Is "Runner's Knee" stopping you?

By Tracy Temmel, DPT at One Nine Sports Medicine in Solana Beach

Running is a favored fitness activity of coastal California. The climate and variety of terrain is an outdoor fitness enthusiasts’ dream. Many recreational runners will experience pain or injury that will limit their personal running goals. In the next few articles I will discuss common running injuries and what you can do prevent them.

Today, I am going to cover “Runner’s Knee,” a term used to describe injury to the Iliotibial Band (IT Band) that results in pain along the outside of the knee. (For more on Runner’s Knee, check out our article on Don’t Dread the Runner’s Knee). The IT Band is a thick, tendinous structure that begins at the outside of your hip, runs along the outside of the thigh, and attaches at the outside of the knee. It is an important muscle used in walking and running as it is both a hip AND knee muscle. When injured, pain is felt at the outside of the kneecap, particularly when the runner’s foot hits the ground in stride.

IT Band syndrome is technically classified as an “over-use” injury, however, I am going to rename this term and say that IT Band syndrome is often times a “misuse” injury. A muscle that is “misused” is likely to be overworked, thereby resulting in muscle damage requiring rest and recovery. The key to preventing this injury from returning once the athlete starts running again, is to ask, “why was it being misused in the first place?”

When answering that question, I like to look at three things: Running form, footwear and environment. 

1) Running form: The IT Band is a critical muscle of running. It assists in controlling the impact that the ground has on your leg as it absorbs the shock of contact. When running, if there is a lot of side to side motion at the pelvis, or if the leg/knee rolls inward, there is a good chance that the IT Band is going to be working extra hard to balance and control that motion. However, the IT Band isn’t meant to work alone in balancing your stride. There are other muscles that assist, such as the hip rotators and abductors (glute muscles). When evaluating a runner’s form, I look to see if the key helpers to the IT Band are not doing their part. If these other hip muscles are tight or weak, stretching and strengthening exercises can be prescribed to avoid over-stressing the IT Band. 

2) Footwear: Improper footwear can also stress the IT Band. Running shoes without enough support can also change the way your body absorbs shock from the ground, and can result in the ITB trying to pick up the slack. If the shoe allows for the foot to collapse inward, the entire shin bone will be pulled with it, making the ITB work extra hard to keep the knee upright. Wearing proper footwear can create an immediate positive change on how a runner’s muscles are being worked. 

3) Environment: It is also important to consider the ground that you are running on and what type of demands it is putting on the body. Running on softer or uneven surfaces will challenge the muscular system in ways that a flat, predictable surface will not. If running on trails, sand, or unpredictable environments excites you, make sure that you are slowly increasing mileage allowing your muscles time to adapt to the new demands. The amount of mileage that a person should increase each week is debatable. There is a popular theory circulating amongst runners that from week to week you should increase no more than 10% of what you ran the previous week (10% rule). The bottom line is that if our bodies are not fully recovered from the previous week’s training, we should allow time to adapt before adding more stressors to the system.

If you are experiencing aches and pain while running, or are concerned that you don’t have a solid recovery or injury prevention plan for the amount of running that you like to do, contact one of our PTs for a consult.

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Dr. Dave Gerbarg

Dr. Dave Gerbarg is the President and Physical Therapist at One Nine Sports Medicine and Physical Therapy in Solana Beach. He specializes in sports medicine for teenage and adolescent athletes.