Fixing outside knee pain August 18 2015, 0 Comments

It is fairly common for runners to get knee pain, and I'd like to take a look at a specific form of this in which the pain comes on the outside of the knee. This is probably because of tightness.

The iliotibial band consists of the the iliotibial tract, a tendon which attaches to the pelvic girdle at the top and the tibia below the knee at the bottom. The gluteus maximus (buttock) muscle inserts into it top-rear, and the tensor fascieae latae muscle at the top-front. This combination is responsible for sideways stability in standing, walking and running. Just above its lower insertion, the iliotibial tract passes over the lateral epicondyle, a bony bump on the side of the knee. Under normal circumstances, it will glide back and forth over this without issue, but if the iliotibial band is tight the resulting friction can lead to inflammation and pain.

How does it get to be too short? Running too much too early can result in the tendons shortening, especially if you don't routinely stretch them when warm after running. Aim to increase either distance or speed (but not both) by about 10% per week for a comfortable progression to fitness, and slow this down if you get untoward aches and pains.

The iliotibial band is relaxed during sitting, and so if you have a sedentary job, it can result in the tendon shortening. There are two main ways to tackle this, stretching and rolling. There are several stretches that you can use, either standing or lying down. For balance, you should always stretch on both sides, and go into and come out of stretches s-l-o-w-l-y - never bounce. One particularly effective yoga stretch (the pigeon) is shown here. From a position on your hands and knees, move the leg to be stretched across your body and then slide the other one backwards until you feel the stretch. You can get additional tension by bringing your head down to the floor and rolling towards the side with the straight leg.

You can roll out the iliotibial band with a solid foam roller, as illustrated. Regulate the amount of weight you put on the roller using your arms and the other foot, and roll back and forwards from knee to hip slowly about ten times. You will have a pretty good clue as to whether the trouble is coming from a tight iliotibial band, as this will be very uncomfortable until it loosens.

Stretch and roll at least once a day, and always when you are warm after a run. If none of this works, it might be time to go and see a doctor or physiotherapist for more specific advice.