Whenever a person begins a running program aches and pains are expected, however in some cases knee pain can be caused from an underlying condition. Iliotibial band syndrome (ITBS) is one of the most common causes of lateral knee pain in runners. In fact, ITBS accounts for approximately 12% of running related injuries.
The Iliotibial band is a thick band of tissue that runs from the hip and attaches right behind the knee. The purpose of the Iliotibial band is to provide support for the knee, especially during walking and running. The Iliotibial band accomplishes this by working in conjunction with other thigh muscles such as the tensor fasciae latae. The Iliotibial band is most active when we are straightening our knee during running. ITBS is caused by the Iliotibial band rubbing against the lower part of the knee when a person is performing activity that requires repeatedly bending and straightening the leg, such as running. This repetitive rubbing can cause friction around the knee and over time will cause pain and inflammation. In runners, ITBS usually occurs because a person has developed muscle imbalances. In addition, they often present with significant weakness of their core and hip muscles. If a runner has decreased hip and core strength their knee may begin to bow slightly inward as they begin to fatigue. As a result this causes the Iliotibial band to stretch and rub against the knee during a run. This is a very subtle movement and most people are completely unaware that they begin to use this compensation pattern when they become fatigued.
Symptoms of ITBS include swelling and sharp or burning pain on the outside portion of the knee. A telltale sign of ITBS is knee pain that occurs consistently after running a certain amount of time or distance. If left unchecked the pain can worsen and in severe cases the knee can even become painful when a person is walking or when they are ascending or descending stairs. The constant stretching and friction of the Iliotibial band can also cause trigger points to form which can lead to additional pain and sensitivity throughout the Iliotibial band. Usually distance runners are at risk for developing ITBS, but people who are cyclist, hikers and people who lift heavy weights, especially people who perform squats are also at risk for developing ITBS.
For occasional short distance runners with mild cases of ITBS resting and icing can be beneficial for resolving symptoms. However, for more enthusiastic runners physical therapy is often required. After a thorough physical examination a physical therapist will identify any muscle imbalances, strength deficits and trigger points. The treatment will revolve around correcting these imbalances and strengthening the hip. Hip strengthening exercises helps to condition the runner’s hip which results in the hip muscles becoming less fatigued during a run and then runner will have better control of the hip. This prevents the knee from bowing in when a runner strikes the ground with their heel during a long run.
Core strengthening exercises will also be prescribed to help improve the control of the hip during running. The core musculature is the foundation of our body. If a runners legs are very strong, but they have a weak core then they will still present with hip instability which may result in a runner’s IT band being stretched and rubbing against the knee causing irritation. In addition to a strengthening program a physical therapist will use ultrasound, various stretches and hands-on techniques to release trigger points that have developed around the Iliotibial band. A physical therapist will also aid the runner in developing an effective running program that will help guide the runner to their running goal. The physical therapist may also observe the patient running to identify asymmetries and compensation patterns the runner has adapted.
If you’re experience knee pain while running or when performing any activity don’t hesitate, call Total Performance Physical Therapy for a consultation today.