Everything you need to know about runner's knee

Response Physio | 25.08.22

Runner knee: causes, symptoms and treatment
from the experts in physiotherapy

What is runner’s knee?

Runner’s knee is a term many people use for general knee pain when running. A true runner’s knee is characterised by pain on the outside aspect of the knee. This is one of the most common injuries for runners presenting with knee pain. This is caused by irritation of the Iliotibial band (ITB) where it crosses over the knee. This condition is known medically as Iliotibial Band Syndrome (ITB Syndrome).

The ITB or ITB tract is a thick band of the facia that runs down the outside of the thigh from the hip and inserts into the outside of the knee.

What are the causes of runner’s knee?

Current evidence suggests that pain is caused by the compression of the ITB over the outside of the knee resulting in an inflammatory response. This is caused by repetitive stress/load being put through the IT band. Potential causes of Runner’s Knee could be related to repetitive overload/overtraining stressing the site. Altered biomechanics of the lower limb can also be a causative factor as this can add more stress to the ITB and the site of injury.

What are the signs and symptoms of ITB Syndrome?

Despite its name, the runner’s knee can also be caused by other sports that involve repetitive bending and extending of the knee, for example, rowing and cycling.

The predominant symptom of runner’s knee is a sharp pain on the outside of the knee. This can be especially pronounced on initial foot contact when running. Climbing and descending stairs can also flare up symptoms of runner’s knee, more so when descending. This also applies to running as running downhill may be more provocative. Some swelling on the outside of the knee may also be seen due to the inflammatory nature of runner’s knee.

Differential diagnosis of knee pain when running:

  • Pain underneath kneecap: Patellofemoral pain syndrome
  • Pain at the bottom of the kneecap: Patella tendinopathy
  • Pain on the inside of the knee: MCL sprain. Pes Anserine tendinopathy.
  • Pain at the back of the knee: Backers cyst. Hamstring strain.
  • Pain on the outside of the knee: LCL sprain

What is the treatment for runner’s knee?

Strengthen the muscles around your knee and hip

Strengthening the supporting muscles around your hip and knee will help to spread the load that is being put through the IT band. An important group of muscles to focus on is the gluts, TFL and lateral quad muscle. Exercises like glut bridges, crab walks, clams and side leg raise will target these areas well.

Stretch the muscles that attach to the IT band

As the IT band is so tough, using a foam roller directly onto this area will not give many benefits. Areas that are beneficial to foam roller are the gluts and TFL muscles. As these muscle groups attach to the IT band, releasing up these muscles will have a knock-on effect on the IT band and reduce tension put through it. The use of a tennis ball or lacrosse ball to release into your gluts and TFL areas is also beneficial. This can be done by placing the ball into the outside area of your hip, making sure you’re on the muscle bulk, finding a tender point and sitting on it. Glut and TFL stretches will also help to reduce the tension on the IT band. The pigeon stretch is a great stretch to target these areas.

Ice therapy

Ice therapy can be used for runner’s knee due to its inflammatory component. Ice will help to reduce the inflammation present in the area and therefore reduce the symptoms felt. Using a bag of ice wrapped up in a tea towel for no more than 20 minutes can help to alleviate symptoms.

Give your knees a break

If pain persists, it may be a good idea to offload your knees and give your knees a break to let the inflammation and pain settle down before gradually building back into your running. As a rule, when building up your running load, increasing your monthly mileage by no more than 10% each month is a good figure to stick to, to prevent further injury.

See a physiotherapist

Once you start to feel the symptoms of runner’s knee, try to get booked in to see a professional physiotherapist. They will be able to come up with a well-rounded plan to strengthen and stretch the muscles around your knee and hip as well as provide hands-on treatment to release into these muscles. A combination of trigger pointing, soft tissue massage and acupuncture can be used in a face-to-face physiotherapy session.

If you are concerned about any signs and symptoms of pain when you are running, please book a session near you below.

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