What is “runner’s knee”?
What is runner’s knee or iliotibial band syndrome?
Running is a physical activity that has great benefits for people who practice it with greater or lesser intensity: it improves the respiratory and cardiovascular system, strengthens the immune system, tones the lower body muscles, improves the locomotor system, helps reduce stress and improves sleep, among other positive effects.
However, it can also have a significant impact on the lower body joints, especially the knees. One of the most frequent injuries in people who practice running or disciplines that involve continuous running on different surfaces is the iliotibial band syndromealso known as runner’s knee.
The iliotibial band is a thick band of fibrous tissue that connects the gluteus maximus muscle and the tensor fascia latae to the tibia, running along the entire outer thigh. This structure plays a key role in the movement of the leg, especially in activities such as running or cycling. Injury occurs when this band becomes inflamed and irritated due to repetitive repetitive friction against the boneThe injury occurs when this band becomes inflamed and irritated due to repetitive friction against the bone, mainly in two areas: the external part of the hip or the knee. The most common rubbing occurs between the webbing and the external femoral condyle external femoral condyleespecially during the initial contact phase of the stride, where an eccentric deceleration contraction is generated.
Pain usually occurs at a specific specific running distance or timeforcing the cessation of the activity. Over time, if not properly treated, the pain begins to manifest itself earlier and earlier, even on shorter runs. It is characteristic that the pain intensifies when running downhill or at slow paces, since in these situations there is a longer contact time between the rib and the epicondyle. In some very aggressive cases, a protrusion or snapping of the tape on the condyle may be noted.
Causes of iliotibial band syndrome
This lesion is of multifactorial multifactorial in originThere is no single cause that originates it. Among the most frequent factors, the following stand out:
– Cintilla anatomy (tightness or excessive tension).
– Deficit of musculature in the lower body.
– Failure to warm up properly before training.
– Training on uneven or downhill surfaces.
– Running in cold temperatures.
– Excessive training load or overtraining.
– Previous injuries or direct impacts on the area.
From the biomechanical point of view, there are predisposing factors that increase the friction of the rib with the femur and favor the development of the syndrome:
– Muscle shortening of the hip flexors and tensor fascia latae.
– Muscle imbalances, especially weakness of the gluteus medius.
– Genu varum (bowlegged).
– Excessive pronation of the foot or flat feet.
– Dysmetria (difference in leg length).
– Very prominent external femoral epicondyle.
– Capsulo-ligamentous hyperlaxity.
In addition, the use of inappropriate footwear, poor training planning or a sudden increase in load can also trigger this pathology.In addition, poor training planning or a sudden increase in load can also trigger this pathology.
Symptoms of runner’s knee
The main symptom is pain on the outside of the kneemore specifically over the lateral lateral epicondyle of the femurthat can be accompanied by inflammation. This discomfort appears with exercise, especially when running, and usually ceases with rest. When resuming the activity, the pain reappears at the same point of the run or even earlier.
In some cases, there may also be pain in the external area of the hip, or even a sensation of friction or clicking when flexing and extending the knee. In advanced stages, the pain can be continuous and persistent, even when keeping the knee flexed at rest.
Diagnosis
The diagnosis of iliotibial band syndrome is usually based on the patient’s clinical history and the symptoms described. The physical examination may include maneuvers such as the Ober testtest, which evaluates the shortening of the fascia lata, as well as palpation of the external femoral epicondyle to localize the pain. It is common to find trigger points along the length of the rib.
For a more precise diagnosis, the evaluation can be completed with the following tests imaging tests such as magnetic resonance or ultrasoundwhich make it possible to visualize the state of the affected tissues. Surface electromyography (EMG) surface electromyography (EMG) can also be used to assess muscle activation during movement.
Treatment of iliotibial band syndrome
Treatment will depend on the severity and evolution of the case. The initial objective is to reduce pain and inflammation, followed by a phase of biomechanical biomechanical correction and muscular strengthening to avoid relapses.
In the initial phases, it is recommended:
– Application of ice on the inflamed area.
– Relative rest or modification of the sport activity.
– Taking painkillers or anti-inflammatory drugsalways under medical supervision.
– Avoid activities that cause pain until functional recovery is achieved.
The conservative treatment includes:
– Manual therapy.
– Personalized therapeutic exercise.
– Specific stretches.
– Electroanalgesia, magnetotherapy, laser therapy y cryotherapy.
– Re-education of the sporting gesture.
– Review of running technique and training planning.
An essential part of the treatment is functional functional rehabilitationbased on an EMG muscle assessment and the development of a strengthening program of the gluteus medius and other stabilizing muscles. strengthening of the gluteus medius and other stabilizing muscles, to correct erroneousto correct erroneous movement patterns.
In the field of advanced physiotherapytechniques can be applied such as:
– PIE (Percutaneous Intratissular Electrolysis) to regenerate injured fibers.
– MicroEPI to reduce local inflammation.
– Neuromodulation to reduce pain and facilitate muscle activation.
– Radiofrequency o INDIBA to promote cellular recovery and improve tissue condition.
In cases that are more resistant to conservative treatment, corticosteroid infiltration may be considered. infiltration with corticoids or other anti-inflammatory substances. And if all the above fails, especially when there is a very fibrotic very fibrous webbinga surgical intervention may be considered. surgical intervention.
Treatment is effective if started early and maintained until complete disappearance of symptoms.
At MIVI Salud we are specialists in the treatment of pain.
We approach each case with a holistic and multidisciplinary holistic and multidisciplinary approachadapting the treatment to the individual needs of each patient. If you have pain in the external area of the knee, do not hesitate to consult with our professional consult with our professional team.
References
– Iliotibial Band Friction Syndrome(n. d.). National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK542185/
– Iliotibial Band Syndrome(n. d.). Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/iliotibial-band-syndrome.html
Director MIVI Sant Cugat. and MVII Sabadell