and Managing Lateral Knee Pain: Causes and Solutions

Lateral knee pain?

Hello Dr.
Li: I had a habit of running three to four times a week, but two weeks ago, I suddenly felt pain on the outer side of my knee while running.
I do not experience any pain while walking or brisk walking.
What could be the possible cause and how can I resolve this issue? How should I take care of it? Thank you!

Sheng, 20~29 year old female. Ask Date: 2006/12/04

Dr. Li Wenlin reply Orthopedics

Hello, in response to your question.
If you do not experience pain while walking or brisk walking, but feel pain on the outer side of your knee when running, it is usually indicative of inflammation of the iliotibial band or a strain of the lateral collateral ligament.
If there were issues within the joint, you might also have symptoms while walking or brisk walking.
I recommend that you refrain from running for now and switch to brisk walking, while avoiding steep or overly strenuous terrains (such as stairs or very hard surfaces).
If you experience pain even while brisk walking, it would be wise to seek medical attention sooner.
If there are no issues after two to three weeks, you can try to resume jogging, starting with a quarter of your usual distance.
If that goes well, you can gradually return to your running routine.
The principle of maintenance is quite simple: do not overuse your body.
If you feel very uncomfortable after running today and still feel unwell the next day, you should reassess your running technique and distance.
In other words, if you feel great after a rest following your run, that indicates an appropriate exercise regimen.
Wishing you all the best!

Reply Date: 2006/12/04

More Info

Lateral knee pain, particularly in runners, can be attributed to several potential causes. Given your recent increase in running frequency and the sudden onset of pain, it is essential to consider the most common conditions associated with this type of discomfort.

One of the primary causes of lateral knee pain in runners is Iliotibial Band Syndrome (ITBS). The iliotibial band is a thick band of fascia that runs along the outside of the thigh from the hip to the knee. When this band becomes tight or inflamed, it can rub against the lateral femoral epicondyle (the outer part of the knee), leading to pain. This condition is often exacerbated by activities that involve repetitive knee flexion and extension, such as running.

Another possible cause is patellofemoral pain syndrome, which can occur when the kneecap (patella) does not track properly in its groove during movement. This misalignment can lead to pain on the outer side of the knee, especially during activities like running or squatting.

Lateral meniscus tears can also present as pain on the outer side of the knee, particularly if there was a twisting motion during your run. Although this is less common, it’s a possibility if the pain persists or worsens.

Bursitis is another condition to consider. The bursa is a small fluid-filled sac that reduces friction between tissues. Inflammation of the bursa on the outer side of the knee can lead to localized pain and swelling.

Management and Solutions
1. Rest and Ice: Initially, it is crucial to rest the affected knee and apply ice to reduce inflammation. Ice should be applied for 15-20 minutes every few hours, especially after activities that aggravate the pain.

2. Modify Activity: Temporarily reduce the intensity and frequency of your running. Consider switching to low-impact activities such as swimming or cycling, which can help maintain your fitness without stressing the knee.

3. Stretching and Strengthening: Incorporate stretching exercises for the iliotibial band, quadriceps, hamstrings, and hip flexors. Strengthening exercises for the hip and core muscles can also help improve stability and reduce the risk of future injuries. Focus on exercises that target the gluteus medius, as weakness in this muscle can contribute to knee pain.

4. Proper Footwear: Ensure that you are wearing appropriate running shoes that provide adequate support and cushioning. Consider visiting a specialty running store for a gait analysis to find the best shoe for your foot type and running style.

5. Gradual Return to Running: Once the pain subsides, gradually reintroduce running into your routine. Start with shorter distances and lower intensity, and pay attention to how your knee responds. It may be beneficial to incorporate walk/run intervals initially.

6. Physical Therapy: If the pain persists despite self-care measures, consider consulting a physical therapist. They can provide a tailored rehabilitation program that addresses your specific needs and helps you return to running safely.

7. Consult a Physician: If the pain continues or worsens, it may be necessary to see a healthcare provider for further evaluation. Imaging studies such as an MRI may be warranted to rule out structural issues like meniscus tears or significant ligament injuries.

Prevention
To prevent future episodes of lateral knee pain, consider the following strategies:
- Warm-Up and Cool Down: Always include a proper warm-up before running and a cool-down afterward to prepare your muscles and joints for activity.

- Cross-Training: Incorporate different forms of exercise into your routine to prevent overuse injuries. This can help balance muscle development and reduce repetitive strain on the knee.

- Listen to Your Body: Pay attention to any signs of discomfort. If you feel pain during or after running, take a break and assess your training regimen.

In conclusion, lateral knee pain can arise from various causes, particularly in runners. By implementing appropriate management strategies and preventive measures, you can effectively address your current discomfort and reduce the risk of future injuries. Always consult with a healthcare professional if you have concerns about your symptoms or if they persist despite self-care efforts.

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