Today our sports therapist Amelia is going to be discussing a certain condition that many runners may come across during their time exercising.
It is an irritation that, if left untreated, can stop you from doing what you love to do… Run!
From experience, the most common question asked when a runner presents with knee pain is “When can I get out running again?” I’m here today to discuss that timeline, including how this condition begins and how to treat it.
What is Runner’s Knee?
It is an umbrella term for several prognoses, with 2 of the most common being:
Iliotibial Band Syndrome (ITBS) - pain at the side of the knee and can sometimes be felt on the side of your hip
Patellofemoral Pain Syndrome (PFPS) - pain, usually on the front of the knee or feels like it is under the kneecap
Why does it happen?
The ITB (Iliotibial Band) attaches to the side of the knee, runs up the side of your thigh and merges into a muscle in your hip - called the TFL muscle for short. When running, your hip muscles must work hard to control the knee on landing. If there is any weakness in your lateral hip muscles, then the ability to support your knee is compromised.
A Runner’s Knee case study:
Let me give you an example of a case study.
Sandra came to me with pain on the side of her knee. The pain had been on and off during running for about a month, but in the last 7 days it would not go away and started to hurt even when walking in between runs. Sandra normally ran 20-25 miles per week over about 3-4 runs.
Sandra had weakness and discomfort in her lateral hip muscles. Like any injury, the primary focus is to reduce pain, appropriately load the structure and then work on strengthening to prevent further injury or re-injury.
The treatment:
Previous theories have suggested massaging the ITB directly to reduce pain. However, the ITB is a tendon-like structure - if you have ever had your ITB massaged you will understand how painful it is if someone digs their elbow in! Sports massage can be painful, but if there is an alternative way to treat with less pain and get better results; that is the way to go.
For Sandra, the alternative was massage and trigger point therapy into their TFL (remember that muscle from above?). Getting this muscle to relax helped her hip relax, which had an effect down her leg, to her ITB and into her knee resulting in less pain.
Sandra felt better at the end of her first session, walked out with less pain than she came in with - a result!
But unfortunately, this only treats the symptoms and not the underlying cause (a weakness in the lateral hip muscles). So, before Sandra left her first appointment, she needed a plan. Initially, this plan did not involve running (appropriately load the structure), but it did involve strengthening exercises for the lateral hip and range of movement for the knee. Sandra also understood that it could take about 5-7 weeks before she would run comfortably again and with the confidence that the knee pain won’t come back…
The timeline:
Sandra came to see me 5 times in the space of 7 weeks. Each visit, her exercises progressed as she got stronger in her hip. At week 3 (appointment 3), we began shorter runs that were strictly not allowed to reproduce the knee pain she had previously. By the final appointment, Sandra was able to run 4 miles pain free and felt stronger in her hips.
To summarise:
Sandra had an overuse injury in her knee from running. She followed the advice and managed to return to running comfortably within 7 weeks!
Amelia’s top tips:
If you currently have any knee pain, here are my three top tips for you…
Have it assessed, don’t ignore it
Engage in the rehabilitation process
If you are a regular runner, include strength training in your program