Ask the Experts - Injury

Answers from Sean Fyfe:

Q. I am suffering from constant knee pain lately. I had an ITB injury in October last year after doing a trail run. For months nothing helped - cortisone injections, orthotics, physio, a LOT of stretching, knee rehabilitation with biokineticists and eventually dry needling. The dry needling helped and I have been running since August again. But now I have knee pain in both knees. What am I doing wrong? Please help me - I am desperate!
Thank you and kind regards
Natalie Wessels

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If you have been diagnosed with an ITB injury, I assume you are suffering from lateral knee pain and the bilateral knee pain you are now suffering from is lateral and the same on both sides. With the information you have provided, I think I can point you in the right direction.
The following is an outline of the possibilities of why your pain is continuing.

The first thing that comes to mind is that it is not an ITB injury. In my experience, lateral knee pain can get very quickly and sometimes incorrectly diagnosed as ITB pain. Your presentation sounds it may be a referral of pain from the lumbar spine. I say this for three reasons. Firstly, you have constant pain. ITB pain is usually just associated with activity, like going up and down stairs, jogging and getting up from a chair. I am not sure if this has been ruled out, but if it hasn’t then it certainly does. The fact that the pain is now on both sides is a common sign that there is a central problem. And lastly, none of the solutions that help ITB injuries have worked. So if you haven’t already, your lumbar spine needs to be assessed, including slump testing (which assesses any neural tension signs). I find that if pain is referred from the lumbar spine to the lateral thigh or knee, the thoracolumbar junction plays a major role.

If this is cleared, these are the other possible reasons for your continuing pain. I usually find that with ongoing ITB pain, the exercise rehabilitation hasn’t been done properly. Glut max and glut med activation and strengthening are the key. You should be at a stage where you can do single leg squats with perfect alignment, good glut max activation. This then needs to be done fast and progressed to jumping and landing type exercises. The only way I ca explain the now bilateral pain is that pain on one side has caused more weight bearing and load on the other side.

You have to be careful with orthotics an ITB injuries. It is my experience that in some cases, people have been given orthotics that have too much support at the foot, and this causes the knee t pushed laterally during weight bearing.
This then increases the tension on the ITB’s. This could explain your ongoing symptoms and why the synmptoms are now bilateral.

The only other possibility that springs to mind is a lateral cartilage or meniscal problem. This may need further investigation in the form of a scan. Hopefully this gives you some direction. My advice is to track down an experienced sports physiotherapist to check these suggestions.

Good luck