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Runner's Knee

Runner's Knee

Runners knee, also known as iliotibial band friction syndrome, is a common over-use injury that affects long-distance runners. It is particularly common in people who spend a lot of time running downhill because of the stresses that downhill running places on the knee joint.

Anatomy of the Knee

How to identify the signs of runners knee?

The most obvious sign of ITBFS is knee pain that occurs during your workouts, and stops shortly after you stop moving. Some people find that this knee pain is reduced if they warm up and then stretch before they go running, or if they wear a knee support. However ITBFS is not something that should simply be 'trained through'. It is important to get a proper diagnosis and to work with a doctor or physiotherapist to make sure that the underlying cause of the pain is removed.

What causes the onset of the condition?

The source of pain can often be a misalignment of the patella when active. The resting position of the patella can increase the likelihood of the suffering from runners knee.

This can often referred to as being a predisposed complaint however physiotherapy is recommended in order to strengthen the surrounding muscles so that the patella can become realigned.

If you suffer from weaker quads then this can have an impact on the patella when active since the iliotibial band runs down the outside of the thigh, therefore it may begin to pull the knee cap towards the outside of the leg should the band be tight.

Your alignment in general can influence injuries and where the knee is concerned this refers to not only the knee joint but the hip and pelvis and even the feet. In the event that your hip or pelvis is misaligned then this can impact on the muscles and compromise the mechanics of the knee joint.

Finally, your feet can play a huge role in this and how you walk. Rolling your feet / ankles as you walk can place undue stress on the knee joint and over a period of time can lead to these types of conditions.

How does sport affect the onset of the condition?

The above causes of runners knee can be translated into a sporting context with changes in your load, biomechanics, footwear and training surfaces all having an impact.

Load refers to the type of running you’re undertaking and ensuring that you minimise the variables as changing too many in session can have a detrimental effect on the body. This can refer to doing speed and distance training simultaneously or terrain and speed training. It is also important to take rest weeks so that the body doesn’t burnout. This all refers to your training programme, especially important when planning to run something like a marathon.

You running technique has a major impact on avoiding injuries in general, not just concerned with runners knee. If your technique is poor then you run the risk of injuring yourself long term, so keep an eye on this and look to train yourself out of any bad habits you may have picked up. To do this you can run in the gyms in front of a mirror to assess your technique, take a video of yourself in action or refer to a physiotherapist work on alignment.

You need to be wearing the right footwear for your chosen sport. When it comes to running footwear is a big part of your gear in selecting the right shoe for your needs and ensure that they remain in top condition since you are supposed to change your shoes every 500 miles.

Finally, you should take a look at the running surface you ae using. Running on solid ground can have an adverse effect on the joints and the increased amount of pressure on the knees. This also refers to the gradients of your routes as if you are used to flat ground and revert to hill training then your body may not be adapted for this, resulting in injury.

What treatment options exists for me?

In most cases, runners knee can be cured with physiotherapy, the use of contrast bathing to reduce inflammation and promote healing, and the use of a knee strap or support to prevent further pronation.

Some physiotherapists feel that using a foam roller can help to manage ITBFS, but this is a more controversial treatment, as there are others who are concerned that foam rolling - while good for relieving short-term symptoms, could cause more harm in the long term.

The use of non-steroidal anti-inflammatory drugs can provide short-term pain relief, and can make it easier for patients to engage in active recovery. Exercises that reduce the friction between the ITB and the Lateral Epicondyle in the thigh can alleviate the symptoms or reduce the likelihood of ITBFS from occurring in the first place.

Knee bracing is also an option, specifically those which are designed to manage the position of the patella. There are a number of options available in the market, simply check the indications for use before making a purchase to ensure you select the right one. If you are unsure which one to select then speak with your physiotherapist.

The condition itself can be quite painful, especially when active, therefore you may wish to use painkillers and anti-inflammatories to help with your overall mobility. The latter also works to manage inflammation and swelling which is one of the main sources of pain.

Is there any way to prevent the condition / stop it from returning?

People who have one leg that is noticeably bigger than the other are more likely to suffer from ITBFS. If you have a leg-length difference of more than 1cm then you should wear a 'build-up' insole in the shorter leg to correct any problems with your gait that could be placing stress on your legs.

Whenever possible, try to run on a flat surface. Running on a road that has a camber can cause an uneven gait which can place stress on your ITB. Wearing proper shoes and running on even ground will help to reduce your risk of injury. If you must run off-road, make sure that the footwear you choose is appropriate, and focus on keeping a steady gait. Start with short distance runs and gradually increase your mileage as you gain strength and endurance.

You may also need to consider strengthening exercises to help build up the muscles surrounding the knee including the quads as this relates to your overall alignment. There are a number of exercises you may wish to consider and this article lists a few of them.

Knee pain can be a sign of a number of injuries, not just ITBFS. Wearing a knee support can help you to manage your knee pain, but if you find that the pain is persistent, recurring, or gets worse over time you should speak to a doctor immediately.