Every year, up to 70% of runners obtain an injury5,8,10. Often, due to the repetitive nature of running, overuse injuries are most commonly seen. An overuse injury presents itself when there is a large amount of high impact repetitive forces to the musculoskeletal structure, such as the ankle, knee or hip in running6, 8, 10. While walking the load is one time our body weight, however while running it is 2-3 times our body weight6. Almost 45% of all running injuries are found at the knee12. Patellofemoral pain syndrome (PFPS) yields 46% of these injuries, followed by iliotibial band syndrome (ITBS), plantar fasciitis, meniscal injuries, and patellar tendinopathy12. Many researchers today believe that overuse injuries are multifactorial and can be a combination of training characteristics, arthropometric, or biomechanic factors5, 8, 9, 12, 13. The purpose of this paper is to provide information pertaining to various overuse knee injuries to better explain what knee pain is.
UNDERSTANDING KNEE PAIN
ITBS involves localized pain just superior to the lateral femoral condyle, or at the insertion point on Gerdy’s tubercle on the outside of the knee3, 4, 7. This irritation develops at the band’s insertion point where friction occurs when the knee is almost at 30° flexion and the ITB slides over the lateral femoral condyle3, 4, 7, 9. The pain is often sharp and burning over the lateral aspect of the knee, and occasionally there may be swelling or thickening of the ITB present3, 4. Signs and symptoms first present themselves during the run and subside afterwards, however, as the condition worsens pain may persist throughout the day even with the simple task of walking3.
It has been found through research that one possible cause of ITBS is weak hip abductors. Fredericson, et al. (2000) found those with ITBS were weaker in hip abductor strength than non-injured runners. Gluteus medius is one of the main abductors of the hip and helps to not only abduct, but also externally rotate the thigh3. When the gluteus medius is weak it leads to a decrease in control of thigh adduction and internal rotation3. Therefore, the runner will demonstrate increased adduction and internal rotation, which increases the amount of torsional forces on the knee3, 14. This also increases the amount of tension on the ITB and can lead to ITBS. The increased torsional forces at the knee can cause malalignment of the patella, and cause another type of knee pain, such as PFPS.
- Apple D.F. Knee pain in runners. Southern Medical Journal. 1979;72:1377-1379.
- Dugan S.A. Sports-related knee injuries in female athletes. American Journal of Physical Medicine & Rehabilitation. 2005;84:122-130.
- Fredericson M., Cookingham C.L., Chaudhari A.M., Dowdell B.C., Oestreicher N., Sahrmann S.A. Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. 2000;10:169-175.
- Fredericson M., Weir A. Practical management of iliotibial band friction syndrome in runners. Clinical Journal of Sports Medicine. 2006;16:261-268.
- Hreljac A. Impact and overuse injuries in runners. Medicine and Science in Sports and Exercise. 2004;36:845-849.
- Keller E.K. Patellar malalignment syndrome in runners. Nurse Practitioner. 1983;6:27-38.
- Messier S.P., Edwards D.G., Martin D.F., Lowery R.B., Cannon D.W., James M.K., Burl W.W, Read H.M., Hunter D.M. Etiology of iliotibial band friction syndrome in distance runners. Medicine and Science in Sports and Exercise. 1995;27:951-960.
- Messier S.P., Legault C., Schoenlank C.R., Newman J.J., Martin D.F., Devita P. Risk factors and mechanisms of knee injury in runners. Medicine and Science in Sports and Exercise. 2008;40: 1873-1879.
- Messier S.P., Pittala K.A. Etiologic factors associated with selected running injuries. Medicine Science in Sports and Exercise. 1988;20:501-505.
- Niemuth P.E., Johnson R.J., Myers M.J., Thieman T.J. Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sports Medicine. 2005;15:14-21.
- Paty J.G. Running injuries. Current Opinion in Rheumatology. 1994;6:203-209.
- Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine. 2002;36:95-101.
- Yeung E.W., Yeung S.S. A systematic review of interventions to prevent lower limb soft tissue running injuries. British Journal of Sports Medicine. 2001:35:383-389.
- Ferber, R. Davis, I.S., Noehren, B., Hamill, J. (2010). Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 52-58.