I experience knee pain while I am running, what can I do?

Whether you are an elite or amateur runner, you may have felt pain in your knee during your runs. In fact, knee pain is a very common problem among runners because the knee joint is particularly vulnerable to excessive loading and thus damage,as it bears the full weight of your body and any extra force when you run. The first thing to do, is to understand in which area of the knee you felt the pain and why. In fact, knee pain is a common problem that could derive from many aspects such as bones, tendons, ligaments, cartilages and menisci all of which can produce differentiated symptoms.

A woman is as young as her knees.
Mary Quant

But we can extend the concept to all human beings. However, if Mary Quant claimed the importance of the knees, she had her reasons. As a "mini skirt inventor", she knew how much knee wear could compromise posture. In fact, the knee is not only the bending between leg and thigh [from Latin: genuine]. It is above all a joint that unites the thigh and leg, allowing the mobility of the lower limbs.

Of the 360 joints that can be counted in the human body, the knee is one of the most important synovial joints. Synovial because the heads of the joints are wetted by a fluid, called synovial or synovial fluid.

 

What causes knee pain?

The knee joint is also the one most prone to injury and damage. The first thing to do, when you feel knee pain, is to understand which area it is coming from. Pain can in fact originate from different knee structures such as bones, tendons, ligaments, cartilage and meniscus. As a result, different symptoms are generated.

It is often found that when suffering with soreness in the lateral region of the knee, runners experience Iliotibial Band Syndrome (ITBS) and it has been reported as the second most common running injury. It typically appears a few kilometres into a run and increases in intensity as the runner continues. The pain is often chronic and then becomes unnoticeable after the workout, but is likely to reoccur at a greater severity. ITBS caused by repeated flexion and extension of the knee. This is an occurrence of friction between the iliotibial band and the underlying lateral epicondyle of the femur.

It is documented that a sudden increase in exercise intensity (mileage) is a large contributing factor to the development of ITBS. Due to the potential increase tension in the iliotibial band (ITB) by altering hip and knee angles, several other possible causes have been identified: downhill running, wearing old shoes, leg length discrepancies, excessive pronation of the foot, tension in the ITB and weakness of the Gluteus Medius muscles. Treatment requires activity modification, massage, stretching and strengthening. The goal is to minimize the friction of the ITB as it slides over the femoral condyle.

The initial focus of the treatment should be to alleviate inflammation by using ice and anti-inflammatory medications under medical supervision. However, the individuals level of body awareness and capacity of modification in the activity are crucial factors to have a successful treatment and to prevent  a relapse.

What does the iliotibial band syndrome consist of?

Due to the potential increase tension in the iliotibial band (ITB) by altering hip and knee angles, several other possible causes have been identified: downhill running, wearing old shoes, leg length discrepancies, excessive pronation of the foot, tension in the ITB and weakness of the Gluteus Medius muscles. Treatment requires activity modification, massage, stretching and strengthening. The goal is to minimize the friction of the ITB as it slides over the femoral condyle.
The iliotibial bendelletta (or tract or band) is the common tendon of two muscles, the big buttock and the tensor muscle of the lata fascia. It fits on the outer face of the tibia, just below the joint. In its course, it passes superficially to a bony protuberance known as the lateral epicondylous, from which it is separated by a serous sliding bag (which in reality is an emanation of the articular synovial with a purse function).

The ilio-tibial strip syndrome presents itself with a chronic inflammatory picture that affects the last part of the winged strip (bandelletta or iliotibial tract) where a mechanical friction can occur that generates a painful inflammatory state that becomes acute in the flexist-extension movements of the knee.

It is particularly widespread among football players, runners and cyclists, it can be caused by overloading or training on hard and irregular ground. Anatomical factors such as knee varism and hyposensitivity of the posterior muscular chain may cause the onset of ilio-tibial strip syndrome.

When an individual suffers from ITBS any activity that requires knee flexion and extension is prohibited, and after the acute inflammation has diminished, it is highly recommended to begin a stretching regimen focused on the iliotibial band, hip and plantar flexors. Once the runner can perform stretching without pain, a strengthening program should be initiated. A strength program should be an integral part of any runner’s activity, in particular, when one suffers from ITBS they have to focus the training on the Gluteus Medius muscle. Finally, running should be resumed only after the runner is able to perform all of the strength exercises without feeling any pain. Furthermore, the return to running should be gradual, starting at an easy pace on a level surface and increasing mileage very slowly.