Pain on the outside of the knee?

A common running injury: ITB Syndrome…

One of the most frequent injuries that we see at Chart Clinic is Iliotibilal Band or ITB syndrome and due to its repetitive nature this is especially common in runners.

What is it?

Iliotibial band (ITB) syndrome is one of the most common overuse injuries in runners which causes pain on the outside of the knee. This occurs particularly when running, cycling or during any activity where you have to bend the knee under load. Pain is also commonly experienced around the knee cap as it can affect how the knee cap functions.

The ITB is located on the side of the thigh which starts from the top of the hip and inserts into the outside of the knee. Pain is usually experienced when the lower part of the ITB rubs against the outer part of the knee. As the knee bends and straightens, this band moves back and forth, irritating fatty tissue which is designed to reduce friction. However, if this band is too tight, the fatty tissue can become inflamed, swollen and painful.

What causes it?

There are a number of causes of ITB syndrome, these include:

  • Running excessive mileage or running too far too soon
  • Too many track sessions running in the same direction
  • Training in worn out trainers
  • Running down hill or on banked surfaces
  • More common in females due to the increased angle between the hips and knees
  • Weakness of the Gluteus Medius muscle which is involved in hip stability
  • Shortened Gluteus Maximus or Tensor Fascia Latae muscles as these blend into the Iliotibial band leading making the band tighter
  • Flat feet

What can I do to prevent injury?

  • Wear trainers which support your running style. Many sports shops offer a service where they watch you run on a treadmill. They can then advise you on what type of trainer is best suited
  • If track running, balance your sessions by running both clockwise and anticlockwise
  • Avoid running on a camber
  • If you are new to running, build up your distance very slowly
  • If you have flat feet, consider visiting a podiatrist to see if you orthotics would be a good option

I have pain on the outside of my knee, what do I do?

  • Grab and ice pack, wrap it in a dry tea towel and place it on to the outside of your knee using the ratio 20:60…20 minutes of icing every 60 minutes
  • Avoid performing activities which make this pain worse. Get yourself into the swimming pool; it's a great training alternative!
  • Go and see an Osteopath, Sports Masssage Therapist or Physio, the quicker you get it treated, the faster you'll be back out running.

It is important to understand why this has occurred, otherwise this will reoccur again and again. Speaking to a qualified manual therapist is a useful option as they can not only offer advice about the injury itself, but can also identify why this has happened through diagnostic testing and what can be done to prevent future episodes.

Surgery is commonly considered to be a final resort. The majority of ITB band syndrome injuries are successfully treated through conservative means, these may included sports massage, acupuncture and stretching, so don't rush to go under the knife as even that is not guaranteed to solve your injury!

Article by Jon Wilkinson, Chart Clinic Osteopath.

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