Popliteus tendinopathy or IT band syndrome: which is causing my outer knee pain?

The short verdict

These are two overuse problems on the outside of the knee, and the main clue is where exactly it hurts. IT band syndrome is much more common in runners and cyclists. Popliteus tendinopathy is less common and is easily mistaken for IT band pain or a meniscus tear. The good news is that both usually respond to the same principles: temporarily reducing the aggravating load, then strengthening the hip and thigh.

How they compare

• Location: IT band pain is on the outer side of the knee, just above the joint; popliteus pain is at the back outer corner, near the joint line
• Triggers: IT band pain often starts at a predictable point in a run and is worse with repeated bending around 30 degrees; popliteus pain is worse running downhill, walking down slopes or stairs, and with sudden direction changes
• Feel: IT band pain is often sharp and stops the run; popliteus pain is more an ache that may linger
• Examination: specific tests load each structure; tenderness location is a strong clue
• Imaging: usually not needed; ultrasound or MRI is used if the diagnosis is unclear or a meniscus tear is suspected
• Treatment: both improve with load changes and hip and thigh strengthening; injections and surgery are rarely needed

Who each tends to affect

IT band syndrome tends to affect distance runners, cyclists, military recruits and people who have quickly increased mileage, especially on cambered roads or a track always run in one direction. Popliteus tendinopathy tends to affect runners and hikers who do a lot of downhill work, including on Qatar's sand dunes, and people with knees that roll inwards or have had previous ligament injury at the back outer corner.

When to see a knee surgeon in Doha

See a specialist if outer knee pain persists for more than a few weeks despite reducing your running, if the knee swells, locks or gives way, or if pain followed a twisting injury, which raises concern for a meniscus or ligament problem. Dr. Gelber at Aman Hospital will examine the outer knee, separate tendon pain from meniscus or ligament injury, and guide a return to running.