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Runners Knee: what it is, how to treat it, and how to prevent it!

Treatment for Runners Knee

Runner’s Knee is the common name for “Ilio-Tibial Band Friction Syndrome.” The Ilio-Tibial Band (ITB) is a long band of very strong tissue that runs from the lateral crest of the hip down the side of the thigh, attaching just below the knee joint (you can feel it on the outer side of the knee, just above the joint). Pain is caused when the IT Band rubs across the bony prominence on the outer side of the knee. This causes inflammation and pain; and commonly also local swelling and stiffness.

The ITB has a small muscle component called Tensor Fascia Lata (TFL). TFL sits high in the band near the hip and contracts to pull on the ITB. In doing so it controls the position of the foot as it hits the ground. TFL can also assist to stabilise the trunk and pelvis over the leg as we land in running (but it isn’t very good at doing this on its own). Stability of the trunk is a product of many muscles including the gluteals (gluteus maximus, medius and minimus) and hip rotators. When these muscles don’t work effectively, the trunk and pelvis shift sideways which increases the tension in the ITB. This tension causes friction over the bony part at the side of the knee, resulting in pain and inflammation.

There is some controversy surrounding the anatomy involved but what is certain is that Runner’s Knee is painful and relates to your biomechanics.    Common in running, Runner’s Knee can also manifest in cycling, football and hockey. The symptoms usually come on gradually and can be related to an increase in training volume or hill sessions. Sometimes the symptoms come on more acutely with speed sessions, changes of direction or plyometrics.

Runner’s Knee usually presents as a localised tenderness and swelling over the side of the knee. The knee is stiff and painful at the start of an exercise session before then settling as you get going. The pain returns later on in the session. When more irritated, pain can be more constant. Pain is often worse in the mornings and when moving after periods of rest.

When should I seek help?

There are many different knee problems that affect runners and these need varying amounts of attention. It is important that you always seek medical assistance if an injury occurs from trauma (such as with a specific twisting action) or if the knee gives way or swells in the joint.

With Runner’s Knee, it is possible that the pain may settle on its own with a little rest, ice and stretching, but when the pain persists for more than a few runs, or if it is getting worse, you should seek the assistance of a sports physiotherapist or other medical professional. There are many members of the sports medicine team that are able to help, and a good professional will advise you how other members of the sports medicine team may be able to help you individually.

A good Sports Physiotherapist is usually the best person to see first. They will be able to diagnose and treat your injury as well as give you exercises to help you manage the injury and prevent recurrence. Treatment of runner’s knee is usually fairly straight forward, although can take quite some time to settle down.

How do you treat ITB problems?

The best advice for initial self-treatment is to avoid the aggravating activity and to ice the area every few hours when painful. You can also try anti-inflammatory gels or anti-inflammatory medications such as Ibuprofen which may also help (we recommend you seek your pharmacist’s or doctor’s advice).

The physiotherapist will massage and mobilise the area to reduce the stiffness, as well as show you exercises to strengthen and re-train the muscles that stabilise the pelvis and trunk. The main muscles to strengthen are the gluteals – these can be worked with exercises such as clams, standing hip abduction, step ups and bridging.

Although often recommended, stretching the ITB is difficult and not particularly useful. Stretching the ITB is not as helpful as many people suggest. The ITB has tensile properties similar to Kevlar, so it is unlikely that traditional ITB stretches are not much benefit. It is a good idea, though, to stretch the muscle groups around the thigh (gluteals, quadriceps and hamstrings). Rolling on a foam roller for regular self-massage is a better idea, and Sports Massage can also be helpful.

When the symptoms of Runners Knee take too long to improve or don’t improve, you should seek further advice and management from a Sports Doctor or Orthopaedic Consultant who specialises in knee injuries. A Specialist may request an MRI to confirm the diagnosis or rule out other problems in the knee. In some cases the Specialist may suggest an injection of corticosteroid. Cortisone is a very strong anti-inflammatory drug that acts locally and can settle the pain quite quickly, but should only be used in special circumstances. Where the pain doesn’t improve despite all other interventions, an Orthopaedic Surgeon may recommend an operation to release the ITB, but this is only ever the case for a very small number of people.

Getting back to running.

When not able to run; swimming, cycling and the elliptical trainer are good ways to keep up your fitness. Once the pain settles enough, the stepper can also be a good way to build your fitness whilst also strengthening the important gluteal muscles. Rowing is another way to keep up your conditioning, but can be aggravating to some whilst not to others, so that will be up to the individual.

A sports physiotherapist will also be able to give you individual advice on cross training to maintain your conditioning and how and when to return to running. A graduated plan for getting back to running will usually involve starting with small amount sand increasing the volume before the speed. The exact advice on how to plan such a programme will depend on the intensity of your symptoms and the specific activity you are training for.

Prevention

To prevent Runner’s Knee, the most important thing to consider is suitable planning of training loads. Increasing loads too quickly, or adding in too many hills or speed sessions without building up to it, can be the most common precursor to ITB problems.

As with most sports, a small amount of strength training can help with both performance and prevention of injury. Exercises targeting the gluteals and general trunk stability, done 2 or 3 times a week, can build strength and endurance, and help control the trunk and pelvis movement over the knee. Stretching may not necessarily prevent Runners Knee, but keeping good flexibility around the hip and thigh will help with your performance.

Correct footwear is really important. Different amounts of support are needed for different people, and the right amount of support can help to control movement about the knee and pelvis by helping the position of the foot as it strikes the ground. A podiatrist may also be able to help, especially with the biomechanical contributions. For some people, custom-made orthotics can be necessary to help control the foot’s positioning.

An Olympic effort: Nicki Combarro’s 83 day long Summer of Sport

Nicki with Victoria Pendleton

Looking back through the diary, my summer of sport consisted of 83 days! London 2012 was a fantastic experience that is hard to put into words and one that many of us will never forget being involved in; however I am secretly relieved that it is all over and normality can resume!

My Olympic journey started towards the end of 2011 when I was asked to start planning the medical provision required by Team GB for their preparation camp that was to be held at the University of Loughborough in June 2012, immediately prior to the Olympics.

The Prep camp opened on June 18th 2012 and was a residential camp where all the Team GB athletes and support staff passed through for a period of time prior to the Olympics. The camp was designed to provide training facilities for the athletes whilst they started to bond as ‘One Team GB’. It was at this preparation camp that they were given all their Team GB kit and did lots of interviews for the media. During their stay the athletes had access to physiotherapy, sports massage, medical support, strength and conditioning support and a recovery suite (ice baths and cryospas).

It was really great to see all the GB athletes prior to the games – full of excitement and hopeful of what they might achieve after years of hard work. With a number of high profile British athletes all in one place, we were a very popular hangout for the media, as well as being visited by VIP’s such as HRH Princess Anne, the Prime Minister, Sir Steve Redgrave and Dame Kelly Holmes.

Nicki with Dame Kelly Holmes

The prep camp was great but long days and living away from my children was difficult. However I won’t pretend that it was all hard work, we did have some down time! The HQ staff (me included) fielded a mean 5 a side football team that took on the University’s Police force and won! On a nice sunny afternoon we managed to get in a bike ride around Leicestershire on Team GB bikes and I even managed an 11mile run along the canal tow paths with two of the Met Police officers who were in charge of security at the camp. Well I had to do some form of exercise to counteract all the Cadbury’s chocolate that we were being given as they were one of the official sponsors of the Games!

Nicki at preperation camp

Once the Games were in full flow I changed my clothes to become one of the ‘Purple People’ and went into London as a Physio Games maker! My role during the Games was to be part of the Medical team at the Velodrome and BMX track. At the venues we ran a physiotherapy service for the athletes prior to and during their training, to keep them on top form prior to their competitions.

Then during the excitement of the events I had the best view in the house! For cycling I was in the middle of the track – ready to go with the Doctors and paramedics in the event that an athlete might fall off their bike doing 50mph! For the BMX I was one of 6 medical emergency teams stationed around the dangerous course, again ready to extract them from the course in the event of a serious crash. The course was amazing and prior to the event we climbed up to the top of the start ramp to experience for ourselves the sheer drop that propelled the bikes into the first ramp! The athletes that compete in this sport must be wired very differently, the danger that they face during training and racing is significant, but makes the sport so exciting to watch!

Despite having covered a variety of sporting events in the past, I can honestly say that I have never experienced an atmosphere quite like that at the Velopark! I was inside the track when Sir Chris Hoy won his Gold medal in the Keirin, everybody screaming and shouting as his bike crossed the finish line, the crowd so loud that you couldn’t hear the person next to you. I was there when Vikki Pendleton made her last unsuccessful efforts to win a gold medal and came away with a silver.

As a Games maker we were supposed to remain neutral and support all countries equally… but in those final races how could I not cheer for Team GB! And cheer I did! After the celebrations of the closing ceremony and the feeling of Olympic fever being over, the build-up to the Paralympics began!

Back in the purple outfit again I restarted my commutes into Stratford; however this time required a little more will-power… with 6:30am shift start times I had to get up at 4:45am every day!

Those early mornings were sure worth it though! Although I was based in the medical polyclinic in the athletes’ village, my role required that I went out to different venues to cover a variety of events. My early morning starts meant that by 8am on some occasions I had seen the sun come up over the Olympic Stadium whilst practising medical scenarios with the Doctors, treating athletes and then watching the events with a trackside seat! The Paralympians were truly inspirational to watch and it was at times a very humbling experience being involved in their medical care.

My summer of sport ended on Monday 10th September when I was invited to attend the athletes’ parade in London as part of Team GB. It was amazing… thousands of people lined the streets to celebrate the success of Team GB with marching bands, Chinese Lions, all topped off with a fly past by the Red Arrows.   These athletes really had moved a country to tears over the course of 6 weeks with their stories of survival, successes and sometimes failures. They had inspired me, they inspired my children and I am sure that they had inspired whole generations.

Even now, weeks after the torch has been extinguished, my children still play ‘Olympics’ with one wanting to be Bolt and the other one wanting to be Jess Ennis… it definitely makes for an interesting competition!

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IN BALANCE, Volume 1, issue 2, Autumn 2012.

Bodyabalance newsletter Autumn 2012: The newsletter of Bodybalance Physiotherapy & Sports Injury Clinic

Featuring:

  • What we did this summer
  • Introducing Alan Barbero
  • Rolling out our online booking
  • All you need to know about the calf muscle

Click on the link above to be taken to a pdf version of our newsletter.

Trackside at the Athletics, London 2012.

George Labor shares his experience of London 2012.

So after months of anticipation and nearly losing the belief that it would ever happen, the e-mail finally arrived. I thought it was yet another e-mail telling me I was still under consideration. But when I opened it, there was something different about this one. It had a lot more writing. In fact it was an e-mail asking if I was still available to work at the London 2012 Olympics and could I cover Athletics: yes and yes!!! I wanted to pick up the phone and scream “I accept!” to someone but the system didn’t work like that and e-mail response was all I could do.

George and Usain Bolt

The timing of the email, just a few weeks before the start of the Games, made it difficult to organise my diary at Bodybalance. We were already on an additional schedule at the clinic to cover the extra service we were providing to the countries using the Hertfordshire Sports Village as a Pre-Olympic training camp. I was asked to start my Olympic shift a week before the Games began; first at the training track and then working throughout the entire Athletics programme.

Accreditation and uniform collection was very exciting and really started to bring the whole experience to life, though the location in East London had not been chosen for its aesthetics. A few tube stops away I got my first experience of what would become the “Olympic vibe”. As the location was near the end of the tube line there were not many people on. Whereas usually everyone would be looking down and not chatting to each other, suddenly complete strangers were smiling away and excitedly talking about what they were going to be doing; it was great. The uniform was at best, in my opinion, functional – I will not be wearing it again.

The first shift came around in no time. Fully kitted out like on my first day at a new school, the uniform which had fitted like a glove when collected, was oddly both too long and too tight in various places. It was 7.30am, a week from the start of the Olympics, and I was travelling on the tube in my full uniform. At this stage a lot of the general public hadn’t seen anyone in this before.  I was getting strange looks and feeling very self-conscious. However, as the tube got closer to Stratford, more volunteers got on and, again, there was immediate solidarity amongst us and we were chatting in no time. The shift flew by but in hindsight without much going on. The majority of the bigger nation’s athletes were in still in holding camps around the UK and Europe meaning there were only a handful of athletes training in London.

The shift I had eagerly been waiting for at the Stadium came around. Yep, I was off to the Olympic Park and the Stadium itself! I kept checking my accreditation had not fallen of my neck. It was worth more than one of Willy Wonker’s magic tickets to me! The first thing that blew me away was the size of the Olympic Park; it was huge. The next thing was how smoothly and efficiently it all was controlled from getting through the military security to moving around the park and getting directions off the volunteers.

The medical team at the Stadium and the warm up track was much larger than other venues; there were 10 physiotherapists and sports massage therapists between the main stadium and the warm up track, 3 sports doctors and an army of first aiders. We were all rotated to cover the different medical areas and the track.

I was in the Stadium on the morning of “Golden Saturday” and the roar when Jessica Ennis was performing was electric. It was nerve racking being on standby with 70,000 people in the stadium and millions more watching live on TV.

I was very fortunate to have a number of amazing, different experiences over the 3 weeks. I was one of the lucky ballot winners to watch the opening ceremony dress rehearsal and I am proud to say I managed to keep it a secret (even from my wife)! I got to watch a huge number of famous track and field athletes on the warm up track in a more relaxed atmosphere than they normally are in front of the world’s media. I was also asked to work for part of the Closing Ceremony and also managed to watch some of it. These truly were once in a life time opportunities that I shall never forget. I am very proud of the small part I played in the London 2012 Olympic Games.

On the fencing piste at London 2012

Kessie Soper shares her experience of London 2012.

Having volunteered to provide physiotherapy support for the London 2012 Games, I was allocated to the sport of fencing which was based at the Excel arena. Fencing is a sport which I’d only worked with briefly once prior to the Games, so this provided a fantastic experience both to learn about a new sport and to be involved with London 2012.

Nearly 2 years after applying to be involved, Games time was finally approaching and I was so excited to have the opportunity to fulfil a lifelong dream to be involved in an Olympic Games.  I had several days of training and my first shift was the week before the competition began. There was already a real buzz of excitement at the venue with everyone working hard on final touches to make sure everything was ready.  The athletes could use the training areas for technical training and familiarisation. This was one of the busiest times in the clinic as the athletes were keen to iron out any last minute niggles; and it was great to start to get to know some of the fencers who would be competing.

kessie on the Piste

After the inspiration of an amazing opening ceremony, the fencing competition began on day one of the Games. With everything in place – special lighting and a sell-out crowd – the atmosphere in the arena was electric. My main role as physio was to sit at the side of the fencing piste with a doctor and be ready to assess and treat any injuries which occurred on the field of play. In between play I was based in the athlete’s medical room to treat those who weren’t competing at the time. It certainly was a perk of the job to have a front row seat to watch all the action! Each day there were medals at stake; knock out qualifying rounds in the morning and the finals in the afternoon. It was great to be able to follow the action and to see the athletes so proudly collecting their medals at the end of the day.

I was surprised at how many injuries occurred during the course of the competition and how frequently I was required to go onto the field of play. Most of the injuries were minor, and the athletes were able to continue competing, though I was required to deal with a couple more serious injuries which unfortunately meant the end of the competition for the athletes involved. This is always a very difficult aspect of working in sport when so much hard work is lost in a moment.

The role also involved quite a bit of behind-the-scenes planning and organisation. As it was shift work I was often working with different people each day. The medical team consisted of a selection of doctors from various backgrounds, physiotherapists, sports massage practitioners and dentists. Each morning and afternoon, we gathered together to organise the day and practice how to deal with ‘worst case’ scenarios, including how to safely and efficiently remove an athlete from the field of play.

It was a great experience to meet and work with so many different professionals from all over the country, who normally work in completely different settings. I learnt all about the sport of fencing, including the 3 weapons, the rules associated with each weapon, equipment and technology, common fencing injuries and I even managed to grasp a little bit about tactics! Everyone involved was immensely friendly, eager to help and the competition ran very smoothly.

Overall, it was a fantastic experience which I will remember very fondly. I felt very proud to play a small part in the 2012 Olympic games, which I am sure will prove to have inspired a generation.