Snapshot A 27-year-old female presents with left-sided lateral knee pain. The pain initially occurred after finishing her run but now occurs at rest. The pain is of sharp quality and worsens with long distance running. On physical exam, there is tenderness upon palpation of the left lateral knee. She has a positive Noble compression test. Introduction Lateral knee pain secondary to overuse injury iliotibial band originates from the iliac crest to the proximal tibia this is a fibrous band provides lateral knee stability Epidemiology Runners, cyclists, and military personnel are commonly affected rowing and swimming may also be a risk factor Presentation Symptom lateral knee pain at the distal iliotibial band as it courses over the lateral femoral epicondyle after repetitive use of the knee (e.g., running) Physical exam tenderness to lateral knee palpation may have swelling at the distal iliotibial band positive Noble compression test Evaluation Clinical diagnosis Differential Patellofemoral syndrome Lateral collateral ligament sprain Treatment During acute phase avoid knee overuse apply ice to affected area nonsteroidal anti-inflammatory drugs (NSAIDs) can be considered After acute phase physical therapy stretching the iliotibial band as well as involved structures (e.g., tensor fascia lata) strengthening exercises involving the hip abductors and core muscles Surgical intervention when patient is unresponsive to physical therapy, NSAIDs, and corticosteroid injections Equipment modification may reduce tension in involved structures e.g., foot orthosis in runners Prevention avoid sudden increases in running mileage Prognosis patients usually respond to conservative treatment without long-term sequelae