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Runners Knee | ITBS Treatment Vienna

Knee pain, especially pain on the outside of the knee joint, can often be the symptoms of runner’s knee. Runner’s knee (also called ITBS = Iliotibial band syndrome or tractus iliotibialis syndrome) occurs preferentially in runners or operators of running-intensive sports (e.g., soccer) and is considered one of the most common causes of complaints on the outside of the knee. But what is a so-called runner’s knee, where does the pain come from and above all, what can you do about it? We clarify these and other questions below.


Läuferknie Runner's Knee Behandlung Wien

What is runner's knee? How does runner's knee develop?

Runner’s knee refers to a pain syndrome that is usually caused by overuse or misuse of the tractus iliotibialis. The tractus iliotibialis, as a reinforcement of the femoral fascia, is a tendon fiber cord of various muscles and extends away from the hip, down along the outside of the thigh to the lateral tibial plateau. It is very important for running because of the stabilizing function for the hips and knees.

In runner’s knee, unfavorable tensile stresses occur as a result of incorrect or excessive strain, leading to inflammation and signs of overuse at the outer bony prominence of the femur, over which the tractus iliotibialis passes. This is how the annoying pain on the outside of the knee occurs and knee pain is the result.

Causes and risk factors of runner's knee

During the bending and extending movements of the knee joint, the tractus iliotibialis slides each time over the outer bony prominence of the femur, the so-called condylus lateralis femoris. Overloading the musculoskeletal system, such as during long-distance running, cycling or rowing, but also other running-intensive sports, can lead to irritation of the tendon cord. The result is inflammation of the tract and the affected leg skin, as well as the intervening bursa.

In addition to overloading due to intensive running, incorrect loading due to an incorrect running style can also lead to complaints. Athletes with bow legs (genu varum) are particularly frequently affected, but an x-leg malposition (genu valgum) can also promote runner’s knee. bow legs lead to increased tension on the outside of the leg and thus to a higher susceptibility to irritation.

Other possible causes and risk factors are foot malpositions, such as flat and splay feet, as well as shortened musculature (especially insufficiency of the adductors) or inappropriate footwear. Weakness of the pelvic stabilizers can also cause the discomfort, as this causes the hip, which is not under load, to sink, creating excessive traction on the tract. Other factors that favor the development are a lack of activity and strength deficits of the gluteal muscles or an inward tilt of the foot.

Schmerzendes Knie während des Laufens - Runners Knee
Mann dehnt sich während eines Ausdauerlaufes

Causes of Runner's Knee (ITBS) at a glance

Symptoms of runner's knee

Affected patients who suffer from the
runner’s knee
suffer from severe, mainly load-dependent pain that makes running impossible and also severely impairs slow walking. This pain is usually localized in the knee area or on the outside of the knee, but it can also radiate. The discomfort can sometimes be markedly strong and stinging , and is often described as cutting or pulling. In addition, there is often a pressure pain over the outside of the knee. Because of the anatomy of the iliotibial tract and its attachment to the tibial plateau, pain originating in the thigh often projects to the knee joint or to the outside of the tibia. In addition, symptoms may also occur in the pelvic area.

Risk of confusion: What diseases are there that bring similar symptoms?

The diagnosis of runner’s knee is usually very clear with a careful history and clinical examination. However, it is not always possible to make the appropriate diagnosis immediately, since other orthopedic diseases exist that exhibit similar symptoms.

The aforementioned projection of pain in the direction of the tibial plateau can mean that the cause is often not recognized immediately. A similar symptomatology is sometimes found with injuries to the outer meniscus or cartilage damage in the outer joint compartment. These can also be the result of a possible
valgus gonarthrosis
be. Hip pain in the context of hip osteoarthritis also very often radiates to the outside of the knee. Other possible differential diagnoses include fatigue fracture, muscle fiber tears, ganglia, chronic collateral ligament instability, or injury to a tendon.

Anatomie eines Knies - Detaillierte Darstellung von Muskelfasern

Are all runners affected by runner's knee sooner or later?

As mentioned, the disease predominantly affects runners and cyclists. However, this does not mean that all runners will be affected by Runner’s Knee sooner or later. Conversely, even short distances can trigger the complaints and do not always have to be symptoms of overload. Besides the Sports load there are risk factors that favor the development of runner’s knee. In addition to the leg misalignments listed, leg length discrepancies, as well as rotational misalignments in the hips and knees are also blamed as causative factors.

Besides the exclusion of all risk factors, there are many preventive measures that can be taken to prevent runners from developing runner’s knee.

How is runner's knee diagnosed?

Meniskusriss Meniskus OP Wien

As mentioned, a detailed history and a good clinical examination can often be sufficient to establish the diagnosis. Typical of runner’s knee is a creaking sensation over the outer femoral condyle, possibly also a kind of crackling sound emanating from the irritated tissue. As a rule, swelling is visible here and the region there is also painful from pressure. The tractus iliotibialis is often shortened and strained. Bending and extending movements of the knee joint with simultaneous internal rotation of the lower leg can cause additional pain, as the tractus is strongly tensioned in the process. The suspicion can be confirmed with an ultrasound examination. In addition, to confirm the diagnosis, targeted local anesthesia may be administered. If the pain returns to this for some time, the diagnosis can be considered confirmed. In case of doubt and to exclude possible other causes, magnetic resonance imaging is advised.

How is runner's knee treated?

Treatment by means of conservative therapy

In most cases, runner’s knee can be managed with conservative treatment options, i.e. without surgery. As initial measures and especially in the acute phase, cooling the knee and applying anti-inflammatory ointments or plasters, as well as consistent stretching exercises of the tract and strengthening exercises of the pelvic stabilizers, abdominal and back muscles are helpful. Supplementary pain and anti-inflammatory drugs can be administered for a short period of time. The affected knee joint should be rested during the acute phase and, if possible, a break from running or cycling should be taken.

Stabilization of the knee using Kinesio Tape can also help the patient recover quickly.

Consistent physical therapy is critical!

Conservative therapy also includes consistent physical therapy. This includes, above all, stretching exercises of the tractus iliotibialis, which is usually shortened, ideally in combination with active friction therapy by:the supervising physiotherapist. Shockwave therapy can also be tried for this condition and often results in faster recovery and relief of pain.

If bow-leg malalignment is partly responsible for the symptoms, sports insoles should possibly be prescribed and worn. Often, unsuitable running shoes are also the trigger of the pain. Here, a treadmill analysis can help to find the right shoes. Applied to cycling, a bicycle analysis can help to identify incorrect saddle height or poorly adjusted clipless pedals.

If a malposition is responsible for the complaints, also a
straightening of the leg axis
is also a possible option to alleviate the discomfort and, above all, to prevent further problems such as rapid wear of the knee joint.

Mann während einer Physiotherapie-Behandlung

I have an important competition coming up: what can I do?

In cases of severe symptoms or before competitions that cannot be postponed, infiltration with cortisone can lead to a rapid improvement in symptoms. Surgeries are rarely necessary. If the iliotibial tract is shortened, it can be incised in a Z-shape, thus lengthening or relieving it. The protruding bone protrusion can also be surgically removed.


In finding these and in the diagnosis, as well as therapy of a runner’s knee, I am available to you as a specialist in Vienna at any time.

Prevention of runner's knee

Suitable, individually fitted running shoes, as well as warm-up and stretching exercises before prolonged exertion, are effective in prevention. Stretching should be done not only before, but also after the sport activity. Regular stretching reduces the tension on the ligaments in the leg. The return to sporting activities should take place in consultation with a doctor if or after complaints.

As a preventive measure, body-stabilizing exercises such as planks and strengthening the gluteal muscles are recommended. The running volume and speed should be increased gradually for runners, and overloads and incorrect loads should be avoided as far as possible. In addition, one should pay attention to sufficient regeneration times.

Strength training and a workout of the entire trunk and hip muscles optimize the motion sequence during running and prevent the hip from sinking on the opposite side of the body.

Pain on the outside of the knee joint is often caused by runner’s knee or what is known as ilitbial band syndrome (ITBS). The complaints can be protracted and do not have to affect only runners. With simple preventive measures, the development of symptoms can usually be prevented. If the disease does occur, there are several therapeutic options to alleviate the symptoms. In many cases, however, risk factors are responsible for the pain.

Summary - Runner's Knee
Dr. Martin Gruber summarizes the most important facts

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