Runner's Knee Pain

How to Heal Runner’s IT Band Knee Pain (Muscle Imbalances, Technique, etc.)

Article Source: Runners Corner

Jan 3, 2011 by runbyu1

Overview: In lay terms, the IT (illiotibial) Band runs from the lateral hip and attaches down below the outside of the knee. IT Band pain is one of the most common of running injuries, usually manifested in the form of pain on the side of the knee although it is sometimes felt up in to the hip area as well.
Potential Causes: In many cases, it is thought that IT Band pain is caused by a muscle imbalance caused from running downhill fast or from running on flat, even, man made surfaces in combination with over-striding/heel striking. Typically, the runner with IT Band pain has central Quadricep muscles that are too strong in relation to the Gluteus Medius and Minimus (stabilizing muscles of the butt). Since the Glutes are unable to hold tension, the IT Band is pulled tighter across the side of the knee, causing the commonly felt outside of knee pain.
The most common scenarios we see are:
1) Runners coming in the shop complaining of IT Band pain a few days after a downhill race or a long run on a flat, even surface (like a road or treadmill). Usually this type of run puts more work on the quads, which causes the imbalance to get worse and the IT Band pain to manifest.  (Many times this scenario is in combination with #2, below)
2) Over-striding or heel striking runners, especially those who run fast or do speed work.
Treatments:  Like with many injuries of this nature, the key to success is getting to the root of the problem by 1) Letting the affected area relax & calm down, 2)  Stretching to loosen up the tension, and 3) Strengthening to correct the imbalances.  Below are some specific ways to do that for IT Band.
1) Short Rest – Just enough for the area to calm down—a few days to just beyond a week is usually enough.  IT Band problems don’t necessarily get better with rest beyond a couple of weeks. Many runners report taking six months or even a year off and coming back to the same problem as soon as they start back in to a training program. This is likely due to the fact that in most cases, a muscle imbalance stays a muscle imbalance. The other piece of this is that a runner doesn’t usually change their running technique drastically after a break either.
2) Break Up Scar Tissue:  While the pain is felt down by the knee, the root of the problem is up in the hip area.  The use of Massage, a foam roller, ASTYM, or other similar treatments will help to reduce the scar tissue that can keep injury recurring.
3) Stretching & Strengthening: We see great success here at the shop with those who do ‘Side-leg lifts’, ‘Standing side leg lifts (Fire Hydrants)’, and one legged squats in order to combat the muscle imbalance.  Pair the strengthening with IT Band stretching exercises and using a foam roller.  See this great article for details on stretching exercises and foam roller usage for IT Band: Stretches & Strengthening: http://runningtimes.com/Article.aspx?ArticleID=6099&CategoryID=&PageNum=1
Foam Roller or massage deep twice a week
3a) GO UNEVEN!—Get off the road (or treadmill!) & walk the downhill: Many runners suffering with IT Band pain report that they can run much farther on an uneven surface (like grass or a dirt trail) before the pain manifests.   The more uneven the surface is that you run on, the more you can strengthen the gluteal muscles and reverse the muscle imbalance—this is key to solving the root of the problem.  In addition, walking any relatively steep downhill portions of the run will keep the quadricep muscles from being worked as hard and allow the runner to go longer without pain.
3b) Avoid Overstriding: Many runners overstride or strike their heel well out in front of their body which causes a pulling motion that puts a lot of extra stress on the IT Band.  Taking a running technique class can be very effective in helping you understand what is going on with your foot strike and how to fix it.  Most, if not all great Running Specialty Stores offer some kind of running technique class for minimal cost.  Here at our shop, we have found Zero Drop shoes (shoes with the heel and the forefoot the same distance off the ground) to be highly effective for many people suffering from IT Band pain.  In some cases, we have seen collegiate runners shake their IT Band in as little as a week simply by switching to Zero Drop shoes.  The theory here is that traditional running shoes, which have a midsole that is twice as high (& twice as heavy) in the heel as in the forefoot, actually encourage (or almost force) overstriding and heel striking because the weight of the back of the shoe pulls the heel toward the ground and the excess material under the heel catches the ground early.  In a Zero Drop shoe, the foot tends to approach the ground more parallel to the ground and land the way they would naturally if they didn’t have a shoe on.   In most runners, this effectively limits overstriding and improves running technique immediately.
3c) IT Band Strap: These straps are placed above the knee and change the point of tension on the IT Band.  In many runners they are effective at reducing the pain.  In most situations, an IT Band strap reduces discomfort but doesn’t necessarily help the injury to get better.
Medical Breakdown: http://emedicine.medscape.com/article/1250716-overview