On my continuing mission to tear up the text book and convention today’s Blog looks to correct some misconceptions about this very common problem. You can cause yourself lots of pain by rollering your iliotibial band (ITB) – go for your life! But it probably won’t help, and most likely will just make your eyes water with the pain. Here’s why it won’t help and what to do about it…
What Is Runner’s Knee?
Let’s get some Latin in. As you well know us Sports Therapists and Physiotherapists like to get get a good bit of Latin in to make us sound more intelligent! The correct title for Runner’s Knee is Iliotibial Band Friction Syndrome (ITBS). As with anything with “Syndrome” on the end it means that the medical fraternity don’t really know what it is.
For those without any formal qualification in anatomy of those who’ve heard of an IT Band but have no idea what it looks like if you take your eyes left at this point it’s the bit in white that runs from the outside of your hip to the outside of your knee from your illium (part of the pelvis) to the tibia (bone in your lower leg). The pain will normally be towards the bottom of this structure.
For many years it was thought that injury was caused by the repeated rubbing of the IT Band over the lateral epicondyle of the femur (a nobbly bit of bone on the outside of your knee). It was thought this lead to inflammation and pain on the outer part of the knee. This normally comes on after a set amount of time running. Usually you can set your clock by it. Whether that’s 5 minute, 20 minutes or an hour and a half. Sometimes it will be painful afterwards, sometimes not.
If you have more general knee pain have a read of our Knee Pain page from the main site.
Why Runner’s Knee?
The lay term is Runner’s Knee but we find this an increasingly inaccurate description. Over the years we have seen Swimmers, Cyclists and even armchair athletes suffering with the condition. Let’s just call it a hurty bit on the outside of the knee. No latin, does what it say on the tin, and we can move on.
Traditional Physiotherapy Predisposing Factors
Traditional thinking was that it was tightness in the IT Band that was obviously the main issue. Hence the endless agonising rolling of the IT Band. Other factors we thought to included glute weakness – which I very much agree with and leg length discrepancy – which I very much do not.
Rant Warning: Firstly, genuine leg length discrepancy is very unusual and can only be proved with a tape measure and an X-ray. Secondly, and most importantly, your legs were probably the same length before you had the injury! Unless you’ve had a nasty incident involving a chain saw… at which point I suggest a case of Runner’s Knee is the least of your worries!
Now I’ve got the rant over with I will concede that pelvic alignment is a predisposing factor which can be misinterpreted as leg length discrepancy. But the length of your legs is a constant.
Other factors were thought to be increasing your training too quickly – as with any injury – change of footwear, change of running surface etc.
Does The IT Band Even Exist?
Boom! There I said. I would like to say you heard here first but I’m just repeating what people with considerably bigger brains than myself are saying. Technically this is correct. The ITB is a figment of your imagination! Now before I get shot allow me to explain.
The IT Band is not an isolated structure. It’s is part of a wider structure of fascia that is continuous over our whole body – think of it as a diving suit that covers our whole body. The reason it was identified in Victorian dissections is that appears thickened in all adult humans. I say adults because if your have a baby to hand if you feel the outside of their leg you will notice there is no IT Band. Now I know babies are generally quite squidgy everywhere but bear with me.
What has been called the IT Band for 200 or so years as actually just a thickening of our “whole body fascial suit” that thickens to give us lateral stability as we learn to walk. In some people it is thicker and tighter than others. Believe me I’ve prodded enough to know.
So What Is The Pain?
As mentioned above the pain was thought to be from inflammation caused by the irritation of the IT Band on the bony nobbly bit on the outside of the knee. However, recent dissection research has shown that this is actually not possible! There is an additional fascial structure which sits over the top of the lateral epicondyle so that the two structures can never actually touch.
Hence the question, what is the pain? My thoughts would be that it’s just overused tissue. Whether that’s fascia or muscle. Probably both. The interesting complaint remains why does it come on after the same amount of time every time? My thought is, and this usually follows through in our treatment of these conditions, is that this structure gets tight and painful at the point when it is exhausted. It is exhausted due to the way you are using it. In other words, the way you run or do things means this muscle has more work to do than it can cope with. When it reaches this point it lets you know and gives you pain.
How Do It Not Get It?
The key to avoiding it and many other similar injuries is not to increase your training to quickly. Stress is always a factor. See previous article on 50 Shades Of Pain. So don’t get stressed! Also make sure you have enough rest days between your training. Glute strength is a factor due to the continuation of the glutes with the fascia that was formerly known as the IT Band (FFKAITB!).
Tightness of obliques (muscles above the sides of your hips) is a factor also as they are continuous with the glutes. Hip flexor tightness is a factor as this will inhibit your glute contraction. So stretching these out will be advantageous.
What Do I Do If I’ve Got “Runner’s Knee”
Whatever you do don’t stop running! No really. Use it or lose it! Just run up to the point just before it starts to hurt. If this is only a short amount of time supplement your running with cycling, swimming or whatever else you fancy that you enjoy. Don’t let that aerobic fitness go just because you’ve thrown your toys out of the pram because you can’t run as far as you would like. It just means it will make you more grumpy and take longer to come back from the injury.
The stretches mentioned in the previous section may help. Rollering your IT Band may help. But if you have a genuine limitation in one these areas the best way to get rid of it is with some hands on treatment. Of course I would say that, but then I genuinely haven’t found a better way of interrupting the movement patterns that cause pain than hands on treatment. I’m not sure I’d tell you if I did, but that’s not that point!
So for us Runner’s Knee is just a label – as most conditions are – to a symptom that happens to be on the outside of your knee. From our perspective it is just another bio-mechanical riddle to solve for each individual. No two cases I have seen in 11 years have been the same.
If you’re interested in getting your “Runner’s Knee” sorted whether it’s pain on the outside, inside or through the middle. We’re not too fussy. The tougher the challenge the more we get excited! Runner or otherwise. Click the contact us button below to arrange an appointment or speak to one of our therapists. Here’s one of our testimonials from one of our clients who not longer has Runner’s Knee:
You can find more information on our Sports Therapists’ approach and how that can help you on our home page.
This article first appeared on our Brighton Physiotherapy site.