“ You cannot stretch it, or foam roller it better, and orthotics wont help you”
Iliotibial band syndrome is the most common cause of lateral knee pain in runners. It is often imagined that the ‘band’ passes from hip to knee and gets ‘tight’ and needs stretching, but in fact this band is affixed the whole way down the leg an cannot be massaged, rubbed , needled or released. The Pain comes from compression of a nerve bundle filled fat pad underneath the fascia as you can see in the diagram – but the underlying cause of this condition is usually the way you run.
There are many reasons why this might be affected in the amount of time you spend in contact with the ground: stride Length, step Rate, crossing over of feet
We start by a full clinical examination to rule out other causes such as meniscus injury or anterior knee joint damage – we usually oder an MRI scan of your knee to check for chondral injury and provide a target for injection if needed.
We then need to look at you run. We do this on a video or 3D RunLab treadmill – where multiple views of your running technique are taken and we look at those – not to see if you are perfect , but to identify if you have several features of running style which can use the fat pad to be loaded
Usually we see 3 common faults
1. Cross over Gait
You run like a catwalk model with your legs angled inwards and with one foot in front of the other
2. Hip Drop
In part caused by number 1 your hip that is not in contact with the leg in stance phase, drops, allowing the load on the stance leg to increase in rotation
3. Ground contact time
By allowing the foot to remain in contact wit the ground too long, the knee is allowed to flex more than it needs, adding to the fat pad irritation
What is the solution??
We occasionally use local anaesthetic to confirm the diagnosis into the fat pad, but start to change the way you run immediately to offload the stressors. We do tai not only by some coaching cues, but by a comprehensive prescribed strength program.
It is not an instant paint on fix, you need to do some work in strength and retraining but we are confident in our results
There are so many variables here that we can influence, that is exciting but potentially confusing, step rate, stride length , flight time, knee stiffness, foot and ankle stiffness and that’s before we look at the shoe stiffness and stack height and drop.
Influencing these variables can also be targeted for performance, a coaches job, is different from using these variable to adapt recovery from injury or recurrent leg pain, preventing training, and our experience in addressing variables that can be easily adapted in combination with strength and power will get a focussed program and back running at the earliest possible pint
We don’t prescribe orthotics, but shoe selection can play an important role, but not in the typical shoe selling focus on motion control and neutral choices. The sagittal ( side view) plane is all important here and cushioning ( stack height) and drop ( heel to toe difference in height) are very useful along with mid sole stiffness in adapting to injury and expediating recovery.