Runner’s Knee can affect runners of all abilities and can be one of the more frustrating injuries. Confusingly, Runner’s Knee is a term that refers to one of two problems; iliotibial band friction syndrome (ITBFS), or patellofemoral syndrome.
ITBFS is where the lower part of the iliotibial band, a connective tissue that runs down the side of the thigh, can become irritated by the repetitive nature of running. Patellofemoral syndrome is an irritation to the joint between the kneecap (the patella) and the thigh bone (the femur).
You can easily tell the difference because ITBFS is found on the outside of the knee and patellofemoral syndrome occurs at the front of the knee. Both problems typically build up gradually and occur the more you run, they don’t normally come on suddenly. They also don’t click or lock, so if you have knee pain that came on traumatically, or if it clicks or locks, the advice in this article is probably not for you.
If you have one of the runner’s knee problems though, there are a few things you can do to help it.
Both problems are most commonly caused by having too much movement in something we call the ‘frontal plane’. This is the side-to-side motion of our body. When our foot hits the floor in walking and running, our knee bends a bit and it drops inwards a bit. This dropping inwards is known as ‘frontal plane motion’. It’s entirely normal to have frontal plane motion in walking and running, but it can be excessive on one side, and this is what causes problems.
There are two main reasons why this might be happening; firstly, if the foot is overpronating as it hits the floor, it drives the tibia (the shin bone) inwards, thus driving the knee in. Secondly, if there is weakness in the lateral glute muscles behind the hip, that causes instability of the femur, which also allows the knee to drop too far inwards.
As with all pains in the body, it is best to see a professional to help you understand what is causing your problem because sometimes it is tricky to see yourself! If however, you have quite asymmetrical feet and one rolls in much more than the other, it may be likely that the foot is the culprit. Or if you feel unbalanced or weak in certain leg exercises, maybe it’s the hips that are at fault. Sometimes, the problem may only show up when running. In the clinic, we film people running outside with a special app on an iPad, and this is the way we can diagnose where the problem is coming from.
With all that being said, the exercises I’ll outline below will help most runners, whether you have pain or not. The only group of people that may not want to do them are those I mentioned earlier who have clicking, locking or a traumatic onset of knee pain.
Movement is hard to put into words, or at least it’s hard to put into a few words, so I will let the picture do most of the talking. I have also made a video with more explanation, which you can view here on our YouTube Channel.
If you are suffering from Runner’s Knee, it is helpful to keep the quadriceps (the muscles at the front of the thigh) stretched and the ITB treated with a roller. You may also find strengthening the glutes to be helpful. There are many ways to do this, but using a resistance band can be a useful tool because it leaves no hiding places for the glutes – they can’t ‘cheat’! Here I show a basic hip extension exercise and a standing ‘fire hydrant’ exercise (imagine a dog peeing on a fire hydrant!).
By keeping the tissues supple and the hips strong, this can help to mitigate the problem.
In many cases, stretching the area and keeping it strong is enough to reduce symptoms, but an osteopath’s favourite question is ‘why?’. Why did it start in the first place? Why were the tissues tight? Why was the knee dropping in? Why were the glutes weak? Why does the foot overpronate?
If you try these exercises and the pain persists, it may help you to see an expert where we can help to answer the ‘why’ question and give you a personalised plan for recovery. Read more about knee pain here or book an appointment online.
And in the meantime, keep on running!