Lateral knee pain on the outside of your knee can be from injuries or overuse. It can range from a mild ache to sharp pain, depending on the cause. About 25% of adults experience knee pain at some point, and IT band syndrome alone accounts for up to 12% of running-related injuries.
Here, you’ll learn why lateral knee pain happens and how to manage it.
What is Lateral Knee Pain
Lateral knee pain (runner’s knee) is on the outside of the knee and can be debilitating and limiting. This type of knee pain can come from injuries and overuse.
This section covers the common causes and symptoms of lateral knee pain so we can dive deeper into it later.
Causes
Several things can cause lateral knee pain, ITBS is one of the most common. ITBS is when the iliotibial band, a thick band of connective tissue, becomes irritated or swollen from rubbing against the knee or hip bones. This is common in runners and cyclists due to repetitive knee bending and straightening.
1. IT Band Syndrome (Iliotibial Band Syndrome)
If you feel a burning or aching pain on the outside of your knee, your IT band might be too tight or inflamed. This often happens if you run, cycle, or perform repetitive knee movements without proper stretching.
2. Knee Osteoarthritis
Wear and tear over time can lead to osteoarthritis, which causes stiffness and pain on the outer side of your knee. If you notice swelling or difficulty bending your knee, arthritis could be the culprit.
3. Lateral Meniscus Tear
A sudden twist or awkward movement can tear the lateral meniscus, the cartilage that cushions your knee. If you feel locking, swelling, or instability, you might need medical attention.
4. Lateral Collateral Ligament (LCL) Injury
Your LCL helps stabilize your knee. If you’ve had a direct impact or overstretched movement, you might experience swelling, weakness, or difficulty turning your knee outward.
5. Patellofemoral Pain Syndrome (Runner’s Knee)
Poor knee alignment, muscle imbalances, or excessive activity can cause pain around your kneecap, sometimes spreading to the outer knee. If you feel pain while squatting, climbing stairs, or sitting for long periods, this might be the issue.
6. Biceps Femoris Tendinopathy
Your hamstring muscles attach near the outer knee. Overuse or strain can cause inflammation, leading to pain, especially when running or bending your knee.
7. Peroneal Nerve Irritation
If you feel tingling or shooting pain along the outer knee and lower leg, your peroneal nerve might be compressed due to injury or poor posture.
8. Overuse or Muscle Imbalances
If you suddenly increase your activity level without strengthening the right muscles, your knee may experience extra stress, leading to lateral knee pain.
Symptoms to look out for
Symptoms of lateral knee pain is the first step to getting better. Common symptoms are swelling, tenderness and feeling of instability in the knee. The pain gets worse with movement and better with rest so it’s a big problem for active people.
Look out for:
- Sharp pain on the outside of the knee: This is a sign of ITBS and gets worse with physical activity like running or cycling.
- Clicking sensation: Those with ITBS may feel a clicking sensation in the knee during movement.
Iliotibial Band Syndrome (ITBS): Main Cause
Iliotibial Band Syndrome (ITBS) is a common cause of lateral knee pain especially in distance runners. This overuse injury is when the iliotibial band moves across the knee joint and causes inflammation and pain on the outside of the knee, often with iliotibial band friction syndrome.
What is ITBS?
The iliotibial band is a fibrous tissue that runs from the hip to the knee and helps stabilize the knee during movement. This band provides support during activities like running and cycling to maintain knee alignment and function.
When this band becomes tight or irritated it can cause ITBS and pain.
Those with ITBS feels pain on the outside of the knee which gets worse with movement. This pain is more pronounced during activities that involve repetitive knee movement like running or cycling. Other symptoms are:
- Popping sensation: Felt around the outside of the knee during movement.
- Pain with activity: Activities that involves knee bending and straightening makes the pain worse.
Causes of ITBS
Excessive foot pronation and weak hip abductor muscles can cause ITBS by increasing tension and friction to the iliotibial band. Strengthening the hip and core muscles can correct these biomechanical imbalances and reduce the risk of ITBS.
Causes are:
- Foot mechanics: Poor foot alignment puts stress to the iliotibial band.
- Hip and core strength: Weakness in these areas makes the iliotibial band tight.
Other Rare Causes
Lateral knee pain is usually caused by common issues like IT band syndrome or ligament injuries, but sometimes, rarer conditions could be the reason for your discomfort. If you’ve tried the usual treatments and still experience pain, one of these rare causes might be worth considering.
1. Fibular Head Dysfunction
Your fibula is the smaller bone on the outer side of your lower leg. If its head (top part) isn’t moving properly due to misalignment or injury, you might feel sharp or aching pain on the outside of your knee, especially when walking or squatting.
2. Popliteus Tendinitis
The popliteus muscle sits behind your knee and helps with stability. If it becomes inflamed due to excessive running or improper movement, you may feel lateral knee pain that worsens when walking downhill or pivoting.
3. Synovial Plica Syndrome
Your knee has small folds of tissue called plica. If the lateral plica gets irritated or thickened, it can cause clicking, pain, or a feeling of something “catching” inside your knee.
4. Superior Tibiofibular Joint Dysfunction
The joint between your tibia and fibula plays a role in knee stability. If it’s hypermobile (moves too much) or restricted, you might experience lateral knee pain, especially when bending your knee under load.
5. Lateral Patellar Compression Syndrome
If your kneecap is being pulled too far to the side, it can cause pressure and pain on the outer knee. This often happens due to muscle imbalances or poor biomechanics.
6. Nerve Entrapment (Peroneal or Sciatic Nerve Compression)
If your peroneal nerve (near the fibular head) or sciatic nerve is compressed, you might feel sharp, shooting pain or tingling along the outer knee and lower leg. This can happen from prolonged sitting, direct trauma, or muscle tightness.
7. Stress Fracture of the Lateral Tibial Plateau
Overuse, high-impact activities, or osteoporosis can lead to small fractures in the outer part of your tibia, causing persistent pain that worsens with weight-bearing.
Treatment for Lateral Knee Pain
Treatment for lateral knee pain includes conservative and surgical options, often a combination of rest, anti-inflammatory meds, physical therapy and in severe cases surgery.
Rest and Anti-inflammatory Meds
Resting the knee and avoiding activities that aggravates the pain is key to managing lateral knee pain. Anti-inflammatory meds like NSAIDs (ibuprofen and naproxen) can reduce inflammation and pain.
Key strategies are:
- Rest and ice therapy: These can reduce inflammation and promote healing.
- NSAIDs: Nonsteroidal anti-inflammatory drugs can manage pain and swelling.
Physical Therapy
Physical therapy is important in the recovery, exercises are tailored to improve knee function and pain reduction. Patients usually see improvement within a few weeks of physical therapy.
Specific exercises for quadriceps, hamstrings and calf muscles are important for knee stability and injury prevention.
Surgical Treatment
Surgical treatment is only considered when conservative methods fail to relieve knee pain. Surgical procedures may involve repairing damaged tissues, removing inflammatory tissues or addressing structural problems in the knee.
Most knee pain can be managed with non surgical treatments like physical therapy and meds.
6 Ways to Prevent It
Preventing lateral knee pain starts with strengthening your muscles, improving flexibility, and maintaining proper movement patterns. Here’s how you can keep your knees pain-free:
1. Strengthen the Supporting Muscles
- Quadriceps & Hamstrings: Squats, lunges, and leg presses help stabilize your knee.
- Hip Muscles: Strengthen your glutes and abductors with side leg raises, clamshells, and lateral band walks.
- Calf Muscles: Heel raises improve lower leg support and balance.
2. Improve Your Flexibility
- Stretch Your IT Band: Foam rolling and targeted IT band stretches reduce tightness.
- Loosen Up Your Hips & Hamstrings: Regular hip and hamstring stretches keep your movement smooth.
- Don’t Forget Your Calves: Tight calves can put extra strain on your knee—stretch them daily.
3. Stability & Alignment
- Work on Your Balance: Try single-leg stands, BOSU ball exercises, and core stability drills.
- Wear the Right Shoes: Supportive footwear helps align your feet and reduce knee strain.
- Consider Orthotics: If you have flat feet or overpronation, custom inserts can provide extra support.
4. Adjust Your Training & Movements
Proper training techniques is important to prevent overuse injuries. Gradual increase in running distance and intensity following the 10% rule can manage stress on the knees. Dynamic stretching before runs and static stretching after can increase flexibility and reduce muscle tension.
- Warm Up First: Do dynamic exercises like leg swings and hip circles before workouts.
- Avoid Overuse: Gradually increase intensity and mix up your workouts to prevent repetitive strain.
- Check Your Form: Proper technique in running, squatting, and jumping prevents misalignment.
5. Manage Your Body Mechanics
- Pay Attention to Your Posture & Gait: Poor walking or running form can contribute to pain.
- Reduce Impact on Your Knees: Run on softer surfaces and limit excessive downhill running.
6. Equipment and Footwear
Proper footwear minimizes knee stress during physical activities. Replace running shoes regularly to ensure proper support and cushioning to prevent knee pain. Proper supportive shoes can prevent issues that causes lateral knee pain.
Replace your shoes regularly to maintain proper alignment and reduce injury risk.
Bottom Line: Summary
Lateral knee pain often happens due to overuse, muscle imbalances, or injuries. If you’re a runner, cyclist, or someone who does repetitive knee movements, you’re more likely to experience this issue. Studies show that runners have a 7x higher risk of IT band syndrome compared to non-runners.
- Lateral knee pain (ITBS) is common in runners and cyclists and you need to know the causes to get better.
- Symptoms of lateral knee pain are sharp pain on the outside of the knee, swelling and instability, so get diagnosed and treated early.
- To prevent it you need to use proper training techniques, strengthen your muscles and wear the right shoes to reduce stress on the knee.
