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Runner's Knee - Understanding Patellofemoral Pain & Iliotibial Band Pain

Running offers incredible fitness benefits, yet it can take a toll on the body. Small aches can swiftly escalate into injuries, hindering our mobility and impeding our running goals. One prevalent issue among runners, regardless of expertise, is Runner's Knee, known as Patellofemoral Pain Syndrome and/or Iliotibial Band Pain/Syndrome. This persistent ailment can disrupt daily activities, emphasizing the need for early intervention. In this piece, we delve into the causes, development, physiotherapy management, and preventive measures for Runner's Knee.


Understanding Runner’s Knee


Runner's knee encompasses various knee conditions causing pain, predominantly observed in the running community. Although more prevalent in runners, this condition can manifest during walking, hiking, jumping, and cycling. Two primary conditions associated with runner's knee are patellofemoral pain syndrome (PFPS) and Iliotibial Band Syndrome/Pain (ITBS).


Patellofemoral Pain Syndrome (PFPS) triggers pain around or behind the kneecap during weight-bearing activities, exacerbated by knee flexion, such as running and squatting. The patellofemoral joint involves the posterior patella (kneecap) and the articulating groove of the femur bone (anterior). It can also be uncomfortable while kneeling on the affected knee.

patellofemoral joint anatomy

Figure 1: Patello-femoral & Tibiofemoral Joint Anatomy (from PhysioPedia)


Iliotibial Band Pain Syndrome (ITBS) similarly causes tenderness on the lateral knee aspect. The iliotibial tract, a thick fascial band along the thigh's lateral aspect, aggravates during repetitive knee flexion and extension movements like running and cycling. The iliotibial tract is a thick band of fascia that runs along the lateral aspect of the thigh. It descends from the deep connective tissues of the tensor fascia latae and gluteus maximus muscles and inserts into the lateral tibial plateau.

iliotibial band syndrome

Figure 2: Iliotibial Band Anatomy


How Does Runner’s Knee Develop?


Runner’s knee typically results from multiple factors with potentially numerous reasons why you may be experiencing pain. Investigative research highlights biomechanical aspects and muscle weaknesses contributing to pain. Often, spikes in training/running load, poor gait efficiency, muscular imbalances, tightness, and reduced stability play roles in PFPS and/or ITBS development.


Treatment for a Pain-Free Return to Running


Physiotherapy aims to alleviate inflammation and pain, employing taping techniques and managing/monitoring training loads. Tailored rehabilitation plans address individual needs, focusing initially on pain management through manual therapy. Long-term rehabilitation emphasizes strengthening and biomechanical enhancements crucial for performance and pain reduction. Distinguishing between PFPS and ITBS is essential as exercises for one may exacerbate the other's pain!


Can Runner’s Knee be Prevented?


Absolutely! Gradual mileage increments and avoiding abrupt increases in running load are pivotal. Well-cushioned, supportive running shoes help minimize knee impact, especially for beginners. A musculoskeletal screening and testing session with our physiotherapist assesses physical and biomechanical aspects, offering insights into Runner’s Knee risk. A customized prevention plan with regular check-ins minimizes injury potential and optimizes training for your goals.


To Finish


Understanding the root cause of knee pain in Runner’s Knee is key to its effective management through physiotherapy. Addressing the underlying PFPS and/or ITBS is vital to prevent recurrence.


Prevention outshines cure! If experiencing symptoms or new to running, consider a physiotherapy consultation or musculoskeletal screening and testing consultation for tailored guidance.


Keep running with joy! 🏃‍♀️🏃‍♂️






References

Messier, S. P., Legault, C., Schoenlank, C., Newman, J. J., Martin, D. C., & DeVita, P. (2008). Risk Factors and Mechanisms of Knee Injury in Runners. 40(11), 1873–1879. https://doi.org/10.1249/mss.0b013e31817ed272

Loudon, J. K. (2016). BIOMECHANICS AND PATHOMECHANICS OF THE

PATELLOFEMORAL JOINT. International Journal of Sports Physical Therapy, 11(6), 820–830. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5095937/

Charles, D., & Rodgers, C. (2020). A LITERATURE REVIEW AND CLINICAL COMMENTARY ON THE DEVELOPMENT OF ILIOTIBIAL BAND SYNDROME IN RUNNERS. International Journal of Sports Physical Therapy, 15(3), 460–470. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296998/

van, Lankhorst, N. E., Robbart van Linschoten, Sita, & Marienke van Middelkoop. (2015). Exercise for treating patellofemoral pain syndrome. https://doi.org/10.1002/14651858.cd010387.pub2

Reliability of a Qualitative Video Analysis for Running | Journal of Orthopaedic & Sports Physical Therapy. (2016). Retrieved May 24, 2023, from Journal of Orthopaedic & Sports Physical Therapy website: https://www.jospt.org/doi/full/10.2519/jospt.2016.6280

Hutchinson, L. A., Lichtwark, G. A., Willy, R. W., & Kelly, L. T. (2022). The Iliotibial Band: A Complex Structure with Versatile Functions. 52(5), 995–1008. https://doi.org/10.1007/s40279-021-01634-3


Disclaimer: This blog is for informational purposes and should not be considered a substitute for professional medical advice. Please consult with our qualified healthcare providers for personalised recommendations related to your specific condition and needs.

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