Doctor, my knee burns on the outside while I run, can it be the iliotibial tract friction syndrome?

The iliotibial tract friction syndrome (ITBS) is the most common cause of lateral knee pain in runners. It is generally caused by an excessive trauma that derives from the repetitive friction of the iliotibial tract (ITB) on the lateral portion of the femur, which is of maximum intensity when the knee is flexed at about 30 degrees.

But first of all, what’s the iliotibial tract? It consists in the fusion of the great gluteus and the tensor fasciae latae muscles in the lateral portion of the thigh, forming a tendon that is inserted in the lateral tibial portion. This tract undergoes considerable muscular actions and mechanical loads. When standing, walking, and moreover running, the action of the great gluteus and the tensor is basically incessant. Particularly, when standing on one foot the tensor avoid the hips to “fall” on the side of the lifted foot. The more running creates a significant load while landing, for example running downhill, the more intense is the activity of the tensor of the fasciae latae. The power exerted from its contraction goes to the tendon, then to the iliotibial tract and then at last, on its insertion in the bone.

Excessive running in the same direction, too many kilometers in a week and running downhill are trigger factors for this condition. Moreover, recent studies have demonstrated that lack of power in the gluteal muscles is a casual factor for this injury. When these muscles fail to activate correctly during the supportive fase in the running cycle, there is a lack of capacity to stabilize the hips and the leg while laying the foot on the ground and the subsequent fases of the step. As a consequence, other muscles need to compensate, often leading to an excessive tension of the soft tissues and subsequent suffering of the muscolar-tendon components.

The initial treatment should concentrate on changing the activity, on the therapeutic choices to reduce local inflammation, on the non steroidal anti-inflammatory medications and in more serious cases, on corticosteroids injections. Stretching exercises, that should always be carried out after a mild exercise with no load (like cyclette) can be started once the acute inflammation is under control. The identification and elimination of myofascial pain (through the use of the feared foam-roller) complete the therapeutic programme and should come before the muscolar strengthening and rieducation. At this time it is possible to proceed with the glutes, quadriceps and hamstring strengthening (Boost&Stretch training are done for this purpose).

With this all-round therapeutical approach, in 6 weeks time symptoms will be regressed or even disappeared and it will be possible to restart running without problems, but paying attention to maintaine the new training method to avoid a return of the inflammation. It is interesting to notice that biomechanical studies have demonstrated that running faster decreases the chances to worsen the inflammation and that quicker steps are initially recommended with a slower jogging rhythm. As time passes by it is possible to increase distances and frequency.


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