“I want to run, but my knees hurt!”

 In Injuries, Recovery & Mobility

I often hear from clients that they want to run, but sore knees stand in the way (bad pun intended).

In this post, I want to explain a common condition that is likely the cause.  

The iliotibial band (ITB) is a track of tendons that travel down the lateral or outer portion the thigh. This connective tissue attaches at both the hip and lateral condyle of the knee.

The ITB is often the source of pain for cyclists and runner due to overuse, malalignment of bones/joints, poor/altered muscle length tension relationships, and muscle imbalance caused by postural deficiencies and lack of proper workout programming.

The RICE (Rest, Ice, Compression, Elevation) method is typically prescribed as a fix.  

I disagree with this method of treatment, as I consider the primary cause largely to be overuse based on body position. If you only treat ITB syndrome with the RICE method, once you’re “healed” you will return to the activity you were performing previously — spoiler alert, the pain will eventually come back. The RICE method is great to reduce inflammation. But in this case, it doesn’t fix anything. If anything, there’s a good chance your muscles have atrophied while resting, which will only make the pain worse when you return.  

Runners and cyclists suffer from ITB syndrome due to the repetitive movements inherent to the exercise. When there is a lack of movement diversity, muscle and joint imbalances develop. This happens to runners and cyclists, because in many cases, it’s the only activity they do. Whether they don’t like to do other things or are creatures of habit, they’ve found what they like. And they do it. Over and over and over. And they all have shitty knees.

I don’t mean to be antagonistic, but we can’t be closed minded when we design our workouts. Even if you aren’t a runner or cyclist, sticking to the same routine week after week will only cause muscle and joint  imbalances that keep you from feeling and moving your best.

Movement imbalance.

When you perform the same type of movement over and over, you limit your proprioception (the way your body perceives space, and moves within that space). This causes you to create comfort zones with regard to everyday movement. As a result, certain muscles become overactive and others underactive. When this happens, we lose a lot of the function of those underactive muscles and have to use our overactive muscles as a crutch. Your joints, connective and soft tissues do not love this. We were built with finite functions (to move very specific ways) and when we stray away from those finite functions, we begin to degrade and wear down tissues at a rapid rate ultimately leading to pain, loss of normal movement ranges, and eventually injury.

As a cyclist or runner, you are flexing your hips far more often than you are extending them which causes specific imbalances in your hips, knees, and low back. This causes a tightness that pulls you to your centerline more than your body wants. This puts a variety of muscles in a bad position to perform their primary function.

One of these muscles is the Vastus Medialis muscle, a medial quad muscle that helps with centerline strength and stability and assists with keeping the foot straight preventing excessive pronation. Once this muscle (along with a few others) is put into a non-mechanically advantageous position, excess stress is placed over the lateral portion of the leg. Add repetition and time, you get Iliotibial Band Syndrome (ITBS)

Fixing ITBS

As we’ve covered so far, ITBS sucks, it’s largely caused by imbalances in your body, and is caused by repetitive activities such as cycling and running.

So what do you do to fix it instead of just applying the RICE band-aid?    

First things first, be sure you know what you are dealing with. Don’t assume you know what is wrong with you. Contact a professional first. Treat injuries and pain seriously. It could hurt now, but if you mess with it and make it worse, it could get worse. So start with these few things.

  1. Alignment test
  2. Natural Gait test
  3. Squat test

These are just some tests I would use personally to check and see if ITBS was something to consider here. Once you’ve determined that it is in fact ITBS you are going to want to focus on what ITBS actually is. The issues weve covered so far have been centered around repeticious movement patterns. These movements are most typically disruptive for center line strength, which means they place excess stress on the outer portion of the leg and draw away the stability and strength of the medial portion of the leg.

The best way to fix this issue is to look at it from an inside out perspective. The IT Band is what’s under tension so we must strengthen the vastus medialus muscle and the glute muscles to take some of the stress off. Here are some movements that can help do those things:

  1. Clam shells
  2. Side lying leg raises
  3. Fixed leg position hip bridges
  4. Wide stance physio ball squats (sumo or athletic sumo stance)
  5. Lateral banded walking
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