Runners Knee (also known as) ITB Syndrome – Do You Have It and How Do You Treat It?
What is it?
A thick, dense, fibrous myofascial band that runs from it’s ‘origin’ attachment of Tensor fascia Latae (TFL) and Gluteus Maximus at the Iliac crest (pelvic hip bone), travels down the outside of the thigh and attaches to the patella and head of fibula, myofascial attachments continue into the Tibialis Anterior Muscle.
If repeated or an overuse of loaded flexion and extension occurs at the knee between 30-40 degrees of movement, the ITB will flick over the lateral femoral condyle (bony bit at the side of the knee joint) and can become inflamed and or can irritate the ITB Bursa (small sack of fluid, friction free module).
Who is affected?
Males and females equally, only tend to affect the most active of athletes that perhaps over-train; it affects 4-8% of long distance runners, cyclists also affected.
What are the symptoms?
A diffuse pain anywhere along the outside of the leg, anywhere from the hip, down more commonly to the outside of the knee (lateral knee) where the tightened IT Band rubs over the bones of the knee, worse especially with ascending stairs, running especially decline or incline, cycling and sometimes walking when severe.
It feels like a repetitive ‘snapping’, ‘twinge’, ‘flicking’ or ‘twang’ of sharp pain over the outside of the knee. The band can become trigger pointed and tender mid band half way up the thigh too. Increased pain with forward swing during gait may be related to patello-femoral joint problems.
What are the causes?
This is thought as an overuse syndrome.
Tight, and shortened ITB, Tensor Fascia Latae (TFL) or Glutes and Tibialis Anterior. Knocked knees (Valgus), over-pronation, or poor control of hip and knee internal rotation with walking and running gait.
Uphills and upstairs and harder surfaces will aggravate. Pronated or flat feet and inappropriate unsupportive footwear can also contribute. ACL laxity can also contribute to excessive tibial rotation.
Bicycle seat too high or improper adjustment of pedals (foot turned inwards). Sometimes leg length discrepancy can be a cause or improper orthotic (insole) correction.
What to do to make it better?
- Rest from the aggravating activity ideally, or alter speed, change to flat, and softer surfaces for running. Bike Fit assessment.
- Stretch the TFL, Glutes, ITB and Tibialis Anterior (TA) muscles. Standing ITB Stretch: Kneeling ITB stretch
- Trigger point with a tennis ball or spiky ball for two minutes per trigger point in each muscle group as above
- Foam roller to release the myofascia and muscle groups: Glutei, TFL, ITB, lateral Quads and Hamstrings, and TA
- Deep tissue Massage, ‘stripping’ of the ITB, as this IT band is extremely hard to stretch, as it is a thick fascia not muscle.
- A biomechanical assessment and provision of orthotics if required.
- Strengthening of the Gluteus medius and minimus to help with lateral hip rotation strength and control in the hip.
- Rock-Tape application can also help with the pain.
- Anti-inflammatory (NSAID’s) prescribed by your GP
- Ice massage or ice pack application for 10 minutes after training.
What’s the healing time?
Depends how chronic and long standing the problem is. If it’s acute and you’ve caught it early it can take 1-3 weeks to settle with the appropriate treatment as above.
If it’s been niggling for some time, once you stop aggravating the pain, rest appropriately, allow the inflammation in the band and bursa to settle and get appropriate treatment it can take 4 to 6 weeks to recover.