Header: Runner

Runner's Knee (Iliotibial Band Syndrome)

During running, with every step the knee joint is exposed to forces up to 300% bodyweight . In a long-distance run, this adds up to about 550% the body weight! The knee joint can withstand such an enormous strain only if all structures involved - bone, cartilage, ligaments, capsule, menisci, and the muscles - work smoothly together

What does"runner's knee" mean?

Runner's knee is a condition in which the kneecap joint (patellofemoral joint) is irritated at the outer side through overuse and/or repeated stress. Affected persons often complain about pain in the knee joint, which typically occurs on the outside of the joint and only after a certain period of running.

Usually the pain is getting stronger during running, so that running must be stopped. After the run, the pain may disappear very quickly and usually is not felt during everyday activities. Sports like tennis, soccer, etc., which actually strain the knee significantly more than running, can usually be performed without difficulty. Symptoms that signal inflamed tissue, like swelling of the knee or the knee feeling hot, are very rare.

What are the causes for a runner's knee?

During recurrent, uniform motion in long-distance running, the tendon plate (iliotibial band), which runs from the hip to the thigh and knee to the outside of the tibial head, must move a thousand times over the prominent outside of the knee joint.

If due to intense running (overload) or bad running (excessive loads), an irritation of the tendon plate occurs, problems emerge that can become chronic. In patients with runner's knee, muscles in the hip area are usually much shorter. Thus, the fascia (iliotibial band) slides with increased tension across the outside of the knee joint and leads to inflammation of the overused tissue. Often, aside from the above described muscle imbalance (shortened muscles), also malalignment of the kneecap , complete or partial dislocation, flat feet or wrong running shoes may be responsible for the condition.

How is a runner's knee diagnosed?

An experienced orthopedic surgeon or sports physician can often diagnose a "runner's knee" based on the description of the pain the patient presents and a targeted examination of the knee joint and muscles. Further diagnostic procedures, such as ultrasound, magnetic resonance imaging (MRI) or X-ray studies, are only necessary if a physical examination does not supply clear evidence. More extensive examinations are recommended to exclude other diseases such as fatigue fracture, torn meniscus or cartilage damage, or if the patient does not respond to a specific therapy.

How is a runner's knee treated?

Even though it is difficult for runner's, the first step should be to reduce the running time! Other sports such as cycling, fitness training, swimming etc. can be performed without problems.

In the acute pain phase, i.e. immediately after the knee pain has occurred, the painful area should be cooled and treated with an anti-inflammatory ointment (e.g. diclofenac, ibuprofen). However, long term it important to identify the cause of the runner's knee and treat it. However, long term, it is important to identify the cause of the runner's knee and treat it: often runner's have shortened muscles on the outer side of the hip, called abductors (gluteus minimus and tensor fasciae latae (TFL). Intensive, independent stretching exercises performed daily will significantly improve the condition and make the treatment successful.

These exercises should be accompanied by a targeted physiotherapy with transverse friction massage and possibly electrotherapy. The patients can also contribute to the healing process of “runner's knee” with measures enhancing local metabolic stimulation, such as ice pack treatments (applying ice packs for 10 to 12 minutes at a time), hot and cold baths, or heat treatments. In more severe cases, the physician may describe additional anti-inflammatory medications with regenerative substances.

Principally, athletes should be concerned with their running style and running shoes. Any misalignment of the leg axes or the feet need to be compensated for by suitable running shoes and possibly special inlays.

Rehabilitation and prevention of runner's knee:

After the acute symptoms have subsided, light workout can be resumed after about 2 weeks. However, it is important to avoid overuse and biomechanical stress on the knee joints.

Accordingly, the training volume should only be increased slowly. One of the main accompanying or preventive measures is stretching before and after running or exercising. Here it is important to stretch the outside of the leg stretched (for example, by crossing of the legs when standing and lateral tilting of the upper body).

Specialists: Runner's Knee / Iliotibial Band Syndrome

For an optimal treatment of a runner's knee, the knee and shoulder experts at the Klinik am Ring are particularly well-qualified. Stefan Preis, M.D. and Jörg Schroeder, M.D., senior physicians at the Practice and Department of Orthopedics and Sports Traumatology at the Klinik am Ring in Cologne, specialize together with their team in the treatment of knee and shoulder disorders. In 2004, they founded the WEST GERMAN SHOULDER KNEE & CENTER, Cologne. The team consisting of eight specialists treats more than 10,000 patients per year. The team consisting of eight orthopedic specialists performs more than 2500 surgeries per year of which about 1200 are arthroscopic surgeries of knee joints.

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