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Dealing with runner's knee

A common injury suffered by avid runners is Iliotibial Band Syndrome, or runner's knee.

Though this overuse problem can occur with many other activities, it's a dead giveaway in those who run.

The Iliotibial Band (IT-Band) is a thick band of fibrous tissue that runs down the outside of the leg. It begins at the hip and extends to the outer side of the tibia (shin bone) just below the knee. The function of the IT-Band is to decelerate the inward rotation (pronation) of the leg as it moves from heel strike to stance phase during walking or running.

As the knee bends and extends, the IT-Band crosses the lateral aspect of the femur (thigh bone), known as the lateral epicondyle. As it crosses this bony area, it can become inflamed and swollen.

Runners, for example, ask the IT-Band to control the deceleration of the leg about 90 times per minute. This makes it an easy target for an overuse injury.

What are the symptoms of ITBS? Pain and tenderness at the lateral aspect of the knee, especially as the knee bends at about 30 degrees (as with running, going up and down stairs, jumping, etc.). Tender spots may be present higher up the outside part of the leg or at the lateral aspect of the hip.

As with many overuse injuries, symptoms may be minimal at first and seem to improve once your body warms up. Don't be fooled by this. If you ignore the pain and continue aggravating the IT-Band, your pain may force you to stop athletic activity. It may also affect your every day life.

What are some causes of ITBS?

* Running on crowned roads. The leg that is on the downward slope demands an increased control of deceleration, placing more stress on the IT-Band.

* Running the same way around a track while training. The inside leg takes a greater deceleration force. In both of these examples, you need to alternate directions.

* Having unequal leg lengths. The shorter leg takes more force.

* Increasing your training volume or intensity too quickly.

* Abnormal pronation, (rolling inward) of the foot

* Tightness or weakness of the IT-Band or hip musculature

Treatment of ITBS begins with activity modification, icing, and anti-inflammatory medication. These will help decrease symptoms, but may not fix the problem.

Stretching the IT-Band is important, but is not usually a cure-all. Many times the reason for the IT-Band being tight is that other muscles around it (glute medius and core muscles, for example) may be weak, causing the IT-Band to be overworking. This must be addressed in order to successfully improve.

Using a massage stick or foam roller may help reduce any "knots" in the muscle. You may also need to strengthen your IT-Band so it can hold up to what you are asking it to do. It is best to consult with a sports medicine specialist to see what treatment and specific rehabilitation program you may need.

Michael Adesso is director of physical therapy and sports medicine at University Sports Medicine's office at 4949 Harlem Road, Amherst.

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