Fix Outer Knee & IT Band Pain with Running-Specific Strength Exercises

I'm not kidding when I say knee pain, specifically OUTER knee pain, is tricky.

If you've ever felt an unexpected twinge mid-run that's threatened to put an end to your workout, then you know.

The stunned, split-second moment of "what was THAT?"

Followed by frantic googling at home.

Only to be bombarded with potential diagnosis such as:

ITB syndrome
runner's knee
lateral ligament strain
meniscus tear
hamstring strain
and worse case scenario, some sort of stress fracture!

Let me be real with you, as your friendly neighborhood physical therapist:

the exact spot of your knee pain/symptom is very important.

But I also realize, pin point that exact location can be very difficult.

Let me explain.

Let's pull two very common "outer knee" issues, ITB syndrome and hamstring strain, and place them side by side.

On the left, you have a common location of ITB pain.

On the right, by the bottom blue arrow, you have a symptom (pain) sight of a distal, lateral hamstring strain.

Can you start to see just how close these two locations are?

Yes, they're both "outer knee pain".

And could potentially BOTH by diagnosed as ITB syndrome.

But one of them is NOT.

But how do you know for sure?

Honestly, you have to get a pro to look at you.

And I don't say this to discourage you.

Yes, you can try straps and braces.

They may help; they may not.

They can be an important tool you use during the healing and rehab process.

But I need you to hear me when I say, no fancy strap is going to 100% save you.

The proven way to fix and prevent outer knee pain is to address the most likely culprits because I know finding the cause of your "outer" or lateral knee pain is important to you.

Just like having the right exercises to prevent it from coming back is your top priority.

As a runner and Doctor of Physical Therapy whose treated more knees than I can count, here the top 4 culprits I look out for:

poor eccentric quad strength
compromised concentric quad strength and endurance
poor glute strength
potential hamstring weakness

Seem similar to last week's blog on how to fix INNER knee pain?

You'd be right ;)

Does that mean the exercises are the same?

ABSOLUTELY NOT.

Let's jump in.

Knee Exercises for Runners: How to Fix ITB Pain with Strength Exercises that Actually Work

Circuits:

WARM UP:

3 Way Glute High Knee Push into Wall

hold each position for 10-15 secs x 2 rounds

*STRENGTH: 3 sets //Medium to heavy weights Reaching Backwards Step Downs (no, these are NOT your normal step down exercise)

Reps X weight

Bulgarian Split Squat Plyo jumps

8-12 reps per leg (work your way up as endurance improves)

Bulgarian Split Squat: Forward Hinge for Glute Emphasis

30 Reps X weight

*Note: Please know this is an incomplete list. There are so many other factors to take into account with lateral knee pain that would result in even more running-specific exercises, including hamstring exercises! The purpose of this list is to at least give you a place to start. I do 1-on-1 coaching where we can deep-dive into your specific situation and get you back to running stronger than ever with a personalized strength plan that addresses your specific weak areas. You can find more information on this on my "Work with me" page.

Knee Pain in Runners: Why you Need More than Squats and Stretches

3 Way Glute High Knee Push into Wall

This little glute warm up is straight from the running gods.
THE REASON I LOVE IT: i know it doesn't look like much. But when you're pushing your knee into a wall, and that wall doesn't move! The glute on your standing leg will start talking to you!
We have multiple layers to our glutes (3 of them), but we also have a group of muscles called our "deep 6" which also help to stabilize our hips. By moving through your running stride by placing and pushing your knee in all 3 different directions, you're effectively waking up ALL of your hip muscles, giving them a preview of the work you want them to do.
Oh, and this exercise can potentially take away knee pain. Pretty neat, right?

Reaching Backwards Step Downs

It's all in the name: REACHING
MY PRO TIP: I love these versions of step downs. They place a little extra emphasis on your glute, while also keeping you mindful (and a little humble) if you've got some quad weakness. Plus, it looks like running-what more could you ask for?
You'll probably see in my video how the weight naturally wants to travel more in front of me to work as a counter balance. This is because I'm holding a plate where normally I'd hold a dumbbell or a kettlebell.
If you're just learning this exercise, go ahead and hold whatever weight implement out in front of you. This will make it easier and feel more natural. But as you get stronger, progress to hold the weight(s) down by your side for some extra strength challenge ;)

Bulgarian Split Squat Plyo jumps

I know what you're thinking: how could bulgarian split squats get any worse?
THE REASON THESE AREN'T THE DEVIL: running is high impact. And your quads need to be able to handle that impact. This relatively gentle, supported, single leg plyo is AMAZING at teaching your quad and glute to produce explosive power AND be able to absorb it.
Because often, outer knee pain occurs when glutes and quads aren't strong enough handle the repetitive, powerful nature of a running stride. As a result, the load gets dumped down the kinetic chain into lateral/outside structures like an ITB or outer hamstring causing you outer knee pain.
This exercise not only helps build strength, but also helps re-teach your body how to coordinate a running-like movement with the correct muscle groups.

Bulgarian Split Squat: Forward Hinge for Glute Emphasis

This is one of my favorite little tricks and I'm giving it to you
THE SECRET: We can bias the bulgarian split squat so it works your glute more than your quad. But realize, one isn't necessarily better than the other. But it's really nice to know how one small tweak and can change an exercise.
HOW DO YOU DO IT? get into your regular BSS stance. Then, hinge forward at the hips. If that's too confusing, stick your butt out behind you. This should place you in a position where you're nearly looking at the ground.
WHY THIS WORKS: by hinging from your hips, you place more stretch on your glute muscles by lengthening those muscle fibers. As you perform the exercise in this position, you're asking those glute muscle fibers to contract and get stronger. Congrats: you're working smarter, not harder ;)

WRAPPING UP

Let's answer one last, very specific question:

Are knee straps for outer/lateral knee pain completely pointless for runners? Do they do anything?

No, they're not a total waste, but they really only help under certain conditions.

Here's exactly how I would use them if you came to me with complaints of outer knee pain while you're running.

If you were able to describe your knee pain as truly being on the side of your knee, potentially above the joint and/or only wrapping around maybe to the back, I may recommend a strap or a brace. (I would NOT recommend you get a strap/brace if you said the knee pain moves around all the time, pops or clicks, or feels vague/hard to pin point.)
I would then have you wear the strap/brace for a short run where you could easily bale if needed. If symptoms got 100%, cool! If they only got 50-75% better, that's still a win because...
The goal of the strap isn't to get you back to running. The purpose of the brace is to allow your knee to move through a greater range of motion/have more pain free mobility so that...
You can strength train, pain-free with running-specific exercises, gradually working you out of the brace completely.

Because eventually, due to your commitment and hard work, you won't even need that brace or strap anymore because you've built injury-proofed quads and you're back to running and racing stronger than ever.

If you're looking for even more injury-proofing, running-specific strength exercises to make your knees bullet proof to help you race stronger than ever, check out my FREE Strength Guide for Runners here:

FREE Strength Workouts for Runners

Until next time, running fit fam...

Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit