Tuesday, 5 July 2011
With the summer now upon us, and running becoming increasingly more popular, I thought it would be a good time to discuss a common running injury. This month I am focusing on Iliotibial Band Friction Syndrome (ITBFS) also known as Runner’s Knee. This is a condition that causes an ache or pain over the lateral (outside) aspect of the knee and is aggravated by running activities. The Iliotibial Band (ITB) is a tendinous extension of the fascia (connective tissue that surrounds many structures in the body) which covers the Gluteus Maximus and Tensor Fasciae Latae muscles; and attaches to the tibia (shin bone). This injury occurs due to friction between the ITB and the lateral epicondyle of the femur (end of the outside aspect of the thigh bone) and is commonly the result of overuse. Signs and Symptoms:
Athlete’s who are experiencing ITBFS tend to have a dull ache over the lateral (outside) aspect of the knee, which becomes aggravated and turns to pain when running. During examination the athlete may have pain or tenderness approximately 2cm above the lateral joint line of the knee. There may also be swelling present over the lateral epicondyle. If you are running a consistent route, the pain tends to come on approximately around the same distance/time. Repeated flexion/extension (straightening and bending) of the knee can also reproduce the symptoms.
Causes:
There are many different factors that can predispose an individual to ITBFS. These can include excessive foot pronation (flat feet), which can lead to an increase in internal tibial rotation. This in turn places added stress on the ITB and tightens the following muscles: Gluteus maximus, Tensor Fascia Latae, hamstrings, quadriceps. Differences in leg length can also predispose an individual to ITBFS. All of these factors, in combination with running downhill, on cambered roads or for a long duration can all lead to ITBFS.
Treatment:
Treatment of ITBFS is varied and there are many different modalities, which can be used. Some of which may include activity modification to avoid all pain provoking exercise. Symptomatic relief such as ice or ultrasound therapy and soft tissue therapy, which would be aimed at correcting any excessive tightness within the ITB, combined with frequent stretches of the ITB and other tight surrounding structures. Myofascial release has been shown to be one of the most effective treatment methods to relieve ITBFS symptoms, either via a therapist or self release using a foam roller (picture below).Strengthening of the hamstrings, quadriceps, gluteus medius and gastrocnemius are also key during the rehabilitation process to prevent the injury recurring. Kinesio tape is also a beneficial treatment for ITBFS. As demonstrated during our recent Forces March (5 marathons in 5 days), where this treatment method was repeatedly used with excellent beneficial effects.
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