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Runners! Treat The Underlying Cause Of Your Knee & Thigh Pain

By Kevin Dandy, PT, MPT, CMPT, CDN | February 14, 2019

Runners, let’s talk. If you’re consistently experiencing pain in the outside portion of your thigh or knee, it’s time to see a physical therapist. A common cause for this type of pain is known as iliotibial band(ITB). When the iliotibial band becomes weak it may result in Iliotibial Band Syndrome (ITBS) and can affect up to 22% of runners.


The iliotibial band is a large, thick, ligament-like tendon that attaches from the tensor fascia latae (TFL) muscle in the hip and pelvis and runs the entire length of the thigh, attaching on the outer side of the knee.  The ITB is the most superficial muscle on the outer portion of the thigh, with fascial attachments to deeper quadriceps muscle (vastus lateralis specifically). The main function of the TFL and ITB are to help stabilize the pelvis and thigh in single leg functions like walking and running.


Pain from Iliotibial Band Syndrome typically occurs over the lower half of the tendon and the insertion point at the knee.  ITBS is commonly caused by lack of proper strength, functional stability, and motor control of the hip and/or the foot and ankle.  Running is essentially repeated squatting on one leg. If the hip (gluteal muscles) lacks proper strength and control the pelvis will drop, forcing the knee into poor alignment and causing pain.

(For more technical detail: The result of the pelvis dropping in single limb stance causes the thigh to adduct, or move inwards from the position that it should be in. The femur, or thigh bone twists into internal rotation, the tibia, or shin bone twists into lateral rotation, and the knee bends inward (knee valgus) as a result.  Poor ankle eversion strength and motor control can also lead to similar compensations. When the knee drops into a valgus position and twisting occurs in the leg, increased stress and friction occurs at the ITB.) With repetitive dysfunctional motion of leg, pain and inflammation can result.


In the past, common treatments of ITBS include rest, anti-inflammatory medication, stretching, and myofascial techniques including foam-rolling. These interventions only treat the symptoms, however, and not the underlying cause of the pain. To properly treat any musculoskeletal injury, the physical therapist must address and try to correct the root of the problem to the best of their ability.  In the case of ITBS, the physical therapist must examine the low back, hip, knee, ankle, and foot as all of these areas can contribute to the problem.

Physical therapy treatment should focus on normalizing proper balance and lower extremity motion during single leg movements. The pelvis and ankle must be functionally stable with single leg squats in order to keep the knee in a normal alignment.  To achieve proper pain free movement your physical therapist may recommend strengthening of the hip abductors and/or ankle evertors, perform single limb balance drills, dry needle the TFL and vastus lateralis, and laser the inflamed ITB.

  • Trigger point dry needling of the gluteal and quadriceps muscles
  • Laser therapy to the iliotibial band
  • Corrective exercises shown below
    • > Side bridge
    • > Side plank
    • > Single leg mini squat with proper posture (see above video)


About The Authors

Kevin Dandy, PT, MPT, CMPT, CDN

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