So during lockdown, I have been able to get out and run the local streets, footpaths and nature trails.  I am running further, faster (marginally!) and for longer as life’s restrictions and responsibilities have been temporarily reduced.  On a recent run, I developed a sharp pain on the outside of my right knee which did not cause me to stop however made the exercise less enjoyable.

 When I finished running the knee pain subsided.  On examination of the outside of my knee, I discovered a tight guitar string-like taut band of tissue, my iliotibial band.  I had experienced ITB syndrome.  The same pain occurred on the next couple of runs of a similar distance which was becoming frustrating.  I was not going to be able to run this off and so a change of approach was necessary.

 The ITB is a thickened band of fascial tissue that originates (attaches) on the outer surface of the pelvis and runs the length of the thigh to insert (attach) to the tibia (shin bone).  The ITB sits on top of the surrounding muscles being quite superficial and easily distinguished to those in the know.  Although not strictly a muscle-tendon the ITB does have muscular input from Gluteus maximus and a lesser extent tensor fascia lata (TFL).  So any weakness, overuse or shortening of these muscles may transfer to the ITB and cause problems. The insertion of the ITB into the tibia provides stability to the knee joint.

Symptoms of pain or ache on the outside of the knee usually associated with running possibly worse downhill and cycling, due to increased mileage or repetition are commonly reported.  Between the insertion of the ITB to the tibia is a fat pad (imagine two layers of cling film with olive oil sandwiched between), which acts as a protection to friction/rubbing of the repetitive gliding and sliding movements of ligaments and tendons over the underlying bone.  Fat pad irritation and inflammation occurs when it is continually compressed or repetitively overloaded by the ITB as it passes the knee due to a combination of muscle weakness, fatigue or shortening.

As I mentioned at the beginning my training load had increased I was running more frequently and further however my body was not conditioned to this step up in exercise, my muscles did not have the endurance to cope therefore shortening causing compression, sharp knee pain and a taut ITB.

Self-help strategies

Foam roller I needed to stretch out and relax my ITB, gluteus maximus and TFL.  Using a foam roller I rolled along the ITB, gluteus and TFL stopping over the areas that were sore and spending a couple of minutes stretching out that was not pleasant however visibly lessened the tension in the tissue.

Muscle strengthening My body required alternative exercise than just running to develop the ability to withstand the load I wished to place on it. My aim was to continue running regularly increasing the distance to manage my weight, life stress and general health.  Building strength and endurance in the hips and legs was key to achieving this outcome.  Body weight, resistance band and weighted exercises were all incorporated into a regular programme of twice weekly circuits to gain strength.

Continuing to run I was able to run a worthwhile distance before I experienced knee pain so I spent a couple of weeks sticking to this (knee pain free) distance however added in a few further sessions to maintain overall weekly mileage which allowed muscles to adapt under tension gaining further strength.  

Fortunately I did not have any further problems with knee pain following this and was able to progress my mileage gradually and achieve my target whilst maintaining a semi-regular stretching and strengthening programme.

Had ITB symptoms persisted I may have taken to complete rest from running, utilised regular ice therapy and anti-inflammatory medication. Following 4-6 weeks of relative rest I could have slowly begun to run again less frequently at first and not so far progressing mileage/km by 10-15% gradually (weekly/biweekly) as ITB symptoms dictated.  If symptoms flared I would go back a step for a week or so then try again to progress until I was where I wanted to be. 

If rest and gradual return to running did not work for me I would have enlisted the help of one of the FP team to assess my running style.  Increasing or decreasing step rate (cadence) or step width is known to reduce excess tissue strain at the knee and therefore knee pain.  An assessment would also be beneficial if I wanted to improve my performance efficiency to achieve better times or distances.

As far as my running is concerned long may lockdown continue!