Increasing the intensity of training too quickly and excessive hill runs are two of the causes of “runner’s knee”.

Photos: CPL Simone Liebelt

A fraction too much friction

Knees up isn’t just a dancing term – it’s what you need to do if you’re in pain from ‘runner’s knee’,
as LEUT Genevieve Liebich explains..

Iliotibial band friction syndrome is a common source of knee pain for athletes and Defence members. It is an overuse injury resulting from repetitive friction of the iliotibial band (ITB) as it passes over the bony parts of the outer knee. This condition mainly affects distance runners and so it is commonly known as “runner’s knee”. But it is also a frequent condition for cyclists and for team sport participants.

Tissue not muscle

The ITB is not a muscle but a strong band of fi brous tissue that extends from the side of the hip bone, passes the outside of the knee and inserts into the lower leg bone. A sac containing lubricating fl uids helps to facilitate smooth movement of the ITB over the bony parts of the outer knee.

Weighty attachment

Weight-bearing activities such as running and squatting require contraction of muscles around the hip and knee, many of which attach to the ITB either directly or indirectly.

This muscle activity causes increa sed tension in the ITB and results in friction as it slides over the bony parts of the outer knee. With repetition, this can cause pain and irritation, but it should be noted that signifi cant repetition is usually required before the onset of symptoms.

Causes of injury

• Training intensity errors – increasing distance or intensity too quickly.
• Muscle imbalances.
• Muscle tightness: ITB, hamstrings and calves.
• Poor hip and knee control during activity.
• Excessive hill runs.
• Leg length differences.
• Bowed legs or abnormal foot pronation.
• Inappropriately fitted shoes or excessive shoe wear.

Signs and symptoms

• Pain over outer side of knee (dull ache to sharp pain).
• Discomfort initially relieved by rest. Grating during knee movement.
• Worse pain if a person continues to run, especially during downhill running.

Use RICE

Reduce inflammation and pain by using RICE (rest, ice, compression and elevation) and sometimes antiinfl ammatory medication (prescribed by MO) or electrotherapy as administered by physiotherapist.

Stretch to strengthen

A comprehensive program of strengthening weak muscles and stretching tight tissues is then prescribed by the treating physiotherapist in conjunction with the MO.

This often entails deep tissue massage to muscles and the ITB. Modifications to running tech- nique as well as a review of the training regime are an essential part of treatment.

Modify training

To allow the member to regain full range of motion, strength without pain and to return to activity, training modifications include:

• Reducing the distance per training session.
• Decreasing the number of training sessions on hills.
• Alternating the direction of the route (alternating clockwise and anticlockwise direction on a circular track).
• Adjusti ng bicycle set-up for cyclists.
• Wearing shoes with good cushioning and possibly inserts.

Most cases will respond to this management.

Occasionally, the treating MO or specialist, to reduce the symptoms of swelling and pain, will prescribe cortisone injections.

Surgery is occasionally performed, but only after extensive non-operative measures have failed to relieve symptoms.

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