Runner's Knee, Shin Splints and ITB: Telling Them Apart

Reviewed by a MISCP chartered physiotherapist at Somerton Physiotherapy.

The quickest guide is where it hurts. Runner's knee (patellofemoral pain) is felt at the front of the knee, around or behind the kneecap, often worse going down stairs, squatting or after sitting. Shin splints (medial tibial stress syndrome) cause pain along the shin bone, typically the inner lower leg, that comes on with running. ITB syndrome (iliotibial band) is felt on the outer side of the knee, often building during a run at a consistent point. Because the causes and management differ, and other conditions can mimic them, a proper assessment is the reliable way to know what you're dealing with; self-diagnosis often gets it wrong.

Three of the most common complaints that bring runners to a physio get mixed up all the time, because they all hurt somewhere around the leg. But they're different problems in different places, and telling them apart points toward the right approach. Here's a general guide though a chartered physiotherapist should assess your own pain to diagnose it properly.

Runner's Knee (Patellofemoral Pain)

Runner's knee is felt at the front of the knee, around or behind the kneecap. It's often worse going down stairs or hills, squatting, or after sitting for a while with the knee bent (sometimes called the "cinema sign"). It's typically related to how the kneecap moves and loads, which links to training load, muscle strength and control around the hip and knee, and biomechanics rather than damage to the knee itself in most cases.

Shin Splints (Medial Tibial Stress Syndrome)

Shin splints cause pain along the shin bone, usually on the inner side of the lower leg, coming on with running and often easing with rest early on. They're commonly associated with a rapid increase in training, hard surfaces, footwear and lower-limb mechanics. Persistent or worsening shin pain, especially if it becomes focal and painful at rest, needs assessment, because it can sometimes indicate a stress reaction or fracture that must be managed carefully.

ITB Syndrome (Iliotibial Band)

• 1
  Pain on the outer (lateral) side of the knee
• 2
  Often builds during a run and can come on at a fairly consistent distance or time
• 3
  Frequently linked to training load, hip and glute strength and control, and running mechanics
• 4
  Different location and pattern from runner's knee, despite both affecting the knee

Why the Diagnosis Matters

These three overlap in a runner's mind but need different management, and other conditions can mimic them which is why guessing often leads to the wrong self treatment and a problem that lingers. A chartered physiotherapist assesses where and how it hurts, your training and your movement, to work out what's actually going on and what will help which might combine load management, targeted strengthening, technique and hands-on treatment. Somerton Physiotherapy assesses and treats running injuries in Dublin. See return to running after injury for coming back safely, and sports massage vs physio for which treatment fits.

When to See a Doctor, Not Just a Physio

Seek prompt medical advice for severe or worsening pain, pain following a significant trauma or a suspected fracture, a joint that is hot, red and swollen, calf pain or swelling, numbness, pins and needles or weakness, or any pain with fever or feeling unwell. This is general information, not a diagnosis or treatment for your situation. A chartered physiotherapist can assess you individually, and see your GP or an emergency service for the above.

Frequently Asked Questions

• How do I tell runner's knee from ITB syndrome?

  Location is the main clue. Runner's knee is felt at the front of the knee, around the kneecap, and is often worse on stairs or after sitting. ITB syndrome is felt on the outer side of the knee and often builds during a run. They're different problems despite both affecting the knee. An assessment confirms which.
• Where do shin splints hurt?

  Shin splints typically cause pain along the shin bone on the inner side of the lower leg, coming on with running. Persistent, worsening or focal shin pain, especially if painful at rest, should be assessed, as it can sometimes indicate a stress reaction or fracture that needs careful management.
• Can I self-diagnose a running injury?

  It's risky. Runner's knee, shin splints and ITB overlap in runners' minds, other conditions can mimic them, and the right management differs. Self-diagnosis often leads to the wrong treatment and a lingering problem. A chartered physiotherapist can assess and diagnose your specific pain.