Stephanie’s Knee Pain During Running: Iliotibial Band Syndrome
We first met 36-year-old Stephanie when she had just finally returned to running again after recovering from plantar fasciitis. She came in as she was experiencing:
✔ Pain on the outside of her right knee, that can be quite sharp at times
✔ Tightness and a pulling sensation on the outside of her right thigh
✔ Worsening discomfort when going down stairs or down a hill
✔ Symptoms mainly present during running + easing with rest
✔ The pain occasionally radiated into her thigh during running and bending the knee
Talking with Steph, she said that her return to running had been gradual – as she was well aware of the risks. She had been doing 5km runs over the first 3 weeks successfully, so decided to step it up to a longer but much slower 13km run, to allow her body to still take it easy and get used to the longer distances lightly. Hence, she was not expecting to develop any pains or problems.
Assessment & Diagnosis: Iliotibial Band Friction Syndrome
After taking Steph’s full history, we completed a comprehensive biomechanical examination which revealed:
✔ A mildly pronated (flatter) foot type
✔ Notable muscle weakness from taking months away from running during her recovery from plantar fasciitis
✔ Tightness in both the calf muscles as well as the iliotibial band
✔ Significant compression on the inside of Steph’s running shoes
We diagnosed Stephanie with Iliotibial Band Friction Syndrome (ITBS), which develops when repetitive bending and straightening of the knee causes friction beneath the structures of the knee. Of course, there are a number of factors that make a person vulnerable to developing this pain – light a tighter iliotibial band, weak hip abductor muscles, the shape of the structures comprising your knee, and many more. Just imagine opening and closing a door over and over again with significant force pushing against the door – eventually, things will start changing and perhaps rubbing against one another. Once it starts, it tends to worsen. This is ITBS.
Our Biomechanical Assessment
Biomechanical assessments carefully and thoroughly assess the biomechanics of your lower limbs – meaning they assess the strength, function and general mobility of the muscles, bones, joints and tissues in your lower limbs – both individually and how they function together as a unit to get you walking, running, skiing and whatever else takes your fancy.
Why Did Stephanie Develop ITBS?
It was the longer and slower run that did it for Steph. The slower you run, the longer you stay in a phase of gait called midstance, which is the time you spend with your foot flat on the ground. When runners don’t have enough fitness and strength built up and they progress too quickly, they fatigue around the 8-9km mark causing pronation (excess foot flattening) and internal leg rotation at the knee, which results in friction over the outside of your knee.
Podiatrist Piet’s Advice
One of the key points with ITBS is that if you keep running and aggravating the knee joint, you will get boney bruising and that takes 6-12 weeks to settle. When you are starting to run, use something like the Couch To 5km program, which involves only 3 days of running training per week.
What we look at specifically in the clinic when it comes to what may be exacerbating your ITBS is:
The age of your shoes
What conditioning you have been doing to prepare yourself for running
How much sitting you do daily
What your current stretching regimen is (if any)
Treating Steph’s ITBS
Like anything, prevention is always better than rehabilitation and thankfully for Steph, her symptoms had only recently started so the injury hadn’t progressed to more severe stages.
We created a running program for Steph which saw her switch to shorter and faster tempo runs to best condition her body for longer runs. We gave Steph a strengthening and stretching program to address her muscle tightness and weakness, and recommended the best type of running shoe for her foot type to replace her older, worn-out pair. We also taught her about load and resting on days that she is standing more, and so may feel a little extra tired.
