in 5 years. Runners knee (patella Femoral Pain) first in my left knee, then just recently ITBS in my right. The first injury did not hurt when i ran, i used to experience a localiserd aching in the knee when i sat with it bent for some time. I would have to straighten it. I was given a great stretch, that after 1 week, it went compeletly. I also had some "strapping" done by the physio. That was runners knee, it is ok to run on unless it causes pain. Its due commonly to instability in hips, causing knee to run smoothly and centrally through the femoral groove at the lower thigh bone.

    Ok, thats runners knee, this is ITBS as far as i know, as i have been told that is what i have at present.

    I donot have any pain normally, only when i run. After a few minutes, i get pain on the outside of my knee cap region, its goes like it was never there as soon as i stop running and walk. I sometimes experience some tightness in the knee area if i sit with my legs crossed for some time. Stairs DONOT effect my injury, tho i feel mines not too severe.

    I have runners world issue may 2002, which has fantastic details of common knee injuries. What there symptoms are and how to fix them, plus stretches. if anyone can advise further on my current injury feel free.
  • Deb - sounds like we are experiencing exactly the same problem.

    After 2 weeks rest, i tried jogging last weekend, but the pain started again in the outside of my right knee after about 10 mins. Like you, I now have no problem walking or going downstairs (although in the first week I could feel slight pain walking downstairs).

    I have not tried running all this week, and have done a series of stretching exercises twice a day (found under ITB on web and on RW website) and have had no pain or twinges at all. Have been able to use XC skier at the gym, fairly hard without any reaction. Hoping after 3 weeks i will be able to jog slowly on treadmill tommorow for 15 mins without effect.

    From reading quite a lot on this subject, if it is a relatively minor injury it seems that with the right stretching exercises etc.. the recovery period can be expected to be approx 3-4 weeks. Obviously this varies for each person and on the severity of the injury.

    Good luck and I would recommend the stretching / massage as it appears to be the key to a successful recovery.

    I’m not a Doctor, but I’m also taking glucosamine and chondroitin tablets which ‘apparantly’ are good in assisting cartlidge, ligament , tendons etc… growth and restructure.
    Check first though.
  • As a suffereer coming back (I hope) from Runner's Knee which may have an ITBS component, I think that Swerve's experiences are extremely helpful - especially in saying that no matter how much muscle development you do, if there are foot and gait problems you won't improve. I have just started experimenting with stuffing my insoles with paper to get a proper balance. This after running 35 minutes last Sunday with my club including an unwise and steep uphill. I found that if I tilt my foot on the painful side a certain way to get more pressure on the inside ball of the foot, it felt a lot better on the knee. Anyway, I am writing here to bring this to the top of the list again so that I can direct forumites from the USA RW forum to come and look, since there are a lot of people over there with these same problems and sharing a lot of helpful exercises. They are Good luck everybody - sharing these experiences is extremely helpful.
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