The Running Injury Bulletin – Runner’s Knee
Runner's knee problems
Join Bug member Ross for his regular bulletin on common running injuries, what they are, how to recognise them and how we can help avoid them. First off runner's knee.
Hi, and welcome to The Running Bug’s first instalment of the Running Injury Bulletin.
As keen runners you may already be painfully acquainted with many of the injuries that I hope to cover over the coming months. The majority of injuries that affect runners are found in the lower limbs, and so this will be the focus of these ‘bite size’ guides.
It goes without saying that these instalments are in no way a definitive guide to pain-free running. If only it were that simple!
If in doubt, see a suitably qualified medical or therapy practitioner, such as your GP or a Physiotherapist. Always check that they are registered with the relevant governing bodies.
So, where to begin? It’s all in the name - Runner's Knee
What is Runner's Knee?
Runner's Knee is the common name for Iliotibial Band (ITB) Friction Syndrome. It is usually an overuse injury that affects the outer / lateral part of the knee.
Despite the name, Runner’s knee is more commonly seen in cyclists, accounting for a quarter of all knee injuries! This strongly suggests that the repetitive flexion / extension movement of the knee in running and cycling leads to the development of ITB friction.
But what is the Iliotibial Band (ITB)?
The Iliotibial Band (ITB) is a thickened band of fascia (connective tissue) that runs down the outer side of the thigh before attaching into the upper and outer aspect of the Tibia (shin bone).
At the hip, two muscles feed in to the ITB – these are the Gluteus maximus (in your bum), and the tensor fascia latae. The strength, flexibility, postural and dynamic control in these muscles will therefore affect this condition.
The Iliotibial Band
Before insertion into the outer side of the shinbone, the ITB runs over the Lateral Epicondyle - a bony prominence at the lower end of the thigh bone (femur).
With the knee straight the ITB sits in front of the Lateral Epicondyle, while when the knee is fully bent the ITB sits behind the Lateral Epicondyle.
Any movement requiring repeated knee bending and straightening will therefore ‘flick’ the lower end of the ITB over this bony prominence. This is not a problem, unless repeated over and over again during the repetitive nature of running. Ouch!
Maximum friction at this point occurs at around 30 degrees of knee bend, which is usually the range used by a steady recreational runner on flat ground.
Friction between the ITB and lateral epicondyle can lead to inflammation of the tissues, pain, and the development of scar tissue.
Is my knee pain Runner’s Knee?
The first symptom is usually pain on the outer side of the knee joint. The pain is usually an intense dull ache, and will be exacerbated by running, cycling, climbing up stairs, or even sitting to standing.
Initially there will be pain after activity but as it progresses there may be pain at rest. Definitely seek the advice of a professional at this point as you may be faced with months out of running!
How do I treat Runner’s Knee?
The aims of treatment are to initially resolve the localised inflammation and pain. This is achieved by rest, ice, and pain relieving medication if your doctor has recommended this to you previously. Non Steroidal Anti Inflammatory Drugs (NSAIDs) can be very helpful but again you should check with your doctor.
The next step is to establish the cause – over-training, worn footwear, repetitive training on a track, altered running style due to training errors, fatigue, or other injury.
Think about your alignment and the relative strength of the gluteal and pelvic muscles. Have you become more pronated (flat foot arches), or have your insoles worn excessively. Seek professional advice on these issues if your initial changes do not work.
A physiotherapist will assess all of these issues and recommend the appropriate course of action. Physiotherapy treatment may include ultrasound, and targeted stretches and strength / stability exercise. Here’s a few preventative exercises.
Exercises for Runners Knee
Any of the above factors mentioned will increase friction between the ITB and the Lateral Epicondyle, increasing the potential for developing Runner's Knee.
To prevent undue tensioning of the ITB, include regular stretches of the Gluteus Maximus and Tensor Fascia Latae into your program. Stretches should be held at the point of discomfort for 30 seconds and repeated three to four times.
Weakness or a lack of control in the Gluteals may lead to altered mechanics in the lower limbs, causing the arches of the feet to fall and the knees to become ‘knocked’.
A strengthening programme to target these muscles includes:
1) Single leg balancing
2) Single leg mini-squats
3) Double leg squats emphasising control, not heavy lifting
4) Core-stability exercises
5) Side-lying leg lifts with an out-turned foot
Attention to these muscles can both prevent and treat over-pronation of the feet in the long-term. Other interventions may include motion controlling running shoes or supportive insoles.
Until next time, happy and healthy running.
Ross Clifford MCSP
Ross Clifford is a Chartered and State Registered Physiotherapist with a specialist interest in Sports and Exercise Physiotherapy and Rehabilitation. This knowledge is combined with a degree in Sport and Exercise Science, and a passion for running and cycling.
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