Chad Dufrene is a Certified Athletic Trainer employed as the Clinical Education Coordinator for the Athletic Training Program at Southeastern Louisiana University in Hammond, Louisiana. He earned his Bachelor of Science in Athletic Training at Southeastern in 2007. He also earned his Master of Arts in Health Studies at Southeastern in 2012. Before his employment at Southeastern, he was the Certified Athletic Trainer at Brother Martin High School in New Orleans, Louisiana.
What is Runner’s Knee? Part 1
By Chad Dufrene, MA, ATC, LAT
At some point in your running career, you have or will hear the term “runner’s knee.” I put “runner’s knee” in quotes because it encompasses a number of injuries or conditions of the knee. “Runner’s knee” refers to either a single or a combination of the many overuse injuries of the knee that affect distance runners. The most common injuries or conditions that fall under the “runner’s knee” umbrella are iliotibial band friction syndrome, pes anserinus tendinitis, and pes anserinus bursitis. I will explain “runner’s knee” in a two part series.
Iliotibial band friction syndrome (ITBS) is an overuse injury to the lateral (outside) part of the knee. Your IT band can best be described as a tough band of tissue that runs along the outside of your thigh to attach two muscles on your hip to your shin bone. One of those muscles is your gluteus maximus which helps provide extension of the hip. The other muscle is your tensor fasciae latae (TFL). The TFL is important because it prevents the knee from collapsing or buckling while you are running by exerting constant tension on the IT band. ITBS is almost always caused by a combination of overuse and improper biomechanics (form). The four most common biomechanical causes of ITBS are excessive pronation, leg-length discrepancy, prolonged running on tilted surfaces, and cross-over stride. I could write a novel describing the biomechanical issues associated with ITBS. I would instead recommend proper coaching, biomechanical analysis, and shoe fitting to deal with those issues.
The average distance runner strides about 2,000 times per mile. The TFL holds the IT band taut against the outside of your thigh. Your IT band is really close to the bony structures of your lower thigh and upper shin when it crosses the knee. The biomechanical deficiencies mentioned above cause your IT band to rub against the bone every time you stride. Poor biomechanics associated with the 12,000 strides of an easy 6 miler cause your IT band to rub against the bone 12,000 times. The best analogy that I can give involves rubbing a rope against a large rock. The friction caused by the rope (IT band) rubbing against the rock (bone) 12,000 times would cause a great deal of damage to the rope.
What are the symptoms associated with ITBS? Pain above the outside of the knee that radiates to below the knee while running is the most common symptom. In more severe cases, there may be a “cracking” or “popping” noise or feeling along the outside of the knee while running. These symptoms will increase while running downhill. A common way to self-diagnose this injury is the inability to perform a pain free single-leg squat. I would like to add that this is not a definitive method of diagnosing ITBS. It is not meant to replace a diagnosis provided by a medical professional.
How do you treat ITBS if diagnosed? ITBS is an overuse injury so rest is the first treatment recommended. Ice bag, cold-whirlpool, ice bath, and ice massage and NSAIDs are the best ways that you can treat the inflammation caused by ITBS at home. What are the best ways to prevent ITBS? I cannot stress the importance of adopting a core strengthening, hip strengthening, and lower body flexibility program tailored for distance running enough. If you do not have access to a distance running coach, I recommend reading articles or books regarding these programs. There are also various lectures and seminars regarding these topics at specialty-running stores. If the symptoms persist for an extended time or are severe, I would recommend setting up an appointment with a medical specialist. They may prescribe steroidal anti-inflammatory and/or physical therapy.
A good home remedy for ITBS involves utilizing a high density foam roller before activity. Lie on your side and place the foam roller between your outer thigh and the floor. Use the weight of your body to roll the foam roller up and down your outer thigh for a few minutes. This action provides a kneading action that rids your IT band of tightness and inflammation. Another home remedy involves filling an empty 2 liter bottle 3/4ths of the way with water. Place the bottle in the freezer for an hour. You can use this frozen bottle in the same manner as you would the foam roller in the previously mentioned activity. I hope that this bit of information helps. I just want to clarify that I am a licensed medical practitioner and that the information I have provided is based off of evidence based research. However, my advice should not replace medical care under the direct supervision of a practitioner if deemed necessary.