Outside Knee Pain

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By: Ehren Allen, DPT, COMT

Pain in the outside part of the knee is common with many sports and activities. It is also called “Lateral Knee Pain.” The pain can come from several parts of the knee.

Outside Knee Pain Causes

The most common causes of pain on the outside of the knee are:

IT Band Syndrome
Lateral Patellofemoral Joint Dysfunction
Arthritis
Lateral Meniscus Tear
Lateral Collateral Ligament Tear (LCL)

IT Band Syndrome

Iliotibial Band Syndrome or ITB syndrome occurs when there is extra friction from the IT Band rubbing over the lateral condyle of the knee. Tightness in the ITB can also cause the knee cap to pull to the outside. Both of these issues can cause pain in the knee.

The ITB should glide over the outside bump on the condyle with bending and straightening of the knee.

The Iliotibial Band is a long thick piece of connective tissue the runs from the outside of the hip, to the knee. The Gluteus Maximus and the TFL attach to it at the hip region. The IT Band attaches to the outside of the knee cap and top of the fibula bone at the knee region.

Iliotibial band anatomy diagram with labels and numbers to show the specific anatomy. IT Band Anatomy

Causes of Increased Friction in the ITB at the Knee

IT Band is too tight
Knee angle causes abnormal force
Weakness in the Gluteal muscles
Excessive foot pronation

Ways to Fix IT Band Syndrome

Run on the other side of the street – This can change the angle on the knee by switching the direction of the pitch of the road.
Add Stability shoes to limit pronation – Custom Orthotics may also be helpful to limit excessive ankle and foot collapse.
Strengthen the Gluteal Muscles – Lying on the side, lift the top leg and keep is straight. Hold 30 seconds, 3X.

Man lying on his side lifting the top straight leg to strengthen the gluteus medius Side-lying straight leg raise

Foam Roller to Release the IT Band – Lying on the side, roll the IT Band over a foam roller. Repeat for about 2 to 3 minutes as tolerated.

woman lying on her side on a foam roller to release the IT band on the left Foam Roller for the IT Band

Lateral Patellofemoral Knee Pain

Lateral Patellofemoral pain or knee cap pain is one of the most common causes of pain in the knees. This type of knee pain happens when the knee cap rides on the outside part of its groove in the knee.

image of knee anatomy showing lateral patellofemoral pain with arrows pointing to the the lateral patellofemoral region.

Causes of Lateral Patellofemoral Knee Pain

Weakness in the Quadriceps – Weakness in the muscles in the front of the thigh can cause the knee cap to migrate toward the outside of the knee. this can cause excessive wear and tear on the outside of the knee cap and the groove of the femur.
Knock Knee Position – When there is an increase in the valgus angle of the knee, the knee cap rides on the outside of the joint.

Diagram showing normal knee angle, increased varus angle or bowlegged position, and knock knee or valgus deformity

Weak Hip Abductors and External Rotators – Weak hip external rotators and abductors can cause to pelvis to drop and rotate. This can increase the valgus angle at the knee with single leg activity, running, and jumping.

Fix Lateral Patellofemoral Knee Pain at Home

The best way to correct lateral knee cap pain on your own is with strength exercises. Strengthening the Quadriceps, Gluteus Medius, and Hip External Rotators can help to improve the mechanics of the knee cap in the groove. Try these exercises.

Straight Leg Raises – Lie with the leg straight on a surface. Tighten the muscles in the front of the thigh as tightly as possible and lift about 12 inches off the surface. Hold for 5 seconds and repeat 20X.

Man lying on a surface doing and right straight leg raise to increase quadriceps strength Straight Leg Raise

Side-lying Hip Abduction – Lying on the side with the painful side up, lift the straight leg. Hold 30 seconds and repeat 3X.

Man lying on his side lifting the top straight leg to strengthen the gluteus medius Side-lying hip abduction

Side-lying Clams – Lying with the painful side up with the knees bent, lift the top knee but keep the foot down. Repeat 20X

Man lying on his side with knees bent and lifting the top knee to do a side-lying clam to strengthen the hip external rotators Side-lying hip external rotation

Arthritis in the Knee

Knee arthritis can cause pain with weight bearing activity such as walking or stairs. Arthritis in the lateral compartment or the lateral patellofemoral joint can cause pain in the outside part of the knee.

Arthritis is inflammation in a joint that lead to a breakdown in the cartilage. This may occur from excessive force over time on the outside of the knee. The most common type of arthritis affecting outside knee pain is Osteoarthritis.

Image of arthritis in the lateral compartment of the knee

Fix Arthritis in the Knee

Exercises for the quadriceps and gentle range of motion exercises may help to calm symptoms of knee arthritis. A stationary cycle can be helpful to maintain range of motion and limit the amount of weight and force on the knee while getting some exercise.

Anti-inflammatory medications may also be helpful with arthritis in the knee.

In severe cases, and knee joint replacement or arthroplasty may be needed. With a knee replacement, and orthopedic surgeon removes the damage cartilage on the joint surfaces. They place artificial surfaces in the knee to allow for movement and walking.

Click to Learn about Robot-Assisted Partial Knee Resurfacing.

Lateral Meniscus Tear

A lateral meniscus tear can cause outside knee pain. Meniscus tears usually occur with trauma but can be degenerative over time as well.

There are 2 menisci in the knee. The lateral meniscus is in the outer part of the knee. A tear in the meniscus can limit knee range of motion and stability.

Fix Lateral Meniscus Tear

Strength and functional training exercises can help to improve pain and return to full function in most people. Physical therapy can help to customize exercises to improve function after a meniscus tear.

If pain persists, surgery may be needed. Surgery for the lateral meniscus may involve a partial meniscectomy or a meniscus repair. In some cases, a meniscus replacement can be performed.

Lateral Collateral Ligament Tear (LCL Tear)

The Lateral Collateral ligament or LCL is a ligament on the outside of the knee. It helps to stabilize the knee and limit Varus forces. As with most knee ligament tear, the LCL tears typically occur with trauma to the knee that forces the knee into a Varus or Bowlegged position.

Image of knee anatomy with label and arrow showing the lateral collateral ligament or LCL

Fix LCL Tear

Partial of minimal tears in the LCL can heal with time and physical therapy. A knee brace can help to limit forces and allow for healing. In severe cases, surgery is needed to repair an LCL tear.

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Watch this video from JOI and JOI Rehab on Why Knee Pain Can’t Wait!

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