A common knee problem that causes soreness into the outside area of the knee during activity is a condition called Iliotibial band Syndrome. The Iliotibial band (ITB) is a long thick band of fibrous tissue that connects the gluteus Medius & Tensor Fascia Latae muscles of the Hip to the outside of the knee. Because of the varying angles of these Hip muscles, the ITB assists in both bending the knee and straightening the knee. Hence it is constantly crossing back and forth over the lateral epicondyle bone of the knee during walking, running and bending activities. Overtime this repetitive rubbing of the ITB against the Lateral epicondyle bone creates friction causing the bursa or fluid sac between the ITB and lateral epicondyle bone to become inflamed creating soreness in the outside of the knee during movement.
Factors that bring about ITB syndrome
a) Forefoot turns inwards b) Tight groin muscles c) One leg is longer than the other d) A tight Iliotibial band e) Sudden increases in running or walking distances.
Signs & Symptoms
Pain on the outside of the knee during active movements of the knee
Climbing stairs or running up a slope aggravates the pain
A stinging pain is noted in the outside of the knee when foot makes contact with the ground during running.
There can be persistent swelling on the outside of the knee. Crackling or crunching noises that are localised to the outside of the knee.
Pain can often be experienced when a person is fully weight bearing with knees bent slightly as seen in a mini-squat position.
Pain can also be noted up along the Iliotibial band between the hip and the knee on the outside aspect of the leg.
Tenderness can be felt over the attachment of the Iliotibial band on the side of the knee, the attachment point is known as Gerdy’s tubercle. Tenderness may also closer to the patella (knee cap)
Treatment & Management
During the acute stage, rest coupled with application of ice to the tender area is required. Once inflammation has reduced, I can commence gradual manual soft tissue manipulation to the gluteus medius, TFL muscles and Illiotibial band. Gradual stretching exercises followed by graded static strengthening exercises are very important. With regard to athletes, Balance exercises and agility running drills are essential to achieving a symptom free return to sport. Finally, poor foot mechanics that cause the foot to fall inwards can be addressed by orthotics.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Clonmel & Thurles.
Contact Number: 0504 26672
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Injury Solutions Clinic
Physiotherapy & Injury Rehabilitation Clinic in Tipperary