One of the most common injuries to affect runners is the dreaded runners knee or otherwise known as patellofemoral pain syndrome or iliotibial band syndrome. This injury can range from moderate to quite debilitating and preventing the athlete from participating in sport and running.

Onset of the injury may be a gradual ache in the knees or quite sudden often from an increase in training frequency or distance run. It can then be compounded by poor footwear, mobility restrictions and joint instabilities.

Symptoms of the injury vary and may include knee pain with running especially up or downhill and pain with sitting for long periods. The pain is generally around the knee cap and may be above, under or just below it. Sometimes there is clicking or crunching sound with knee movement and it can swell up.

There are several causes for this injury however the most common to affect the endurance running community is a weakness through the stabilising muscles of the hip . Due to the nature of the sport it is very easy for runners to fall into bad movement habits. These habits are not correctly engaging the hip stabilisers and core which allows a shift in pelvis forcing the knees to track inward toward the midline when running. As they track in there is excessive pressure put on the iliotibial band which runs down the side of the thigh to the knee. Then on the push off phase of the gait the quadriceps, glutes and adductor muscles are loaded incorrectly. This movement pattern tightens the outside of the thigh which then puts pressure on the knee cap which prevents it from moving through its normal range of movement irritating all the surrounding tissues which leads to the pain experienced.

To treat the injury during the early stages depends strongly on the severity of the injury. For severe dysfunction stopping running may be necessary in cases which aren’t as significant a change in distance or even just eliminating hills short term may be sufficient. Soft tissue therapy is also key in reducing the load on the outside of the quadriceps muscle, restore correct tone to the glute medius muscle and any other muscles which have been compensating for the hip and core weakness. Other at home exercises which can help in recovery is foam rolling the iliotibial band and glute stretches as shown below.

As the injury decreases in pain rehabilitation is key in preventing the injury from returning and will also have an effect on overall power with your run as the lower limb will be engaging correctly. The three most effective exercises for hip stability in running are:

Glute Bridges with Band

 Crab or Monster Walks Sideways

Clams

These exercises should be performed daily for 3 sets of 10 each. After 2-3 weeks the muscles should engage correctly and a gradual return to running will be able to be tolerated. With stronger hip stabilisers our athletes often return to sport with better technique and achieve their goals to continue to hit PB’s for time.

Written by Dr Creagh Court
Chiropractor
Elite Health & Performance