{"id":91619,"date":"2023-10-27T11:35:48","date_gmt":"2023-10-27T09:35:48","guid":{"rendered":"https:\/\/42krunning.com\/runners-knee-a-hip-issue\/"},"modified":"2023-10-27T11:35:48","modified_gmt":"2023-10-27T09:35:48","slug":"runners-knee-a-hip-issue","status":"publish","type":"post","link":"https:\/\/42krunning.com\/en\/runners-knee-a-hip-issue\/","title":{"rendered":"Runner\u2019s knee: a hip issue"},"content":{"rendered":"

What happens when, while preparing for an important race, you overdo the mileage? You\u2019re very likely to end up with iliotibial band injury<\/strong> or, as it\u2019s more commonly known, runner\u2019s knee <\/strong>or runner\u2019s band<\/strong>. <\/p>\n

Runner\u2019s knee or iliotibial band syndrome<\/h2>\n

I remember that in 2015 I got a phone call on a Wednesday, four days before the Valencia Marathon. On the other end of the line, they said: \u201cHi David, I\u2019m a friend of Jacob\u2019s and he told me you can fix my runner\u2019s knee problem for this Sunday, when I\u2019m running the Valencia Marathon, and I want to set a personal best\u201d<\/em>. My reply was: \u201cSetting a personal best will depend a lot on whether you can actually run on Sunday\u201d<\/em>. <\/p>\n

I booked him in straight away and confirmed he\u2019d built up excessive training, very demanding in terms of mileage; I also found he had an overly knock-kneed knee, an overly valgus ankle, and incorrect muscular timing<\/em> that was activating the tensor fasciae latae and tightening it up to the point where he couldn\u2019t run.<\/p>\n

I told him I was going to patch up his runner\u2019s knee problem to try to get him to race on Sunday, although I warned him I couldn\u2019t guarantee he\u2019d be able to finish. I decided on the following treatment: <\/p>\n

    \n
  1. Dry needling and electro-needling of the tensor fasciae latae.<\/li>\n
  2. A functional knee taping to align his knee on impact.<\/li>\n
  3. An ankle taping to prevent the excessive valgus that was triggering activation of the tensor fasciae latae.<\/li>\n<\/ol>\n
    \"Runner\u2019s<\/a>
    David Valenzuela applying functional taping.<\/figcaption><\/figure>\n

    I asked him to try running 10 km the next day, Thursday (3 days before the race), and told him that if everything went well after that session, he could hope to make it to the start line of the marathon and consider the possibility of completing the 42.195 km despite his runner\u2019s knee problem.<\/p>\n

    The next day he went out to train and ended up doing 18 km (not 10, as I\u2019d told him) \u201cbecause I felt good\u201d<\/em>. \u201cWith this, will I be able to finish the marathon?\u201d<\/em> he asked me after admitting he\u2019d done 18 km; my answer was simply \u201cwe\u2019ll try\u201d<\/em>.<\/p>\n

    Obviously, he didn\u2019t know (and I didn\u2019t tell him) that with every impact the knee and ankle taping would lose effectiveness and that little by little the pain would return; my hope was that he could get to km 25 without any issues and that from there he could hang on as the increasing pain set in.<\/p>\n

    This real situation I\u2019ve described (and which has happened to me more times throughout my professional career) is something sports physios sometimes have to face. And in a situation like this you have to decide to do palliative physiotherapy\u2014meaning you do whatever it takes so the athlete can compete\u2014setting aside therapeutic physiotherapy, which would actually solve the problem. <\/p>\n

    But what is runner\u2019s knee, or runner\u2019s band?<\/h3>\n

    Runner\u2019s knee syndrome<\/strong>, or iliotibial band syndrome<\/strong>, is a common injury<\/strong> in runners whose training is too intense and who have accumulated too many kilometres in their legs.<\/p>\n

    \"Runner\u2019s<\/a>
    Trail runner Fran Naranjo during a training session.<\/figcaption><\/figure>\n

    It\u2019s an injury that starts with pain on the outside of the knee<\/strong> and gradually increases, becoming very intense during long runs or training with too many impacts. It\u2019s a pain that starts mild<\/strong> and keeps getting worse<\/strong> until it turns into a painful burning sensation that eventually forces you to stop because the pain becomes unbearable<\/strong>. <\/p>\n

    The muscle affected\u2014and the one behind the problem known as runner\u2019s knee\u2014is the tensor fasciae latae<\/a> muscle<\/strong>; it\u2019s a hip muscle<\/strong> with a long tendon that inserts into the outer side of the knee. When the pain starts, it\u2019s normal to mistake it for a knee issue, but the real problem is in the hip\u2019s tensor muscle. <\/p>\n

    A runner who lacks adductor strength and has limited abductor function will develop overload that causes knee pain. In other words, if they\u2019re stronger on the outside than on the inside (adduction closes the leg and abduction opens it), having more strength in the abductor side (the one that opens) will create knee pain, but the real issue is in the hip. <\/p>\n

    What should you consider when assessing runner\u2019s knee syndrome?<\/h4>\n
      \n
    1. Weakness in the hip abductor muscles due to overload.<\/li>\n
    2. A runner with poor alignment when the foot strikes the ground, creating knee valgus or varus, will cause overstretching or weakness in the tensor fasciae latae.<\/li>\n
    3. A runner\u2019s short leg will create a weight shift that puts more load on one knee; to avoid scraping the ground, the athlete tends to run with abduction.<\/li>\n
    4. Excessive ankle valgus due to loss of strength in the posterior tibialis will force the runner to lift the foot, creating poor flight in the stride and forcing the tensor fasciae latae to lift the leg.<\/li>\n
    5. Multidisciplinary work between the physiotherapist, strength coach, and podiatrist to achieve good biomechanics for the patient.<\/li>\n<\/ol>\n
      \"Runner\u2019s<\/a>
      Sports physiotherapist David Valenzuela, from Box55, treating ultrarunner Iv\u00e1n Penalba.<\/figcaption><\/figure>\n

      What should you do if you develop runner\u2019s knee?<\/h4>\n
        \n
      1. First, keep in mind that if we work the muscles without controlling foot posture<\/strong> (plantar proprioception), we won\u2019t be able to treat the injury.<\/li>\n
      2. Second, remember that runner\u2019s knee is actually a hip issue, so you need to improve hip mobility and strength<\/strong>.<\/li>\n
      3. Third, you need to manage all the strength work for the intrinsic foot muscles<\/strong> to improve how the knee adapts to the ground.<\/li>\n
      4. Fourth, you\u2019ll need to do lower-mileage training<\/strong>.<\/li>\n
      5. It\u2019s a good idea to support rest periods with pool workouts and cycling sessions<\/strong>.<\/li>\n
      6. See a physiotherapist<\/strong> once a week to improve muscular timing and reduce muscle tone.<\/li>\n<\/ol>\n

        Going back to the patient from the beginning, he was able to finish the race and even beat his time from the previous year. When he came back to the clinic on Monday after the marathon, I noticed the top of his foot was burned, so I asked what had happened and how he\u2019d managed to improve his time. <\/p>\n

        He told me that around km 15 he had an incident at an aid station: “As I approached the aid station, I stepped on a banana peel without realising it, slipped, and slid under the aid station table, dumping all the cups of water over myself. The whole ankle taping got soaked and after a few kilometres it started rubbing, causing so much pain that I completely forgot about the knee pain. In the end, I pushed on and finished sprinting”<\/em>, he explained with a smile, showing his second-degree burn on the top of his foot.<\/p>\n

        Moral: never stop chasing your dreams. In competition, any detail can help you reach your goals. Sport isn\u2019t healthy, competition isn\u2019t healthy, but the sports physiotherapist is there to understand you, support you, and with a bit of luck \u201cheal\u201d you. <\/p>\n

        Today, this patient is still running marathons with insoles, with a lower training load and less mileage build-up, with optimal hip activation, and with his knee and foot perfectly aligned so he can enjoy the sport he loves.<\/p>\n

        Congratulations to all runners who, come what may, have the courage to step up to a start line to go after their sporting challenges; sports physios will always be there with you.<\/p>\n

        More articles by David Valenzuela, sports physiotherapist at Box55<\/h5>\n

        Sports physiotherapist David Valenzuela is one of the regular contributors to the 42K blog. Many endurance runners\u2014trail running, track, etc.\u2014come through his clinic, so he knows perfectly well what the main running injuries are, such as shin splints<\/a>, plantar fasciitis<\/a>, patellar tendinopathy and Achilles tendinopathy<\/a>, lower back pain<\/a>, hamstring tear<\/a>, or ankle sprain<\/a>. <\/p>\n

         <\/p>\n","protected":false},"excerpt":{"rendered":"

        What happens when, while preparing for an important race, you overdo the mileage? You\u2019re very likely to end up with iliotibial band injury or, as it\u2019s more commonly known, runner\u2019s knee or runner\u2019s band. Runner\u2019s knee or iliotibial band syndrome I remember that in 2015 I got a phone call on a Wednesday, four days […]<\/p>\n","protected":false},"author":4,"featured_media":91620,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_joinchat":[],"footnotes":""},"categories":[1599],"tags":[],"class_list":["post-91619","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-training-and-preparation"],"_links":{"self":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts\/91619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/comments?post=91619"}],"version-history":[{"count":0,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/posts\/91619\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/media\/91620"}],"wp:attachment":[{"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/media?parent=91619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/categories?post=91619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/42krunning.com\/en\/wp-json\/wp\/v2\/tags?post=91619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}