Runners Knee / ITBS

Runners Knee / ITBS

ITBS (liotibial Band Syndrome) is the most common cause of pain on the outer side of the knee. Primarily occurring in runners, it is also known as runner’s knee. 

It is caused by the tractus rubbing on the femoral condyle, which leads to irritation and pain.

Triggers can be both systemic or muscular, and can be treated using insoles, proper running shoes, regular stretching, and physical therapy.

Cryotherapy, taking a break from running, and topical ointments may help when pain is acute.

ATTENTION: Sensations of pain are often projected towards the top of the tibia, meaning that the cause is often misdiagnosed. It is therefore advisable to do an MRI in addition to the clinical examination.

This is a pain syndrome that primarily occurs in runners and is therefore also known as runner's knee . Additional synonyms include: iliotibial band syndrome (ITBS) or band syndrome, as it affects the iliotibial band. The iliotibial band is a strip of fascia (fascia = a band of wide-stretching, tendon-like sleeve over muscles) that supports the musculature on the lateral side of the thigh and runs from the iliac crest downwards to be anchored to the head of the tibia.

Pain therefore primarily occurs because the band rubs on the joint protrusion (= epicondyle) of the femur, like a rope on a cliff edge. This can lead to overexertion and irritation of the skin on the leg and the bursa mainly in long-distance runners or mountain climbers. ITBS occurs particularly frequently after longer periods of running down mountains - it is a pain syndrome, however, that is known to be painful in many long distance runners.

ITBS is generally the most frequent cause of pain on the lateral side of the knee. It is also widespread in cyclists.

ITBS often occurs in runners who have the following problems:

• varus leg axes (= O-legs)
• overpronation in the pushing off movement
• weakness in the pelvic stabilisers, whereby the non-weight-bearing hip sinks and there is excessive pull on the band.

SYMPTOMS

ITBS is indeed indicated as harmless, however the pain can be markedly severe and stabbing, making running impossible (I myself had ITBS when taking part in the Florence marathon). The fact that the pain only initially occurs when running is typical for band syndrome, however it can also become noticeable later when walking. Some runners are torn away from training for months as a result of band syndrome and inadequate treatment...

As the iliotibial band runs to the head of the tibia, the pain that comes from the epicondyles (see above) projects into the knee joint or to the lateral side of the tibial head. The projection of pain towards the head of the tibia is the reason the cause is often not identified. As a result, many runners have been treated unsuccessfully for meniscus and cartilage problems, despite their problem actually being band syndrome.

DIAGNOSIS

Typically crepitations over the femoral condyles, possibly also a type of crackling, is indicative of irritated tissue. The region is often also tender on palpation. In case of doubt, an MRI is advised, with which other causes can also be ruled out.

TREATMENT

In the acute phase, the following should be carried out: Cryotherapya break in training (also no cycling as the band rubs over the condyles painfully here too), anti-inflammatory ointments or plasters (which should contain Diclofenac or something appropriate), consistent exercises to stretch the band, strengthening exercises for the pelvic stabilisers and the stomach and back musculature.

Physiotherapy is a must to bring the ITBS symptoms under control. During this, exercises to stretch the often shortened band must be learned, preferably in combination with active friction therapy carried out by the physiotherapists caring for the patient.

In the case of varus leg axes, sport insoles should be prescribed where necessary. The majority of runners that come to me in the surgery with band syndrome, however, are overpronators and run with unsuitable running shoes. Carrying out a treadmill analysis in a specialist shop is therefore quite crucial to make sure you are running with the correct shoes.

Once the pain has disappeared and you want to slowly begin training again, you must warm up the affected region of the band in the knee area before partaking in sport (either with a heater or with thermal ointment). Exercises to stretch the lateral thigh musculature (primarily the tensor fasciae latae muscle) are very important, e.g. by crossing the legs when standing or lying down.

You should avoid long-distance runs in the first few weeks after commencing training. Cooling with cryopacks must be carried out after sport.

Running downhill should be avoided.

In the event that all these measures prove unsuccessful, or if you are close to a marathon that you have been training for for months, infiltration with cortisone can lead to a rapid improvement in the symptoms.

Once all conservative treatment measures have been fully exhausted with no success, an operation can alleviate the symptoms or lead to significant improvement in the symptoms. The band is cut in a z-shape during this operation and is lengthened and relieved as a result. In runners with very pronounced O-legs, straightening of the legs should certainly be discussed.