yogabook / pathologie / runners knee

Runners knee / Iliotibial band syndrome/tractus syndrome (ITBS)

Definition of

Insertional tendinopathy caused by training-related overuse (relative to the level of training and other important factors, see below), especially in runners. Runner’s knee is a classic overuse syndrome. Even a single significant overuse can trigger the ligament syndrome, but it is more often the result of repeated overuse. For a long time, the cause was thought to be the rubbing of the iliotibial tract against the epicondyle of the femur, but more recent findings show that it is primarily the pressure of the tract on the ligament that causes it. In principle, the pain can originate from muscles, tendons, cartilage or the capsule. The periosteum and bursa can also be affected. Most common pain in the outer knee in runners. In German, no distinction is often made between the actual runner’s knee and chondropathia patellae.

Cause

1. Overload

Predisposing

– Behavior

1. Unsuitable running shoes
2. In addition to regular running, other regular knee stress factors
3. Inappropriate training program: too frequent training sessions on sloping roads, too fast training build-up, too many fast training sessions
4. Training before completing the regeneration phase
5. Insufficient warm-up before running
6. Running on a surface that slopes outwards
7. Technical deficiencies when running

– Musculoskeletal system

1. Mainly bow legs, but also knock knees
2. Foot malpositions such as flat foot, flat foot(pes planovalgus), hollow foot, or as a result of ankle joint distortions(supination trauma)
3. Primarily hypersupination, and secondarily hyperpronation when running
4. Muscular shortening, particularly in the lateral area of the thigh, especially the iliotibial tract and the tensor fasciae latae, as well as the gluteus medius and gluteus minimus
5. Tilting the pelvis towards greater flexion when running
6. Weakness of the hip joint muscles that stabilize the pelvis, e.g. gluteus medius, leading to significant movement of the pelvis in the frontal plane when running
7. Exorotation of the lower leg in the free leg phaseof the leg when running
8. Leg length differences, pelvic obliquity
9. Poor proprioception and coordination
10. especially one-sided weaknesses of the core muscles

Diagnosis

1. anamnestic and clinical, mainly due to pressure pain on palpation
2. Running and shoe analysis
3. Imaging in case of treatment failure: MRI shows fluid seam between iliotibial tract and bone
4. Tests and signs: Renne, Ober, Noble

Symptoms

1. Pain initially only after running
2. later, sharp pain on the outer knee proximal to the joint space, which can force you to stop running and may even severely hinder walking
3. Frequent: pain first when running for a long time, then when climbing stairs, then when walking
4. Reproducibility through running
5. only rarely signs of inflammation

Complications

1. Recurrence tendency, injury cycle

Therapy

1. Cryotherapy (ice packs), alternating baths, heat packs
2. Anti-inflammatory plasters or ointments
3. Training break: avoid triggering pain. Possibly temporarily switch to pain-free sports
4. Strengthening the pelvic-stabilizing hip muscles, abdominal and back muscles
5. PT: myofascial release, transverse friction, fascia roll
6. Stretching the ITB-associated muscles
7. Phonophoresis (ultrasound with anti-inflammatory agent)
8. Check running style, running shoes, muscles, foot and axes. For bow legs: insoles. No excessive pronation support
9. Rarely surgically through a Z-shaped incision to lengthen the TI
10. Prognosis: Healing after 6-8 weeks. Resuming training too early can lead to the injury cycle
11. Shock wave therapy
12. Local infiltration with cortisone or platelet-rich plasma
13. Slow return to training with warm-up and stretching exercises

NHK

DD

1. Meniscus damage
2. Arthroses
3. Fatigue fracture