Suffering from runner’s knee? This is what's happening

Runner's knee is a lateral knee pain that occurs as a result of irritation or inflammation of the ITB, also known as ITB syndrome. — Filepic

Whether it’s from overuse, injuries or old age, knee pain is a common complaint in all adult age groups.

You may have experienced pain at the front of the knee, on the outside (lateral) or on the inside (medial).

There are many causes of knee pain, but today, we will focus on lateral knee pain as a result of irritation or inflammation of the iliotibial band (ITB), or what is known as ITB syndrome.

Often referred to as runner’s knee and a bane of endurance athletes, other people who suffer from this injury include skiers, weightlifters, hikers and cyclists.

If you are flat-footed, female or have bowed legs, you’re more predisposed to getting this injury.

First, a little anatomy: the ITB is a thick cord of connective tissue – similar to a tendon – that runs along the outer thigh from your iliac crest (top of your hip bone) to the top of your tibia (one of the two major bones in your lower leg).

This cord’s role is to stabilise the hip and knee, especially when doing high impact exercises like running or jumping.

When you bend and extend your leg, this band moves over the lower outer edge of your thigh bone.

If it’s functioning properly, the ITB glides effortlessly over the thigh bone, but when it’s tight, or with repeated bending and extending, there may be friction as the band crosses the joint.

This friction annoys the tissues that lie beneath the band.

When the ITB becomes stressed through overuse, you will usually feel pain on the outside of the knee, above where the ITB crosses the joint.

You will immediately sense it via a sharp lateral knee or hip pain.

You’ll also feel it when you take side steps.

The pain is an aching, burning feeling that sometimes radiates up the thigh to the hip.

It can also be accompanied by a clicking sensation, caused by the ITB snapping across the joint.

In runners, the pain usually occurs just after the heel hits the ground and gets worse as the run goes on.

Downhill and long, slow running tend to worsen the symptoms.

You might notice this pain only when you exercise or it may start at the end of your workout.

Slow recovery

So, the knee joint itself is not the issue, but the ITB is, and depending on where the irritation occurs, it can cause pain on the outside of the knee or the outside of the hip.

Some studies show that weakness of the hip abductor muscles is one of the leading causes of ITB syndrome, along with greater knee internal rotation.

The hip abductor muscles are the ones that engage when the leg is lifted out to the side, i.e. the gluteus minimus and gluteus medius.

However, there are also multiple studies that say that some of the conventionally held ideas regarding the cause of ITB syndrome may not be accurate, as researchers cannot find a clear link between them.

Although ITB syndrome is easily diagnosed clinically, it can be extremely challenging to treat and recovery can be frustrating.

Treatment requires active patient participation and compliance with activity modification or total stoppage from activity – for the diehard exerciser, this is hard.

Most people respond to conservative treatment involving rest, ice and anti-inflammatories.

As the ITB is thick and fibrous, it cannot really be stretched and using a foam roller on the lateral knee won’t do any good either.

A better option is to stretch the muscles surrounding it.

However, your doctor has to rule out other problems such as tearing of certain lateral ligaments or cartilage that stabilises the knee joint, or arthritis located on the side of the knee joint, first.

Try out some of the stretches shown in the gallery below and hold each position for 30 seconds before switching sides.

Once you can stretch comfortably without pain, strengthening exercises can commence.

Surgery is an option

With ITB syndrome, it is imperative to rest from aggravating activities, otherwise the condition can become chronic and may take months to heal.

I’ve got one student who’s been suffering from this condition for over a year now!

At worst, injections or surgical intervention may be necessary.

In a 2009 study published in the European Society for Sports Traumatology, Knee Surgery and Arthroscopy journal, a group of surgeons performed an arthroscopic technique to treat resistant ITB syndrome in 36 athletes.

They removed the irritated tissues that lay underneath the ITB without touching the ITB itself.

Basically, these tissues became extremely sensitive when they were disturbed, and once triggered, they refused to behave “normally” again.

Out of the 32 patients who were successfully followed up, the surgeons reported that all had good or excellent results, and went back to sports after three months without any pain.

A meniscal lesion that required treatment was found in two patients, while another, who only had a fair result, also had associated cartilage lesions of the femoral condyle.

For some people, rest, painkillers and physical therapy are all it takes to recover, but for others, nothing works.

The only way to stop the pain is to remove the pressure, stop irritating the tissues and let them calm down.

And it worked for these patients – the problem was fixed.

So, in stubborn cases, surgery could be an option.

If you’re a runner, remember that once you return to your beloved sport, take it slow and try to run on even, flat surfaces as much as possible, with a good pair of shoes.

Running on uneven terrain can cause the ITB to flare up again.

If you run on a track, make sure you run in both directions.

And proceed gradually.

Revathi Murugappan is a certified fitness trainer who tries to battle gravity and continues to dance to express herself artistically and nourish her soul. For more information, email [e-mail]. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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