Runners Knee (IT Band Syndrome)

Runner’s knee is a condition in which the kneecap (patella) rubs roughly against the end of the thighbone when the knee moves.

Signs and Symptoms of Runners Knee (IT Band Syndrome)

Tightness in the iliotibial band.  The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the shin bone. Its purpose is to straighten the knee as well as to move it out sideways. 

Dull pain beneath the front or on the sides of the kneecap.

Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.

Pain occurs when walking up or down stairs, kneeling, squatting, and sitting with a bent knee for a long period of time.

Grinding noise, as the rough cartilage rubs against cartilage when the knee is

Pain aggravated by running, particularly downhill.

Swelling of the knee.

Weakness in hip abduction.

Tender trigger points in the gluteal area may also be present.

What causes IT band syndrome?

Runner’s knee may be caused by a structural defect, such as: wide hips (female runners), knock knees, subluxating Patella, high patella, small medial pole of patella or corresponding portion of femur, flat feet or leg length difference.

Incorrect or worn shoes.

Malalignment of the kneecap.

Complete or partial dislocation.

Injury.

Overuse.

Overtraining – increasing your running mileage too soon.

A tight or naturally wide IT band — a fibrous band of tissue on outer thigh that extends from the hip to below the knee) also affects knee stability. If too tight, this muscle/tendon of the outer thigh can pull the knee to one side.

Tight hamstrings

Tight Achilles tendons

Weak thigh (quadriceps) muscles — The quadriceps muscle assists in the proper tracking of the kneecap. Weakness in the Vastus Medialis (Inner Thigh)of the quadriceps, can prevent the kneecap from tracking smoothly.

Weak hip muscles such as gluteus medius.

Overpronation of the feet– rolling of the feet onto the outside excessively when walking or running while the front thigh muscles (quadriceps) pull the kneecap outward.

Excessive hill running.

Running on a cambered surface.

Most of these factors can be addressed through changes to your training program, the use of insoles or heel pads and a thorough rehabilitation program.

Prevention

Stay in shape. Good general conditioning is important to controlling and preventing knee pain. If you’re too heavy, you may need to lose weight to avoid overstressing your knees.

Remember to stretch well before running. First do a 5-minute warm up, followed by stretching exercises. Stretch before and after exercise.

Increase training gradually. Avoid sudden changes in the intensity of exercise. Increase force or duration of activities gradually.

Use proper running form. Lean forward and keep your knees bent. Also, try to run on a clear, smooth, resilient, even, and reasonably soft surface. Never run straight down a steep hill. Walk down it, or run in a zigzag pattern.

Strengthening of quadriceps, hamstring and calf muscles. 

Correct shoes, specifically motion-control shoes and orthotics to correct overpronation.  Wear running shoes that have good shock absorption and quality construction. Be sure that shoes fit properly and are in good condition. If you have flat feet, you may need shoe inserts.

Avoid painful stimuli, for example downhill running.

Stretch the Iliotibial band after training.

Treatment

See a sports injury specialist, orthopedic physician, Clinical Exercise Specialist, Advanced Health and Fitness Specialist and/or a physical therapist.

Have a trained professional athletic shoe salesperson check your feet and shoes for overpronation.

Consider orthotics. Arch supports placed in both exercise and street shoes may help. Sometimes, shoe inserts have to be custom-made.

Stop running until it can be done without pain is important. Riding a bicycle in low gear (if not painful), rowing, and swimming, can be continued to maintain physical fitness.

Avoid running or walking downhill, downstairs or down inclines.

Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs –check with your doctor

Apply ice to the knee area – for 10 minutes every 2 hours, in order to reduce the inflammation.

Avoid weight-bearing activities and keep foot elevated where possible.

Avoid exercises or activities that require your knees to be bent.

Self-massage – using arnica oil or anti-inflammatory gel, on the sore spot around the knee.

Strengthen the quadriceps muscle when pain-free.

Stretch the muscles: IT band, Achilles, hamstrings, quadriceps, and gluteal muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 – 3 times per day.

Return to running gradually.

Full recovery is usually between four to six weeks.

See a personal trainer who is also a Clinical Exercise Specialist or Advanced Health and Fitness Specialist to set up a program for you that will include the correct strength and stretch exercises for you.

Strengthening the legs

Place a pillow under knee, tighten quadriceps, push knee down into pillow and lift foot up. Repeat 20 times.

Wall Sits. Place back against wall. Bend knees slowly to between 45 – 60 degrees. Ensure that the knee travels over line between big and second toes. Hold for a count of 30 seconds. Repeat 10 times.

Step-downs. Stand on a step. Tighten quadriceps and lower the opposite leg slowly to the ground. Ensure that knee travels over line second toes. Then raise the leg up onto the step using the muscle of the leg on the step. Repeat 20 times.  Increase the number of repetitions in increments of 5 every two days, all the way up to 60 reps.

Strengthening the Vastus Medialis (Inner Thigh) Muscle

Exercise 1. Repeat frequently throughout the day: Stand with both knees straight. Contract the quadriceps muscles (in the front of the thighs), raising the kneecaps. Hold this position for a count of 10.

Exercise 2. Do 3 sets of 10 every other day: Sit on the floor with both knees straight and the legs apart. Rotate legs outward so that the toes point as far to the side as possible. Slowly raise the injured leg from the hip (with the knee straight), hold for 10 seconds 10 inches from the ground, and then lower it, keeping the knee straight.

Exercise 3. Do 3 sets of 10 every other day: Sit on the floor with two or more pillows under each knee so that it is flexed at a 135° angle. Place a 5-pound weight on the ankle. Slowly raise the foot by straightening the knee, and then slowly lower the foot. Progress by increasing the weight on the ankle.

See a Doctor if pain doesn’t respond to self-treatment in two weeks