Lateral (outside) lower leg and knee pain

Lateral (the outside part) knee pain and lateral lower leg pain is fairly common, especially with running, jumping, and squatting.  This pain can be very limiting and cause you to shorten your training run or modify your workouts.  But, that is not how it has to be.

Several different areas of your body can contribute to the pain.  Depending on the cause of the pain depends on how it needs to be addressed in order to resolve it.

TFL/lateral quadriceps or peroneal tightness

Basic anatomy first: At the top of our IT band is a small muscle, abbreviated TFL.  Then off the TFL comes the IT band down the outside of your thigh, sitting right on top of the lateral quadriceps.  The IT band connects just below the knee joint and connects fascially into the peroneals, which are small muscles on the outside of the lower leg that go down into the foot.

The IT band itself is a band of non-contractile tissue, so technically the IT band cannot be “tight” like commonly thought.  What does happen, though, is either the TFL gets tight, causing a pull on the IT band and a resultant pressure on the knee, or we develop adhesions/restrictions between the IT band and the lateral quadriceps.

The peroneals do not as frequently cause lateral knee pain, but at times can cause tension on the lateral knee due to fascial attachments when they are tight.

Weakness in hips

Hip strength and muscular endurance assist to control the mechanics of the knees.  When the hips are weak or they start to fatigue, the knees start to collapse inward.  This inward collapse causes an abnormal torque on the knees and stress on the tissues surrounding the knee.

For short term, the body can adjust/adapt.  As this continues over time with increased repetition, the body develops pain from the increased stressors to the area.

The fix?  A combination of exercises to strengthen the region as well as re-training of motor patterns.  You can strengthen all you want, but if you don’t also train your body to move properly with the new strength, it will not matter.

Weakness in feet

Just like if the hips are weak, if the feet are weak or lack the necessary endurance for control over increased impact of jumping or high mileage running, it can also cause problems at the knee.  When the feet are weak and fall inward (overpronate), an abnormal torque is caused at the knee and increased strain is caused in the muscles and soft tissues in the leg. 

For short term, the body can adjust/adapt.  As this continues over time with increased repetition, the body develops pain from the increased stressors to the area.

The fix?  A combination of exercises to strengthen the feet as well as re-training of motor patterns.  You can strengthen all you want, but if you don’t also train your body to move properly with the new foot control, it will not matter.

What can you do now?

The following videos show you some things you can do to start addressing your  issues:

Rolling/smashing

Strengthening feet

How I address it with physical therapy

When it comes to lateral lower leg or lateral knee pain, addressing it becomes more complex since a lot of different areas, both up and down the leg, can contribute.  Because of this, it can take a little longer to fully find the cause of the problem.

It also takes a bit longer because the pain is typically ignored initially, so other compensation issues have developed that need to be addressed as well.

Once addressing the specific tight area, the areas that are stiff above and below also need to be corrected.  And then the areas need to be strengthened in order to restore proper motor patterns and maintain proper mechanics under fatigue.

If only the area of pain is addressed and not everything else, it is likely that re-injury will occur.

Related Posts

Leave a Reply