Dec
Ileotibial Band Syndrome- Outside Knee Pain
Doc,
The outside of my knee is killing me. I’ve been training for the marathon. We were up to 14 miles when it started getting worse. Can I still do the upcoming marathon? Do I need surgery?
Truly,
Knee’ding Help
Greetings Knee’ding,
You have lots of company and do not need surgery. Iliotibial Band Syndrome (ITBS) is the most common cause of knee pain in runners. Surgery is not necessary.
The Iliotibial Band (ITB) is a muscle and tendon that goes from your outer hip (or ilium), down your entire thigh, into a spot on the shinbone (tibia), just below your knee. It is very important in stabilizing the pelvis when you run. A strong ITB prevents side-to-side hip motion during the stance phase of running.
This important tissue passes back and forth over the thigh bone with every step you take. As it does this, it rubs on a bump or condyle on the bottom of the thigh bone. At the spot where the ITB rubs over the condlye, friction builds up, resulting in inflammation and swelling.
The pain of ITBS may come on worse after a rapid milage increase; a tough hill workout; overstriding; a long run on a cambered road; inadequate stretching.
If you have bowlegs, ITB tightness, or unequal leg lengths, you may be more likely to get ITBS. A good Sports Medicine physician can make recommendations for treating these predisposing conditions.
We already said that surgery is not the answer to this condition. There are a few things you can do decrease the pain of ITBS and prevent it from returning:
• Decrease your mileage by 25-50% until your nearly all better. Cross train to maintain fitness. Water running and elliptical training are great.
• Put hill work on hold for a while.
• Alter your pace. If you usually run 8 minute miles, try running a few 9s, then a few 7:30s. This changes the angle of the knee during footstrike and may decrease the irritation of the ITB over the thigh bone.
• Strengthen the ITB so it can easily do its job of stabilizing the pelvis. Stretch the ITB during and after your sworkouts. Stretching should initially be done several times a day. A good Sports Medicine provider can teach you appropriate exercises.
• Ice the affected area after your workouts.
• Alternate running direction on cambered surfaces and avoid very pitched roads all together.
• A lateral heak wedge may decrease the predominance of the thigh condyle, thereby decreasing ITB friction and irretation.
• A cho-pat band or strap worn just above the sore area helps by decreasing the rub of the ITB over the bone and by changing the mechanical end of the tendon.
• Anti-inflamatory medications may help.
• Physical Therapy modalities like phonophoresis may help.
• Corticosteroid injections work very well for ITBS, but should be reserved for those with more than 6 months of problems or those that need to get better quickly for an important race.
