Pain on the Outside of the Knee When Kneeling | 7 Potential Causes

There are many causes for general knee pain – knee osteoarthritis, meniscus, ligament tears… But what about pain on the outside of your knee when kneeling?

There are at least 7 reasons for pain on the outside of the knee. The most common ones include iliotibial band syndrome, bursitis, or a tear in the meniscus and/or ligament.

But, most symptoms of these injuries are fairly similar. And, of course, they all hurt on the outside of the knee. Sometimes, the pain can even get worse with kneeling.

In any case, they do have their differences which we will talk about today. In the end, hopefully, this will be enough to help you tell the difference.

Let’s get to it!

7 causes of lateral knee pain while kneeling

1) Iliotibial band syndrome

The iliotibial band (IT band) is a thick band of connective tissue. You’ll find it on your outer thigh, running from your hip to the lateral side of the knee.

Now, iliotibial band syndrome (ITBS) refers to lateral knee pain related to the IT band. It’s commonly caused by activities where you constantly bend and straighten your knee.

This is why ITBS is the most common knee injury in long-distance runners and cyclists. Athletes in running sports like soccer and basketball are also prone to ITBS. And, it’s more frequent in women than men. (1)

The main symptom of ITBS is lateral knee pain.

It often gets worse with knee movements. Like walking, climbing stairs, or kneeling.

At first, you may feel the pain only at the end of your training. As ITBS advances, knee pain can be present at rest.

If there’s any of the following, it’s likely your knee pain is due to ITBS (1):

• You run on hills or on tilted surfaces often.
• Your training technique isn’t optimal.
• You changed your training intensity abruptly.
• You’re running with longer strides than usual.

The treatment for ITBS is conservative.

Rest is key to let the IT band heal. Icing your knee during flare-ups can help as well. It can reduce pain and inflammation.

It’s also important to go to physical therapy. Athletes with hip weaknesses are prone to develop ITBS. A PT can identify those weaknesses and improve them. This will treat the syndrome and prevent future episodes at the same time.

Also, foam rolling is a popular strategy for managing ITBS. But, the truth is that studies haven’t found relevant benefits from it yet. Still, it can’t be denied that some people feel less knee pain after using a foam roller.

So, if you enjoy foam rolling, it might help with your ITBS symptoms. If you don’t like it, you don’t have to do it. Try other strategies instead, like stretching.

2) Iliotibial knee bursitis

Knee bursitis happens when a bursa on the knee joint becomes inflamed. A bursa is a fluid-filled sac. You’ll find it between muscles, tendons, bones, and/or skin. It reduces friction between those structures.

The main causes of knee bursitis are kneeling for long periods and excessive friction.

The most common type of knee bursitis is prepatellar bursitis. It affects the bursa on top of the kneecap. It’s common in carpet layers, as they spend most of their time kneeling.

But, there’s also a bursa under the iliotibial band.

That bursa is between the thigh bone and the IT band. Right before the band attaches to the knee. Excessive friction can irritate it, causing knee problems on the outer part of the joint. This is called “iliotibial bursitis.”

Iliotibial bursitis is common in runners. The symptoms are like IT band syndrome, so it’s easy to confuse them. Their main differences are:

• In bursitis, you’ll have a swollen lump under the IT band. Close to the knee joint. An ultrasound or MRI will show the swollen bursa.
• If it’s IT syndrome, the bursa will be ok.

Treatment for iliotibial bursitis focuses on rest and home care.

This will let the bursa heal. It can take a few weeks to recover from it, though. So, please be patient.

Also, it’s best to go to physical therapy. A physio will check your running patterns and optimize them. That way, you’ll reduce the friction on the bursa and prevent future episodes.

3) Lateral meniscus tear

A meniscus is a C-shaped cartilage that acts as a shock absorber. We have two menisci in each knee (2):

• The medial meniscus, on the inner side of the knee.
• The lateral meniscus, on the outer side.

Meniscus tears are common knee injuries. The rate in the US is 61 per 100,000 in the non-athlete population. This rate increases in athletes and the military. (2)

A meniscus can tear during sports, when running and changing directions suddenly. Also, aging weakens the cartilage, making it prone to tears. (2)

If the tear is on the lateral meniscus, you may have lateral knee pain. The pain will likely also get worse when kneeling. It can be hard to walk, too.

If it’s a torn meniscus, these other symptoms can also be present (2):

• Knee pain and swelling that worsens in the 2-3 days after the injury.
• It can be hard to straighten the knee joint.
• You may feel like the joint locks up.
• The joint may click or pop when it didn’t before the knee injury.
• You may have knee instability.

Doctors often ask for imaging tests if they think there’s a torn meniscus. This will show the size and location of the tear. That way, your healthcare providers will design the best treatment for you.

The treatment for lateral meniscus tears depends on their severity.

Most of the time, it will include some sort of physical therapy. You may have to wear a knee brace if you can’t bear weight on the injured leg. Severe cases with persistent symptoms may need surgery.

You’ll need at least 6 weeks to recover from a torn meniscus.

4) Lateral collateral ligament injury

The lateral collateral ligament (LCL) is on the outer side of the knee. It goes from the thigh bone to the shin bone. It stabilizes the knee, along with the other three ligaments – the ACL, PCL, and MCL. More about them further down.

The LCL can get injured after a sharp blow on the inner side of the knee, with the joint straight. This often happens during contact sports. Also, in running sports with sudden changes of direction. (3)

It’s rare to have an isolated LCL sprain.

Most of the time, the injury includes other knee structures. Like the ACL, PCL, or meniscus. Female athletes, tennis players, and gymnasts have a higher risk of an LCL injury. (3)

This type of injury can cause significant pain on the outer knee side. The symptoms can worsen when kneeling or with weight-bearing movements. Like standing up or walking.

The treatment depends on what caused the LCL injury.

Also, whether the injury affected other knee structures or not. Mild and moderate LCL sprains can improve with conservative treatment. But, athletes with severe sprains may need surgery.

The recovery time for an LCL sprain is at least 4 months. (3)

5) Knee osteoarthritis

This type of knee arthritis is caused by wear and tear. With aging, our joint cartilage weakens. This causes inflammation and can affect the nearby tissue. Thus, causing knee pain.

That’s why people with knee osteoarthritis are prone to have other knee injuries. Like ligament sprains, meniscus tears, bursitis, or tendinitis. (4)

The risk of having knee osteoarthritis increases with age. People with the following are also prone to wear and tear (4):

• A previous knee injury or surgery.
• Rheumatoid arthritis.
• Gout.
• A job with prolonged kneeling or standing.
• Muscle weaknesses on the lower limbs.
• A BMI >25.

Although common, not all people with knee osteoarthritis have knee pain.

Some studies suggest ~15% of people with knee osteoarthritis have symptoms. The rest aren’t symptomatic. Researchers are not sure why this happens yet.

For that 15%, the most common symptoms of knee osteoarthritis are (4):

• Knee joint stiffness and swelling.
• Gradual, aching pain on the knee.
• Knee pain worsens with movement.
• Knee pain also gets worse with a lack of exercise.
• Symptoms improve with rest, cold therapy, or over-the-counter medications.

Treatment prevents the injury from getting worse.

To date, there’s no way to grow the worn cartilage back. So, treatment focuses on delaying the wear and tear as much as possible.

The first line of treatment is physical therapy. PT will strengthen your legs and manage symptoms. A therapist will also teach you strategies to manage your symptoms at home.

Knee braces can also help. They reduce the load on the joint, so there’s less friction between tissues. Again, the type of knee brace you will need depends on your symptoms.

Once conservative treatments aren’t effective, your doctor may recommend surgery. Often, the orthopaedic surgeon replaces the damaged part. But, replacing the whole joint can sometimes be necessary.

Learn more: Everything you need to know about knee osteoarthritis

6) Tibial fracture

“Tibia” is the medical term for “shin bone”. So, a tibial fracture happens when the shin bone breaks. These fractures are common in the elderly. They’re present in 4% of that population. (5)

A shinbone fracture can happen after a direct hit, like falling on your knees. Or, after twisting the leg while changing directions. As with other lower leg fractures, tibial fractures are medical emergencies.

If you fractured a bone, it’s likely you’ll have severe pain.

The pain is often on the location of the fracture. Symptoms will probably worsen with movement as well. You may not be able to kneel due to pain.

Once in the ER, the doctor will do a physical examination. If they suspect a fracture, they will request an X-ray. This will show the exact place of the fracture. Also, any alignment problems with the bone fragments.

The proper treatment will depend on whether the fragments are aligned or not. If they are, you may need to wear a cast for at least 3 weeks. If they aren’t, the doctor may have to perform a surgical alignment.

7) Knee contusion

A contusion – or bruise – happens when a blood vessel leaks blood into an injury. A direct hit on the area can cause this.

Therefore, a knee contusion is also likely to come with other injuries with pain outside of the knee.

Your skin will look red, blue, or black at first. You may feel a burning pain and notice swelling in the affected area. But, it should get better after a few weeks.

Note that this injury can be confused with an LCL tear. So, it’s still best to visit a doctor to make sure your ligament is okay. (3)

Other causes of knee pain while kneeling

These other causes of knee pain while kneeling may also hurt on the outside of the knee. But, it isn’t always the case as some of them hurt on the back of the knee or even at the front:

Baker’s cyst

Our joints are surrounded by a capsule of soft tissue. Within that capsule, there’s synovial fluid. This liquid keeps our joints lubricated and nurtured.

In a baker’s cyst, the backside of the knee joint capsule is weak. The synovial fluid accumulates in that area, creating a sac behind the knee. This injury can be a sign of knee arthritis.

Most cysts don’t cause symptoms. But, in those who do, the pain worsens when kneeling.

Patellar tendonitis

The patellar tendon is part of the quadriceps muscle. It covers the kneecap and attaches to the tip of the tibia. Patellar tendonitis is an inflammatory condition of this tendon.

It’s common in jumping and running sports. Hence, why it’s also known as “jumper’s knee.”

The overuse from sports causes tiny injuries to the tendon. If they don’t heal properly, they accumulate. This causes pain and swelling at the front of the knee. (6)

The knee pain from patellar tendonitis can worsen when kneeling.

Knee ligament injuries

Our knee has several ligaments. The most prone to injury are:

• The anterior cruciate ligament -ACL.
• The posterior cruciate ligament – PCL.
• The medial collateral ligament – MCL.
• The lateral collateral ligament – LCL, Mentioned above.

Any of them can have a sprain. This can happen after a bad move or a direct hit during sports. A ligament sprain will cause knee pain at varying degrees.

The intensity of the symptoms often depends on the severity of the injury. Some people may have mild pain, others may not be able to kneel or walk. (3)

Osgood-Schlatter disease

Like patellar tendonitis, Osgood Schlatter is caused by inflammation of the patellar tendon. But, here, the injury is at the insertion point of the tendon at the top of the tibia.

It’s common in active children and adolescents. And, the symptoms may worsen after a growth spurt. If it’s not treated properly in childhood, it can cause flare-ups in adulthood. (7)

The main symptom is a painful lump below the kneecap. This will cause sharp pain on the top of the tibia when kneeling.

Related: The best knee supports for Osgood-Schlatter disease

When to see a doctor for lateral knee pain while kneeling?

If any of the following is happening, please seek medical advice:

• You can’t bear weight on the injured leg.
• You can’t straighten your knee.
• The pain and swelling aren’t improving after 72 hours.
• The other leg is starting to hurt as well.
• Your knee is clicking or popping, but it didn’t before the injury.
• You have unexplained weight loss.
• The pain doesn’t let you sleep.
• You feel like the knee is giving out under you.
• There’s a visual deformity on the knee joint.
• You have a fever.

Your doctor will perform a physical exam to determine the cause of knee pain. They may need blood or imaging tests as well.

Once the diagnosis is ready, your healthcare providers will design the treatment plan.

FAQs:

Conclusion: Pain on the outer side of the knee joint while kneeling

Knee pain severely affects 25% of the adult population. In order to recover, you need to identify the cause and treat it. (1)

There are several causes of pain on the outside of the knee. The main source will depend on your lifestyle, age, how the pain started, and other factors.

The fastest way to figure out what injury you have is by going to the doctor. A healthcare provider will assess you and design a treatment plan according to your needs.

Resources

1. Hadeed A, Tapscott DC. Iliotibial Band Friction Syndrome. [Updated 2021 Jun 5]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK542185/
2. Raj M A, Bubnis MA. Knee Meniscal Tears. [Updated 2021 Jul 21]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK431067/
3. Yaras RJ, O’Neill N, Yaish AM. Lateral Collateral Ligament Knee Injuries. [Updated 2021 Aug 4]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK560847/
4. Hsu H, Siwiec RM. Knee Osteoarthritis. [Updated 2021 Jul 25]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK507884/
5. Thompson JH, Koutsogiannis P, Jahangir A. Tibia Fractures Overview. [Updated 2021 Aug 7]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK513267/
6. Santana J A, Mabrouk A, Sherman Al. Jumpers Knee. [Updated 2021 Aug 6]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK532969/
7. Smith JM, Varacallo M. Osgood-Schlatter Disease. [Updated 2021 Jul 30]. Statpearls. Retrieved on September, 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK441995/