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Runners Knee Explained

I can tell you all about runner knee as it is a condition that I experienced myself. I had this condition when I ran the Bristol half marathon a couple of years ago and is extremely painful and will stop you from running all together if not treated properly, believe me I know!

The medical term for runner’s knee is known as Iliotibial band syndrome which will be explained later on. First let’s look at some of the common signs and symptoms of runner’s knee.

  • pain on the outside of the knee
  • pain or a feeling of tightness on the outside of the thigh
  • pain on the outside of the thigh when running
  • referred pain in the buttocks/gluetial muscles

This condition can also affect cyclists too. There many other types of knee pain but today the focus is pain on the outside of the knee.

Anatomy Lesson

To truly understand this condition we must have a look at the anatomy of the hip and leg. The Iliotibial band is not a muscle so it does not contract and act like a muscle but is a form of connective tissue known as fascia. Fascia is everywhere in the body and provides a 3d web of tissue. The easiest example to think about is your skin. Your skin is a form of fascia, now imagine that the fascia tightens in your forearm. This will constrict movement in the forearm, cause flexion in the wrist and cause possible symptoms that might be associated with carpel tunnel syndrome.

What commonly happens in runners knee if that the muscles that attach to the iliotibial band tighten causing the fascial band to tighten. The iliotibial band inserts on the tibial condyle/the outside of the knee.(in the diagram this is labelled as gerdys tubercle). When the band tightens this causes it to rub on the outside of the knee causing pain. One possible treatment strategy then is to focus on lengthening the gluteus maximus and tenser fascia latae which both attach to the iliotibial band. By lengthening and relaxing these muscles this reduces tension in the band allowing it to return to its normal length thus reducing friction on the outside of the knee. I have seen a lot of people treating this condition by using foam rollers on the band. Not only does this cause agonising pain but it’s not treating the problem because the band is long not short so if anything this may make it worse.

Other Possible Causes

  • Overuse. Training too much too quickly
  • Leg length discrepancies
  • Over pronation
  • Weak gluteus medius
  • Overtight tfl and gluteus maximus
  • Other muscular problems

The main culprit Gluteus medius

On average 80% of all running is done on one leg so it makes sense to test the strength of a runner standing on one leg and training should include single leg raises and strengthening exercises.

The gluteus medius abducts the leg and helps stabilise the knee and femur whilst on one leg. It also stabilises the pelvis whilst on one leg. If it is weak then this will cause the pelvis to drop. Weakness of this muscle causes excessive internal rotation which is going to cause tfl and gluteus maximus to tighten to compensate for this movement. If you consider that during an average run a leg will strike the ground somewhere between 80 and 90 times it becomes very clear that you need to have control and stability for correct alignment. You can try this for yourself by standing up and turning your foot inwards and noticing the muscles on the outside of your leg tightening. Therefore the treatment should be focused on strengthening this muscle. A simple test you can do yourself is see how steady you are at standing on one leg. If you are unsteady then probably your gluteus medias is weak. Another test to do is a squat in front of a mirror and see if one leg turns inwards. If it does then this is a suspect weak gluteus medias.

Other possible Causes

There are of course many other possible causes of runner knee injuries. In practice it is always best to look at a global picture to identify other muscular problems.

  • Foot biomechanical problems
  • Over pronation
  • Tight psoas muscle
  • Ligament damage
  • Meniscus tear
  • Excess fluid in or around the kneecap causing patella tracking problems
  • Rectus femoris over tightening

Correct Treatment

  • Stretching tfl and gluteus maximus
  • Strengthening gluteus medias
  • GAIT analysis to check feet are not over pronating
  • Correct footwear
  • Core stability e.g. Pilates class
  • Stop running temporally

Photo Guide to self treatment see website for photos

One of the best treatments is to use a foam roller to release, massage and lengthen the tensor fascia latae. You only want to be using the roller from the iliac crest to about a third down the leg. Use your weight and body position to work into the muscle.

The next foam roller exercise works into the gluteus maximus. Again work into the muscle by adjusting the angle of your body position. You can increase the stretch on the muscle by bringing the raised knee closer to your body. If you feel any tender points stop and ease into them until you feel a release.

This is a general exercise to work into the gluets (muscles in you buttocks). Use your feet to work the roller up and down whilst your hands support you.

Single leg raises will strengthen the gluteus medias. Start with feet together and raise one leg. When raising the leg do it slowly and using control. Equally when lowering the leg do it very slowly

Again this is a single leg raise but the leg starts from a 45 degree angle. This makes the leg raise harder forcing the muscle to contract more. This can be especially hard for people with it band problems to do.

Again this is a single leg raise but this time a fitness band is around the legs. This provides resistance to the exercise forcing the gluteus medias to work harder.

There are other exercises which can be useful For example one legged skipping may be useful. There are other exercises that I do with clients for example getting them to stand on one leg whilst throwing a ball at them to catch can be a fun way of strength training. There are also lots of stretches you can do with a foam roller so its well worth buying one. I hope you have enjoyed the article and that it will help you get back to running.

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