Doctor's Corner

Dealing With Knee Pain

First of 2 Parts

Welcome to Doctor’s Corner, a regular feature on Outsports. This feature is designed to give athletes--whether competitive or weekend warriors--practical advice on staying healthy and staving off injury. If you have any questions, suggestions or other concerns please feel free to Dr. Gloin directly

By Dr. Matthew Gloin
Outsports.com

At some point or another knee pain is something that most of us will experience.  The knee joint much like the shoulder joint is a complicated and often problematic area for many.  Sometimes a knee complaint can be brought on by a wild weekend of skiing or in other instances a knee problem may arise while on a slow and cautious walk to the kitchen. 

If knee pain is something that has made you contemplate getting a scooter or even worse a walker please continue reading.  In this article I will uncover one of the most common causes of knee pain: Iliotibial band friction syndrome (ITBS), otherwise known as the “outside part of my knee seems to always hurt.”  

The knee is composed of three bones that include the femur, tibia and fibula. The femur is the large bone in the thigh and the upper portion of the knee joint.  The tibia is the bone that one can feel while grasping the shin and the fibula is the long bone that runs along the outer portion of the leg. The knee is a hinge joint and because of this its primary motions are flexion and extension.  Muscles are attached at specific points around the knee joint and the location of these attachments dictate the action of the muscle. Muscle tissues that attach to bone are called tendons.  Repeated use of a muscle can result in an overuse injury known more commonly as tendonitis.  A tendonitis involves pain and inflammation at the point of greatest irritation.  Treatment in most cases is best if addressed aggressively and in a focused manner.   

Iliotibial Band Syndrome

What is this? 

The iliotibial band (ITB) is an extension of the gluteus muscle and the tensor fascia latae.  These two tissues taper downwards along the outer side of the thigh and form a dense tissue (ITB) that attaches to the outer portion of the knee joint.  An irritation of the ilioltibial band at the point where it attaches to the outer knee (lateral epicondyle) is called iliotibial band friction syndrome.  For many this means pain while sitting (cinema sign) and constant irritation when active.  

Why does this happen? 

ITBS is an overuse injury related to repetitive flexion and extension of the knee.

Suspected causes that contribute to ITBS include: prominent lateral epicondyle, tight iliotibial band, gluteus muscles, tensor fascia latae, leg–length discrepancy caused by uneven pelvic tilt (lumbar spine not moving properly), out-toeing during gait (caused by tight piriformis muscle). 

Common training errors that may aggravate an already irritated ITB: 

•  Abruptly increasing running mileage

•  Running on uneven surfaces

•  Running on inclines

•  Not replacing shoes after 500 miles

How does one get rid of ITBS? 

Three-stage treatment: 

1) Resting the knee (1-3 weeks), stretching the iliotibial band, hamstrings, quadriceps, calves (daily, 30 sec, 1-2x each leg, see stretching article) and applying ice for 10-15 minutes after physical activity that involves the knee joint (see ice vs. heat article).

2) Chiropractic therapy to return proper motion to the joints above and below the knee, ultrasound to reduce swelling and promote healing and cross-friction massage to eliminate scar tissue build-up (frequency of therapy depends on the severity of the problem and the response to treatment).  

3) Consider getting a complete foot exam to evaluate the need for othotics, resume regular activity once able to climb stairs, and once regular cardiovascular activity that was once provoking no longer causes pain or discomfort.

* As mentioned care for this complaint should be aggressive and focused.  This means a proper diagnosis should be made first by a professional and then treatment provided as the severity of the problem requires. 

Other Suggestions for Prevention of an Overuse Injury: 

• Increase running mileage at most 5% to 10% per week

• Train with “Walk/Run”: i.e. split running time by adding walk breaks. Find a ratio that works well by experimenting with different times.

• Buy shoes that suit your sport and the shape/structure of your feet. 

To your good health.

Always consult with a doctor for diagnosis and treatment recommendations prior to beginning any self-therapy on your own.

Other health columns:

• Heat vs. Ice
• Stretching myths and facts
• Treating ankle injuries

Photos by Brent Mullins / Outsports.com