How Does the Foot Cause Knee Pain in Runners?

Iliotibial Band Friction Syndrome is the second most common overuse injury among endurance athletes. Also know as Iliotibial Band Syndrome, IT Band Syndrome, and ITBS, it is a common cause of knee pain in runners and cyclists. In fact, ITBS has been reported in up to 12% of distance runners.

The most frequent complaint of ITBS sufferers is pain at the outside of the knee. They will typically report that the pain will come on at a predictable distance and then worsen throughout the remainder of the run. This pain usually goes away at rest. In its later stages, the same pain may begin with other, less stressful activities, such as stair climbing or even walking. 

So what exactly is ITBS?  The Iliotibial band is a thick reinforcing band of tissue that stabilizes the outside of the thigh and upper leg. When the knee is bent at about 30 degrees, the IT band changes position and moves backward behind a prominence (the lateral femoral condyle) at the outside of the knee. In short, ITBS is inflammation of the outside of the knee from repeated friction as the knee bends and the IT band snaps back and forth across this bony prominence, becoming irritated. 

There are many reported causes and contributing factors to ITBS. Those who are bow-legged, have high arches, a tight iliotibial band, or a limb-length discrepancy are more at risk.  All of these conditions can increase the amount of shock transmitted through the leg to the knee. The knee then has to absorb all of this extra force by bending more and more friction from the IT band results.

So how do you make sure you don’t become the one out of ten runners that will develop ITBS? As with most overuse injuries…avoid overtraining. One study actually found 42% of all ITBS cases to be associated with training errors such as increasing miles too quickly. Nearly half of those cases caused by training errors could be attributed to a single excessive harmful training session.

Other ways to prevent ITBS include the use of custom orthotics to correct for deficits in pronation.  If you are bowlegged, have high arches, or a limb length discrepancy, orthotics can correct the biomechanical shortcomings you were born with, increase running efficiency, and help prevent injury. If you have any of the aforementioned conditions, also avoid shoes that decrease pronation such as “stability” or “pronation control” shoes.

Stretching is a mainstay of prevention of the initial injury or re-injury. To stretch the IT band, stand with your hand out in front of you, holding onto a surface such as a counter for balance. Cross your right leg behind the left leg. Now lean to the left and you will feel an increasing stretch at the right hip. Hold this stretch for 15 seconds. Perform the stretch three times for each side. 

If you do develop IT band syndrome, icing and anti-inflamatories are the usual treatments. The most successful treatments have included immobilization, icing, stretching and a quick return to activity. Interestingly, running at faster pace has been correlated with a lower incidence of ITBS.  This is because the higher cadence requires the knee to remain flexed at a higher degree and decreases the amount of friction to the IT band.  This being the case, you should shorten your stride and pick up the cadence. 

Including IT band stretches in your routine can help to prevent the knee pain common with ITBS. If you have high arches or are bow-legged, use your orthotics and avoid motion control shoes. Avoid running along on a down-sloping road (such as always facing traffic). Train sensibly and stick to your training program. Do all this and the one out of ten runners who get knee pain from ITBS…won’t be you!

Christopher Segler, DPM, AACFAS

Award Winning Foot and Ankle Specialist

MyRunningDoc.com 

Stay Fit. Go Long. Run Fast. Be Strong.