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Runner's Knee

Runner's Knee

Running injuries can affect anyone, from the most experienced racers who push themselves to their limit to the utmost beginners whose muscles are just not used to the strain. In this article we will cover the most common type of running injury: iliotibial band friction syndrome (ITBFS), more commonly known as runner's knee.

Runner's knee is what happens when the iliotibial band (ITB) - a thick band of connective tissue that stretches from the outside of the pelvis past the knee joint to the outside of the shin bone - rubs against the outside of the femur as your knee straightens and bends while you run. This can result in inflammation of the iliotibial band and its underlying tissue.

How common is runner's knee?

According to Runner’s World, 42 per cent of all overuse injuries affect the knee joint. Iliotibial band friction syndrome is by far the most common overuse injury for runners, hence the common name for the condition. Cyclists can also suffer from iliotibial band friction syndrome.

How do you get runner's knee?

Iliotibial band friction syndrome is categorised as an overuse injury and there are two main types of cause. The first is as a result of training errors and the second is connected to biomechanics. Training errors that can end up in runner's knee include pushing yourself too hard too soon, especially if you are not used to running, or not giving yourself enough recovery time after strains and injuries.

Altered biomechanics are a more complex cause of ITBFS, but just as common. These kinds of causes can range from asymmetry in one limb compared to the other to angulation of the knee or foot position to dysfunction in the glutes where the iliotibial band attaches. Any of these factors can make you more prone to getting runner's knee.

What does it mean to have runner's knee?

A common misconception about iliotibial band friction syndrome is that the band becomes tight and that this is what causes the pain. Tightness is sometimes an issue for some patients, but inflammation is the main cause of pain for most people.

You might also find that the pain dies away when you are not running; however, as soon as you put pressure on your knee again, the pain will start up once more.

How can it be treated?

The pain from iliotibial band friction syndrome comes from inflammation, which takes time to build up; therefore, many people only really start to feel the pain after a long run. This will generally be because you have increased your mileage too quickly, not letting your body adjust to the longer distances and greater impact. Once this inflammation starts, it can be very difficult to calm it down.

Many people make the mistake of trying to keep on running and end up seeking help too late or from the wrong sources. Plenty of articles will extol the virtues of foam rollers as a cure for ITBFS; however, while these may work for some people, for others it will be a pointless exercise. If you have perfect biomechanics and no training errors and your ITBFS has been caused solely by your iliotibial band getting tight, then a foam roller may help to calm this down; however, most patients require a more complex treatment of adjusting training methods and physiotherapy.

The basis of most treatment comes from looking at your movement faults and adjusting them accordingly. Treatment for runner’s knee is tailored to each patient and there is no real fix-all solution for this condition; instead, you need to work out exactly what biomechanical fault has been causing your pain and then try to eliminate this fault.

If physiotherapy methods fail, another type of treatment that can be considered is a steroid injection into the bursa, which is a sack of fluid that sits just behind the iliotibial band to prevent friction. If the bursa has become inflamed, a steroid injection can offer temporary relief; however, since the friction is caused by movement faults, anti-inflammatories cannot solve the problem in the long term if movement patterns stay the same.

What should you avoid to prevent it happening again?

To prevent runner's knee recurring, you should use caution when you jump back into your training schedule. A good rule of thumb for general running health is to avoid increasing your weekly mileage by more than 10 per cent each week. This allows your body to adjust to longer runs and to adapt to the increased joint and muscle movement.

A physiotherapist can help you to analyse whether you are putting extra pressure on your knees as the result of a weak core, for example, or whether there are other changes you can make to your running habits. Some physiotherapists suggest that running on different surfaces can change the forces going through your knee joints.

Unfortunately, many people with iliotibial band friction syndrome will have to stop running altogether for a short amount of time; otherwise, the inflammation will never settle. After this you can look into analysing whether your biomechanics are altered and how to adjust the movement patterns that might be causing too much stress to the iliotibial band.

Final thoughts

It is important to get an accurate diagnosis if you believe you have runner's knee. There are several different kinds of knee injury that can result from exercise and overuse, all of which are treated in slightly different ways. Another condition that might cause a similar kind of pain is patellofemoral pain syndrome (PFPS), which occurs when a mistracking kneecap irritates the femoral groove in the thighbone where it rests.

If you have PFPS, you will probably feel tenderness around or behind your kneecap - usually towards the centre of it - in addition to pain in the front of the knee. There will also be a sense that the knee is giving out or cracking. PFPS can be aggravated by steps, hills or other uneven terrain. ITBFS will usually present pain at the sides of the knees and this pain can even extend as far up as the hip. If it is ITBFS, the area is likely to be tender to the touch and will probably appear swollen

As the differences between PFPS and ITBFS are quite subtle, it is important to see a doctor or physiotherapist to establish from which condition you are suffering. A physiotherapist will also be able to analyse your gait for biomechanical causes and help you to build your training regime back up at a sensible and practical rate.

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