How to Tell the Difference and What Actually Helps
If you’re an active adult dealing with lateral or anterior knee pain, chances are you’ve heard it called “runner’s knee” or blamed on a tight IT band. But here’s the problem: those labels don’t tell you what’s really going on and they don’t give you a clear plan to fix it.
At Cleveland Performance Chiropractic, we look beyond symptom location and use a full-body, movement-focused approach to figure out what’s driving the pain and how to get you out of it.
The 3 Most Common Knee Pain Issues We See
1. Patellofemoral Pain Syndrome (PFPS)
- Where it hurts: Around or behind the kneecap
- What aggravates it: Stairs, squats, prolonged sitting
- What’s going on: Often caused by hip weakness, quad imbalances, or motor control issues during loaded movement
- Evidence says: Strengthening the hips and quads leads to better outcomes than passive treatments alone
2. Iliotibial Band Syndrome (ITBS)
- Where it hurts: Sharp or burning pain on the outside of the knee
- What aggravates it: Running downhill, longer distances, or repetitive loading
- What’s going on: Poor hip control, excessive knee valgus, or overuse without proper strength support
- Evidence says: Hip abductor strengthening and gradual load progression are key to long-term improvement
3. Patellar Tendinopathy
- Where it hurts: Just below the kneecap, usually on one side
- What aggravates it: Jumping, heavy squats, running faster or uphill
- What’s going on: Tendon overload and limited capacity for force absorption
- Evidence says: Eccentric loading and shockwave therapy show strong clinical results
Don’t Forget the Spine: Referred Pain Happens Too
Not all knee pain starts at the knee. In some cases, especially if the pain feels vague, shifts locations, or isn’t tied to a clear movement pattern, the real source could be referred pain from the lower back.
Issues like lumbar disc irritation or nerve root sensitivity can cause pain that mimics IT band syndrome or patellofemoral pain. That’s why we always screen the lumbar spine and perform neurodynamic tests during your evaluation.
Treating the right source matters. If the issue is coming from your spine, no amount of foam rolling your IT band will fix it.
What Our Evaluation Includes
Every knee case starts with a detailed assessment, including:
- Your activity history, training load, and symptom timeline
- Motion-captured full body movement exam
- Movement tests like single-leg squat, gait analysis, and landing control
- Hands-on testing for joint mobility, tissue sensitivity, and nerve involvement
- Review of contributing areas (hip, foot/ankle, spine)
We don’t guess. We test.
The Hip-Knee Connection: Why Proximal Control Matters
One of the most common mechanical contributors to both patellofemoral pain syndrome (PFPS) and iliotibial band syndrome (ITBS) is a lack of neuromuscular control at the hip, especially when the leg moves inward or rotates during activity.
During activities like running, jumping, squatting, or lunging, insufficient control of the gluteus medius, gluteus maximus, and deep external rotators can lead to:
- Increased hip adduction (the thigh moving inward)
- Excessive internal rotation of the femur
- Dynamic valgus at the knee (knee collapsing inward)
This altered movement pattern increases the lateral displacement of the patella, placing abnormal compressive forces on the patellofemoral joint and/or creating friction and tension on the iliotibial band at the lateral femoral condyle.
Clinical Insight:
- A study by Powers (2010) demonstrated that decreased hip abductor and external rotator strength is strongly correlated with altered lower limb kinematics and increased patellofemoral joint stress during functional tasks.
- Fredericson et al. (2000) found that runners with ITBS had significantly weaker hip abductors on the symptomatic side compared to controls.
These deficits are often subtle on static posture exams but become obvious during dynamic movement assessments—such as single-leg squats, step downs, or running gait analysis.
One of our favorite exercises to control the hip while moving is the video posted below. This is a low risk exercise that stresses the kinetic chain. When performing, try to keep your hip level and stable while you pass the weight from side to side.
What That Means for You
When hip musculature fails to control the pelvis and femur:
- The knee joint is forced to compensate, often with poor alignment
- Ground reaction forces are poorly absorbed, especially during deceleration or landing
- Tissues at the knee, particularly the patellar tendon, lateral retinaculum, and IT band, experience higher tensile and compressive loads
Without addressing these proximal contributors, knee-focused interventions (like taping or stretching) often fail to create lasting change.
How We Fix It at CPC
Our rehab approach includes:
- Targeted hip strengthening, including side planks, single leg squat variations, banded lateral walks, and single-leg glute bridges
- Reactive control drills, such as lateral step-downs with feedback or resisted rotation
- Progressive integration into functional tasks like running, squatting, or bounding with movement cueing
By restoring proximal control, we reduce the downstream stress on the knee and improve total limb coordination and efficiency.
The video below is a great exercise we use later in the treatment plan to help control the hip and pelvis while loading the knee.
When to Get Checked Out
It’s time for a full evaluation if:
- Your knee pain has lasted more than 2–3 weeks
- You’ve tried foam rolling, rest, or basic exercises with no improvement
- The your running form is changing because of pain