Twinges in your knee? What could it be?

There’s little worse than getting into the swing of a really good exercise program or workout routine, with all of the motivation to stick to it, the time set aside to do it, and the dedication to keep at it, but then your body just doesn’t want to play along and it starts presenting with niggles and aches and pains.

It’s exactly what happens to many runners out there… You feel like you’ve run for miles, and you’re feeling more comfortable with each step but then you start getting this twinge in your knee. It’s as if instead of getting stronger and fitter, you start declining in ability! What’s going on?

Runner’s knee

One of the most common injuries runners face is called runner’s knee, or iliotibial band (ITB) syndrome. It accounts for 22% of all overuse injuries in running. And that’s exactly what it is: an overuse injury from putting miles on your feet, rather than a traumatic, acute, or specific incident¹.

Its  injury that causes inflammation of the large band of connective tissue that runs along the entire length of the thigh, connecting the muscles and tissues at the hip and buttock to those around the knee². The main function of this large band is to stabilize the knee and also help with the inward rotation of the hip.

This injury results in pain that is on the outward facing side of the knee, and it can typically be pinpointed as a precise location of pain³. It is very specifically located to this area, and any other pain around the hip or down the leg is something else⁴.

Of course, there can be other areas of pain associated with ITB syndrome and how it can cause other imbalances in the other moving parts you use to run, but the first and most prominent site of pain is that which has been described above.

Do you have ITB syndrome? What do you do about it?

3 Steps for ITB Syndrome treatment

Step 1. Target that inflammation

Because it’s inflammation that’s causing the pain, you want to stop whatever it is that’s causing the inflammation, that’s the first step⁵. Unfortunately, this means putting your running shoes back in the closet for a couple of days at least. Rest and icing the injury is a good place to start, and topical anti-inflammatory creams can help.

Step 2. Work the band

Many forms of muscular inflammation and injury respond well to stretching and massage, and the ITB is one of them⁶. Because of the size of the band, it’s useful to use a foam roller to help get that deep tissue massage if you’re not inclined to check yourself in for a sports therapy massage every other day depending on the severity of your injury. It is, however, recommended that you do seek professional attention for the injury, even if it is simply going for a massage twice a month with a professional who is familiar with the injury. This is also good practice to make sure that it is ITB syndrome you’re dealing with and not something else.

As part of your recovery, it is ok to keep working out while you’re resting your ITB. Cross training that doesn’t aggravate the injury can be performed as a means to keep up your strength and fitness levels. Don’t know what exercises to do? It’s quite simple: if the exercise you’re doing makes your knee hurt, try another one. Remember to stretch after your workouts, too.

Step 3. Strengthen your ITB

As soon as you can start feeling that there is no pain associated with movements that use the ITB, start strengthening it to prevent the same injury from recurring. The gluteal or buttock muscles are of particular importance⁷ as they help to stabilize the top of the band. Here are two exercise ideas:

• Using a resistance band around your lower thighs, and lying on your side with your knees bent at 90 degrees, raise and lower your top knee away from the other but keeping your feet together, like a clamshell. As your get stronger and the pain subsides, build up to 3 sets of 10 reps each side.

• In a side plank position, raise and lower your top leg. Keep your foot pointed slightly down; remember the ITB is used to assist in this inward rotation of the hip joint, so you know it’ll be working during this movement. Your form here is important and it’s an exercise that requires whole body strength. If you feel too unstable, drop your opposite hip to the floor and perform the same movements. Work up to 3 sets of 10 reps a side.

Now that you know how to get your ITB band in good shape to begin hitting the pavement again, there are a couple of other factors to take into account to protect your ITB^8,9,10 - and prevent other injuries - in future:

• Check in with your running style.
• Don’t forget to include strength training into your running routine.
• Make sure your running shoes are suitable.
• Don’t increase your mileage too suddenly.
• Balance out your hills - both up and down - with running on flatter surfaces.

Correct running biomechanics, the right equipment, stretching and strengthening all areas of your body that have been under strain can have a significant impact on whether your ITB syndrome recovers, and it will also impact your risk as to whether you develop any other running injuries or not in the future.

References:

1. Saikia, S., & Tepe, R. Etiology, Treatment, and Prevention of ITB Syndrome: A Literature Review. Topics in Integrative Health Care 2013, Vol. 4(3).
2. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R 2011;3:550-61.
3. Pedowitz RN. Use of osteopathic manipulative treatment for iliotibial band friction syndrome. J Am Osteopath Assoc 2005;105:563-7.
4. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician 2005;71:1545-50.
5. Kirk KL, Kuklo T, Klemme W. Iliotibial band friction syndrome. Orthopedics 2000;23:1209-14; discussion 14-5; quiz 16-7.
6. Fredericson M, White JJ, MacMahon JM, et al. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Arch Phys Med Rehabil 2002;83:589-92.
7. Distefano LJ, Blackburn JT, Marshall SW, et al. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther 2009;39:532-40.
8. Noehren B, Davis I, Hamill J. ASB clinical biomechanics award winner 2006 prospective study of the biomechanical factors associated with iliotibial band syndrome. Clin Biomech (Bristol, Avon) 2007;22:951-6.
9. Fredericson M, Cookingham CL, Chaudhari AM, et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J Sport Med 2000;10:169-75.
10. MacMahon JM, Chaudhari AM, Adriacchi TP. Biomechanical injury predictors for marathon runners: striding towards iliotibial band syndrome injury prevention [abstract]. Intl Soc Biomech (Hong Kong) 2000