Runners Knee: Part 2

22 Nov

And so – finally – the other common cause of what we call ‘runners knee’. As is often the way with most injuries and their name, it’s probably fair to say that a high number of sufferers of Iliotibial Band Syndrome (I.T.B.S) are not what they would consider active runners. In fact, a high number of people who lead quite inactive lifestyles can complain of this due to the body becoming less supple, and it’s very common in people new to exercise for the same reason. So; 

What is it?

A quick bit of basic anatomy first; The Iliotibial band (I.T.B) runs from your glute muscle (your butt!), along the outside of your thigh to the top of the smaller shin bone, just below and to the outside of the kneecap (patella). Its job is in stabilising the knee, and assisting straightening the knee. As the knee bends and extends, the I.T.B can rub against the bone near the knee and cause pain. 

How does it occur?

There are a number of factors that can bring on the symptoms of I.T.B.S. Generally (and this is merely my own finding) I feel that a major factor is strength and activity at the origin of the I.T.B – namely, the Glute muscles. A huge number of patients that I see – be that housewives, weekend warrior athletes or International athletes – spend a vast majority of their day sat on their backsides, meaning that the gluteal group of muscles become lazy, short, and weak. This can have a huge effect on the bio-mechanics of the lower body, and as the glute feeds into the I.T.B, this band of fibrous tissue becomes extremely tense, taking a load that it shouldn’t need to and causing pain at the knee. For me, Runners Knee is often a secondary symptom or a referred pain.

Other causes range greatly; at the other end of the leg, overpronation (inward rolling) of the ankle can create stress; running on cambered surfaces or heavy uphill running sessions; trigger points within the I.T.B; and of course, that least favourite word of anyone in training – overuse. 

Symptoms?

Pain on the outside of the knee and a tightness in the iliotibial band, or more generally felt in the outside of the thigh. Pain normally aggravated by running, particularly downhill. Pain when pressing in at the side of the knee. Weakness is sometimes felt when moving the hip away from the body, and you may even be aware of tender points in the gluteal area. 

Treatment?

There are mixed opinions on the treatment of I.T.B.S. Some Therapists – and indeed sufferers of I.T.B.S – advocate a technique called ‘stripping’ of the iliotibial band (huge amounts of pressure placed upon the ‘tight’ I.T.B – often with an elbow or forearm – and then dragged up the leg). I’m not a huge fan of this for a few of reasons; 1) The I.T.B is not a muscle and so doesn’t have the same properties as a muscle. I’m yet to read convincing evidence that ‘stripping’ is necessary. 2) I believe that it’s very rare for an I.T.B to be the sole cause of the pain. And 3) It hurts like hell. And while I’m 100% of the opinion that a little bit of pain for long term gain is fine, causing pain for pains sake is not what I’m looking for. I prefer local deep pressure, friction and myofascial release techniques combined with rehabilitive work on the cause- be that glute tension or overpronation of the ankle etc.

If the injury is at an acute, or even chronic stage, then Kinesio Tape® can be used to mechanically correct the I.T.B (http://www.dc-injuryclinic.co.uk/indexabout.htm) while other manual therapy treatments take place. This can sometimes enable sufferers to continue training. 

Self help?

Icing the tender area post activity will always aid in the reduction of inflammation, and I have found great benefit in heating the tender area (using a wheat bag or hot water bottle) and then stretching the I.T Band ( see photo). Some people find great benefit in using a Foam Roller on the problematic I.T Band – but bear in mind that it can be uncomfortable (to put it very politely!) in the acute or chronic stage – be strong!

With the bottom leg, place the ankle on the top knee and push toward the floor, lengthening the thigh and the I.T.B (the red lines)

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work
 

For more information please visit www.dc-injuryclinic.co.uk

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