knee injuries symptoms 1
4 Free Sports Injury reports: To download your free Achilles Tendinitis, Knee Pain, Core Stability and Shoulder Injuries reports, use the form below: (As a bonus, we'll start sending you our free weekly newsletter, Sports Performance Bulletin.)
Knee Injuries Symptoms: Do your knees sometimes give you the blues? If so, you're in good company: knee injuries are the curse of many athletes, especially runners
Page 1 2
If your knee pain is lateral (on the outside edge of a knee), then it's likely that you are suffering from one of the most common knee complaints - iliotibial band syndrome (ITBS). As you may have learned the hard way, ITBS may aggrieve your knee enough to drastically limit or even completely stop your training.
ITBS has been around since man (and woman) first learned to run, but it wasn't actually described in the medical literature until 1975 (Sports Injuries and Their Treatment, p. 56, J. B. Lippincott Publishers, Philadelphia, 1975). The syndrome is often labelled an 'overuse' injury, but that's a very poor way to describe the origin of the problem, since it implies that the main source of difficulty is excess mileage. The truth is that runners can be afflicted with ITBS on a regime of just five to 10 miles per week, even though such volume would hardly constitute overtraining. The key source of ITB disorders is actually a lack of strength and flexibility in the iliotibial band, sometimes combined with a perverse fondness for running either on the track or on crowned roads, as you'll see in a moment.
Abduction and adduction
What exactly is the iliotibial band? It's not a jazz group whose members tap in time to their music with their tibias. The central feature of the iliotibial band is a key muscle, the tensor fascia lata, which runs down the outside of the thigh just below the hip. Like all muscles, the tensor fascia lata has a band of connective tissue at each end which bind it to bone. The upper band merely ascends vertically a short distance to attach at the top of the hip (thus the name ilio-), but the lower one runs all the way down the side of the thigh before attaching to the lateral side of the tibia, just below the knee (hence the name -tibial).
Overall, the iliotibial band scoots down the outside of the leg from the hip to below the knee, kind of like a broad stripe in one's 'musculo-tendinous uniform'. If you're curious about the muscle's name, the word 'tensor' means 'makes tense', 'fascia' means 'band', and 'lata' signifies 'wide', providing a pretty accurate description of the characteristics of this key muscle.
If you do some digging in any human anatomy book, you'll find that the key action of the tensor fascia lata and its associated bands of connective tissue is supposedly to 'abduct the thigh' (in the patois of human anatomy, 'abduction' means moving a body part away from the midline of the body). At first glance, this 'key action' seems to make sense. If you activate a muscle which originates at the hip and runs down to the outside of the leg just below the knee, wouldn't it simply pull the leg outward, away from the other leg and from the imaginary centre line of the body, a bit like flapping a wing? Of course it would, but how useful is that motion during running? In fact, how instrumental is it to everyday life?
Someone who makes a habit of abducting his legs during movement should set his sights on the ballet stage, instead of athletic competitions. The real function of the ITB during running is not to flap the leg outward but to control and decelerate adduction of the upper part of the leg. Adduction is the reverse of abduction; it's the movement of an anatomical structure toward the body's midline. And it's this very motion which requires constant control during running.
If that's not exactly crystal clear, picture yourself running for a moment. Let's say that you have 'toed off' from you left foot, soared through the air for a fraction of a second, and have just landed on your right foot. As you do so, your right foot tends to pronate (the ankle joint rotates in a clockwise direction and the foot rolls to the inside), your tibia rotates in a clockwise direction, and - lo and behold! - your femur (the bone in the upper part of the leg) moves inward (goes through adduction). If you still can't picture this, see for yourself by going through your running mechanics in semi-slow motion.
The role of the ITB is to control this adduction - about 90 times per minute per leg as you run and almost 22,000 times during a four-hour marathon! No wonder the ITB sometimes complains! What makes things especially tough for the tensor fascia lata is that when the right foot makes contact with the ground and the left leg begins to swing through there is a natural tendency for the left hip to drop temporarily, pulled down by the omnipresent force of gravity. As it does so, the pelvic girdle 'rocks' like a seesaw; the right hip goes up as the left hip goes down.
As you probably guessed, since the ITB runs from the hip down to the knee, the upward movement of the right hip stretches the tensor fascia lata and overall ITB at the precise time that it is trying to shorten and control adduction of the right thigh. That constitutes an 'eccentric' movement of the tensor fascia lata, and you no doubt know that eccentric actions are the ones which can be especially trauma-provoking to muscle tissues.
Of course, that's one reason why mere stretching of the ITB can never be the complete answer to real or potential ITB troubles. One also has to fortify the tensor fascia lata and its associated connective tissues - making them strong enough to withstand all that relentless eccentric yanking. We'll show you how to buttress your iliotibial bands in a moment, but for now let's make it clear how to tell when you truly have ITB syndrome and not some other condition.
How to diagnose ITB syndrome
As mentioned, a key aspect of ITB syndrome is lateral knee tenderness.
As often as not, the pain won't really hit home until the first one or two miles of a workout have been completed ('Iliotibial Band Friction Syndrome in Runners,' American Journal of Sports Medicine, vol. 8, pp. 232-234, 1980). Once it starts, the pain tends to be persistent if you keep going - and frequently gets worse during downhill running (and while walking down steps). The discomfort may radiate up and down the leg, but - strangely enough - the pain will often almost disappear if you stop running and begin to walk slowly and with short steps.
If you have ITBS, a unique examination called the Noble compression test will often be 'positive'. As you lie on your back, your doctor will place his or her thumb over the lateral epicondyle of your troubled leg (the lateral epicondyle is the hard knob on the bottom, outside part of your thigh bone). With the thumb on your epicondyle, you will actively flex and extend your knee. If maximal pain occurs at about 30 degrees of knee flexion, watch out! You probably have ITB syndrome.
The reason your knee 'cries out' during this test is very simple: when your leg is straight, the ITB lies in front of the epicondyle; as you flex your knee the ITB actually passes over the lateral epicondylar surface. As you repeatedly flex and extend your knee (as you would during running), the ITB keeps moving back and forth against the epicondyle; if the ITB is inflamed and swollen, the friction associated with this epicondylar 'rub' can produce quite a bit of pain, especially when your doctor is forcing the ITB to be in close contact with the bone. Similarly, if you have ITB and you stand with all your weight on your affected leg and flex the knee to about 30 degrees or so, you will probably feel a lot of pain if you apply pressure to the outside of your knee.
(As an aside, walking 'stiff-legged' with the affected knee locked in place will often eliminate most of the pain, because it keeps the ITB from rubbing back and forth against the epicondyle.)
In truth, though, ITB problems don't always occur at the knee. Pain may also be present below the knee, where the ITB actually attaches to the tibia, and discomfort may also occur much higher up - in the tensor fascia lata itself or in its tendinous connection with the hip. Many runners recall an especially intense or prolonged workout just before their ITB troubles started. Often, ITB strikes near the beginning of the cross-country or track season, when athletes are attempting to step up their training loads. Having 'bow legs,' excessive leg-muscle tightness, a leg-length discrepancy, or very pronounced foot pronation can all increase the risk of ITBS.
Traditional treatments for ITBS
The widely accepted way of taking care of ITBS once it arises is certainly less than perfect. Usually, athletes are told to cut back on their intensity and volume of training and to work out only on smooth, non-hilly terrain. Icing and non-steroidal anti-inflammatory medications are recommended to reduce discomfort and inflammation, and athletes with ITBS are cautioned never to try to 'run through' the pain.
Obviously, those are decent and logical suggestions, but note that not one of these strategies actually addresses the true cause of the ITBS. The athlete who alleviates the symptoms of ITBS with reduced workouts, drugs, icing, and hill phobia and then returns to normal training is often destined for another serious ITB flare-up, with the second episode frequently worse than the first. Unfortunately, severe cases of ITBS can last for up to six months!
Of course, stretching the ITB is often recommended as an ITBS cure-all, and stretching is almost never a bad idea. However, it's important that the stretching routine you adopt actually improves the flexibility of the ITB in a functional way. That can hardly be said for the traditional, popular ITB stretches prescribed for runners, which never mimic the biomechanical patterns associated with running. An over-emphasis on stretching may also lull runners into thinking they are truly getting at the root of their ITB problems, when in fact their gains in flexibility must be combined with advances in strength in order to make the ITB highly resistant to injury.
Comments