Runner’s Knee / Illiotibial Band Syndrome
By Dominic McKinley, MD, CAQ and Joe Mullins, M. Ed., LAT, ATC

According to an article published in the Journal of the American Academy of Orthopedic Surgeons, one in five runners will experience a yearly knee injury ('Running Injuries to the Knee,' Journal of the American Academy of Orthopedic Surgeons, vol. 3, pp. 309-318, 1995).  Internet searches for the incidence rate of illiotibial band (ITB) syndrome reveals that this malady accounts for an approximate 12% of knee injuries in running.  Therefore, if you are an avid runner, you have a very high chance of experiencing lateral (outside) knee pain at some point in your running life.

What is Runner’s Knee/ITB Syndrome?

The ITB runs along the outside of the thigh and attaches to the outside part of the knee.  Runner’s knee is an irritation of the ITB at or near its attachment to the knee.  This irritation is caused by friction that is built up during each repetition of the running cycle.  The greatest amount of friction occurs between a 20 and 30 degree knee angle.  Since this angle is assumed with great repetition during the running cylce of long distance runners, the ITB can succomb to these mechanical stresses and result in an inflammatory response.  Additionally, weak hip abductors can also result in increase stress on the ITB.

Common Signs and Symptoms of Runner’s Knee

Tenderness along the outside of the knee with the following presentation:

• Pain starts as minor discomfort, but worsens

• Discomfort initially relieved by rest

• Pain with running downhill

• Pain with running on uneven surfaces

Treatment of Runner’s Knee

Treatment of runner’s knee coincides with the three stages of tissue healing:

• Anti-inflammatory medication (NSAID’s) to prevent the inflammatory stage of tissue healing from being prolonged

• Soft tissue mobilization and stretching during the regeneration phase of  tissue healing

• Continued stretching along with hip strengthening/stabilization exercises for the abductors, adductors, external rotators and extensors during the remodeling phase of tissue healing

• Decrease running distance until pain free or nearly pain free

• Decrease hill and stair workouts until pain free or nearly pain free

Prevention of Runner’s Knee

Athletes can be proactive in preventing runner’s knee by incorporating the following:

• Undergo a Performance Based Functional Assessment to identify any underlying physical imbalances that may be predisposing the athlete to injury

• Initiate a preventative flexibility program

• Initiate a post-running regeneration program that includes stretching and self massage techniques

• Evaluate running shoes for excess wear

• Avoid downhill and uneven terrain running until pain free

Bottom Line

As with many overuse type injuries, runner’s knee can be largely prevented through a proactive approach.  However, in the event that you begin experiencing the above symptoms, seeking appropriate and expedient assistance from a sports medicine professional can help you get back to running quicker.

Dominic McKinley, MD, CAQ is a primary care sports medicine physician with Guilford Orthopaedic and Sports Medicine Center in Greensboro.  He serves as team physician for N. C. A&T State University and Bishop McGuiness High School.  He enjoys running.  Dr. McKinley can be contacted at 336-275-3325.  More information about Dr. McKinley and the services he provides can be found at www.guilfordortho.com.

Joe Mullins, M. Ed., LAT, ATC is Founder and Director of Athletic Training & Conditioning, Inc.  He specializes in functional orthopedic evaluations and works with athletes from middle school, high school, and college to professional and Olympic athletes.  He can be contacted at joe.mullins@athletictrainingandconditioning.com.  More information about Joe Mullins and the services he provides can be found at www.athletictrainingandconditioning.com.