Runner's knees

Synonyms

• iliotibial band syndrome
• Tractus syndrome
• Tract chafing
• Iliotibial band syndrome
• IBS (iliotibial band syndrome)

definition

A runner's knee / chafing of the tract is understood to be a degenerative change in the iliotibial tract that is brought about primarily by running movements, with the associated sometimes severe pain in the outer area of ​​the knee joint.

Symptoms

The main symptoms of a runner's knee are external knee pain that can occur when running or briskly and which can increase in intensity over time.
If you take a resting position, the pain usually subsides again. Swelling or reddening, as with classic inflammations, occurs in the rarest of cases. The pain is aching, burning character and in some cases is associated with functional impairment in the knee or lower leg.

Most of the time, the first pain occurs in the runner's knee when walking downhill. In advanced stages, however, complaints can also arise when walking uphill or even when running on a straight level.
Also at an advanced stage, pain also occurs when sitting with strongly bent legs. In addition to the pain, a runner's knee can sometimes also be audible.
Due to the great amount of friction between the muscle attachment and the protruding bone, the runner's knee can sometimes crunch or rubbing loudly, which the examiner or the person affected can hear.

Find out more about: Acute knee pain - that may be behind it

Diagnosis of a runner's knee

Besides the Health survey (anamnese) the physical examination is the most important diagnostic factor of the runner's knee.
If patients report the classic pulling, burning or stabbing pain in the corresponding area, especially when going downhill or when running, a first suspicion of a runner's knee can be made.

During the physical examination, the examiner will passively move the leg while the patient is lying down and wait to see which movements the patient reports pain. Furthermore, with the thigh fixed, the lower leg is rotated to the left and right and the extended leg is pressed in and out. In this way one can rule out the differential diagnostic causes of the complaints.
That would be mentioned here External meniscus damage, in which pain would occur mainly during external rotation and damage to the external ligament, in which pain would occur when the leg is stretched outwards.
If the leg or knee joint is swollen and reddened, this would indicate inflammation. A common inflammation in the knee joint is bursitis (Bursitis).
Does the Kneecap when the leg is stretched out and settles down as if on a carpet of liquid, this is the so-called "dancing pattela“For a joint effusion, which in most cases has an inflammatory cause. In order to rule out the other causes, imaging can also be carried out to identify the cause roentgen of the knee joint or one Magnetic resonance examination can exist. Ligament injuries, meniscus damage or arthritic changes can be seen or excluded here.

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The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Risk factors

In addition to the sports mentioned, such as running, misalignment of the legs is an important risk factor.
Long incorrect loads can lead to a runner's knee much more often than properly loaded legs. Furthermore, athletes who exercise themselves and, above all, perform cold and untrained sports are also more at risk of developing a runner's knee than trained athletes.

prevention

First of all, care should be taken at an early stage to adopt a suitable physiological posture when running and walking.

At a young age, any malalignment should therefore be compensated for with orthopedic insoles. Athletes should exercise according to their current training condition and, above all, ensure that they have a sufficient warm-up phase before starting sports. If you have already had symptoms of runner's knees in your own family, you should be more careful with doing sports that favor a runner's knee. Because anatomical events can be passed on from generation to generation and thus lead to an increased susceptibility of a runner's knee.

Therapy of the runner's knee

How is therapy carried out for a runner's knee?

First of all, in therapy one Runner's knee between one acute pain phase and one long-term therapy of the cause distinguished. In the acute phase of the runner's knee, cooling of the affected area and anti-inflammatory measures (ointments / medication) are recommended.

Even if one is affected Runner's knee (Tractus syndrome) don't like to hear:
The first step in therapy one Runner's knee is to switch off the causative factors, in most cases this To run. If a regular runner has a runner's knee, he has to drastically reduce, if not completely stop, running.
Instead, others should do that Knee joint gentle sports.
These include swim, Cycling, fitness training etc.

Symptomatic therapy should be carried out immediately after running, which mainly consists of cooling the knee and immobilising it. Furthermore, attempts can be made to reduce the inflammatory component with anti-inflammatory ointments / medication. Mention should be made here of ointments with the active ingredient Diclofenac or ibuprofen.
In many cases, runners' knees are the result of a lot of movement being made with a leg whose muscles are hardened or shortened. In order to cross this anatomical hurdle, a daily stretching and Stretching program be performed.

If the muscles loosen and the tendons lengthen with regular repetition of the stretching activities, the likelihood of the runner's knee advancing is reduced. Furthermore, regular physiotherapy should be carried out.
The symptoms can be alleviated by stimulation current treatments or cold applications. In some cases it can also be useful to apply heat to the knee.
If it is a question of a runner's knee / tract chafing due to anatomical misalignments, it is possible to influence the anatomical position of the ankle and knee joint favorably by choosing the right running shoes and orthopedic insoles.

Stretching exercises on a runner's knee

If you have complaints of the Runner's knee you are sure to be interested in how you can alleviate and prevent them. A fairly simple option are stretching exercises that the Iliotibial tract is stretched. Here are some exercises, all exercises are written for the right knee, if you have problems on the left, simply swap left and right in the following.

In the first exercise stand upright with your feet parallel, with your right hand you can support yourself on the side of a wall. Now cross your legs, keeping the left foot steady while the right is passed behind the left. Then place your right foot behind your left foot on the left. Both feet point forward. Now press your hips carefully to the right towards the wall. You should now feel a stretch on the outside of your right thigh. Be careful not to tilt your upper body to the right. Hold this position for about 20 seconds.

For the second exercise sit on the floor, legs forward. Now cross your legs by placing your right foot to the left of your left knee. Now grab your left knee with your left hand. You can now carefully push your right leg outwards with your left arm, thereby stretching the iliotibial tract.

In the third exercise stretch both the iliotibial tract and the muscles at the back of the thigh. To do this, stand up straight and cross your right leg in front of your left leg. Then bend your hips until your hands can touch the floor. Hold this position for at least 15 seconds. Common mistakes in this exercise are bending the knees. The aim of the exercise, however, is to stretch the muscles and not to reach the floor with your hands. Don't worry if you don't hit the ground right away. Try to get to the ground as much as you can, if there is some space it will improve over time. Another common mistake is getting your heels off the ground. Try to stay firmly on the ground.

At a another, technically very simple exercise, first lie flat on your back. Spread your arms flat on your sides. Now lift your right leg and move it to the left. Make sure that you do not turn your entire pelvis but only move your right leg. Hold the leg as far to the left as possible for 20 seconds. The main focus of this exercise is to stretch the iliotibial tract.

Tap the runner's knee

Physiotherapy is an important part of the therapy. This can achieve an improvement in pain symptoms with the help of a variety of different techniques.
A treatment method that is often used by some physiotherapists for a runner's knee is the application of a so-called Tape bandages. The bandage consists of elastic, stable bandages which are applied using a certain technique and are intended to support and stabilize certain anatomical structures during movement.

The Taping the knee as well as the so-called Iliotibial bandwho is responsible for the discomfort can thus help alleviate the discomfort. In addition to the correct application of the bandage, the point in time at which it is applied is also decisive for the success of the therapy.
The bandage should not be used as the sole therapy in the acute phase of the runner's knee, but rather should be applied in the build-up phase when the amount of training is increased.
The bandage can help to support the fascia, which is responsible for the discomfort in the knee and thigh, and to prevent the recurrence of pain.

Therapy with the Blackroll

By stretching certain fascia and muscle groups as well as by performing massages that promote blood circulation, an improvement in the pain symptoms can often be achieved.

Exercises that independently participate in a so-called Blackroll can often achieve the same effect as physiotherapeutic therapy after professional guidance.
A Blackroll is a hard foam roller that can be used for exercises. Exercises that are designed to stretch the fascia and promote blood flow to these structures can be performed well with a Blackroll. Frequent use of meaningful exercises with the Blackroll can prevent a runner's knee from occurring again in many cases.

However, attention should also be paid to other risk factors that can promote the occurrence of the pain syndrome. It is also important to only perform the exercises on the Blackroll according to professional guidance so that important and irritated structures are not incorrectly stressed and at an unfavorable time of the treatment.
A treating physiotherapist or orthopedist can help to use the Blackroll effectively at home.

Causes of the runner's knee

What are the cause and shapes of a runner's knee?

Main cause of that Runner's knees is an overload (e.g. by frequent To run) the tendon plate that extends between the outside of the hip and the upper outer part of the lower leg.
The so-called Iliotibial band with M. Iliotibialis runs along almost the entire upper outer surface of the thigh and is mainly used for flexing the leg in the hip and for external rotation in the hip joint responsible.

For anatomical reasons, it can happen that the tendons of the muscle begin to rub / rub against a certain protrusion of bone between the lower and upper thighs. This always occurs when certain movements are carried out too often and too intensively and when the anatomical conditions can favor the development of a runner's knee (If one).
With repetitive movements of the leg, the muscle attachment is always partly strongly and partly less strongly moved over the bone process. There is pain.

People who do frequent endurance runs and who often exercise too long and too intensely are particularly at risk. The movement of the leg typical for cycling can also be a Runner's knees (Tractus Syndrome) cause. A distinction is made between the causes acquired causes from congenital causes. The congenital causes include, above all, misalignments of the legs, in which an increased pressure or tension on the Iliotibial band burdens. Especially patients with bowlegs (Genu varum) have an increased risk of getting a runner's knee.
The most common causes of acquired reasons for a runner's knee are, above all, incorrect loading of the legs while running.The acquired causes also include so-called classic running errors in athletes. Mention should be made here of the training without sufficient warm-up and the overload, which does not correspond to the actual training condition of the athlete.
In addition, shoes with pronation support and walking on hard surfaces (e.g. asphalt) are common causes of this Runner's knees.

Duration of a runner's knee

The time it takes for a runner's knee to completely regress and heal the damaged structures can vary widely.
This depends above all on the extent of the damage and inflammation of the affected structures as well as the therapy and behavior after the occurrence of the symptoms.

Above all, it is important that the stress that led to the occurrence of the specific complaints is initially prevented and thus the affected inflamed structures are spared.
If the fascia is further stressed, the injury can develop into a chronic condition which can last for months to years. With adequate therapy of the runner's knee and consistent rest, the injury should be restored 6-8 weeks be healed.

A slow increase in the scope of sporting activities is recommended only towards the end of the healing phase. If pain occurs during light sporting activities, we recommend waiting and taking more rest.

Summary

Under a Runner's knees is understood as a pain syndrome that is particularly noticeable when walking or running.
The cause are bottlenecks between bone on the outside of the lower leg and the muscle that is passed over it. With every movement of the leg (bending, crouching) there is increased friction between the muscle (Iliotibial tract) and the Osseous process. This friction can increasingly lead to pain during movements. One then speaks of the so-called runner's knee. In addition to the general medical examination, the doctor will primarily ask the patient about risk factors that can lead to a runner's knee and, above all, ask about the nature of the pain that is reported for a runner's knee.
The pains are mainly pulling, burning, biting pains that can develop on the outside of the lower leg but also up to the hip can pull. The first symptoms of a runner's knee may be pain when walking downhill. In advanced stages, a corresponding pain can also be triggered when going uphill or when running on a straight level.

In some cases there are also functional restrictions when moving. In the differential diagnosis, apart from damage to the external ligament or meniscus, bursitis, i.e. bursitis, must also be excluded.
Here, the doctor performs typical movement maneuvers on the patient lying down, which would trigger symptoms in the case of the differential diagnostic causes. To exclude a arthrosis An X-ray image of the knee can be made or a magnetic resonance examination can be carried out to rule out ligament or meniscus damage.

After a runner's knee has been diagnosed, the sport that was triggered must be reduced or completely stopped. Instead, alternative sports such as swim or fitness training. At the moment of acute pain, the knee can be cooled with ointments or ice packs. In addition, anti-inflammatory ointments (e.g. Diclofenac) can be used. Long-term attempts can be made to widen the narrow point between bones and muscles. This should be done with regular stretching succeed (several times a day). A surgical procedure is almost never indicated. The form of treatment consists of physical therapy and physiotherapy on the one hand and a reduction in risk factors (choice of sport).