yogabook / pathologie / runners knee
Contents
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.
ITBS or runners‘ knee is one of the most common overuse-related disorders of the tendons of the lower extremity. Runners are affected with an incidence of 14%. It also occurs with a lower incidence in racing cyclists, footballers, hockey and basketball players and rowers. The ITBS often forces people to take a break from sport. A single cause can rarely be given, but indirectly, increased friction of the iliotibial tract over the lateral femoral condyle at around 30° leads to tissue irritation. The lateral rominating condyle has a hypomochlion function to a certain extent and therefore tightens the iliotibial tract more. At first, the symptoms only occur after heavy exertion, but in chronic cases this may progress to rest pain. Various disorders must be ruled out in the differential diagnosis, such as an external meniscus, external ligament damage and a PFPS with lateral emphasis. The pain is proximal to the lateral joint space. The lateral femoral condyle shows pressive tenderness, with a maximum at 30 degrees of knee flexion and additional varus stress of the knee joint. The ITBS may be associated with localised swelling and crepitations. The upper test shows a contracted tractus iliotibialis or tensor fasciae latae. Sonography often shows an oedematous thickening of the tractus iliotibialis. If symptoms persist and conservative treatment fails, an MRI is indicated. This disorder is generally treated conservatively until further notice. Disruptive factors such as pelvic obliquity, pelvic curvature, leg length discrepancies, axial misalignments, foot misalignments must be recognised and treated. Weight-bearing adaptation will almost always be necessary and, if necessary, a break from sport. The modulation of exertion is an important aspect. Biomechanical factors such as footwear when running, the surface and topography, as well as parameters such as the height of the seat post when cycling can be important. NSAIDs can be used initially to provide relief, and extracorporeal shock wave therapy also has its place here. Surgical intervention is only recommended if conservative therapy fails, after which the load is increased in a pain-adapted manner. Mobility does not have to be restricted. During the first six weeks there is no sport.
Cause
- Overload
Predisposing
– Behavior
- Unsuitable running shoes
- In addition to regular running, other regular knee stress factors
- Inappropriate training program: too frequent training sessions on sloping roads, too fast training build-up, too many fast training sessions
- Training before completing the regeneration phase
- Insufficient warm-up before running
- Running on a surface that slopes outwards
- Technical deficiencies when running
– Musculoskeletal system
- Mainly bow legs, but also knock knees
- Foot malpositions such as flat foot, flat foot(pes planovalgus), hollow foot, or as a result of ankle joint distortions(supination trauma)
- Primarily hypersupination, and secondarily hyperpronation when running
- 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
- Tilting the pelvis towards greater flexion when running
- 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
- Exorotation of the lower leg in the free leg phaseof the leg when running
- Leg length differences, pelvic obliquity
- Poor proprioception and coordination
- especially one-sided weaknesses of the core muscles
Diagnosis
- anamnestic and clinical, mainly due to pressure pain on palpation
- Running and shoe analysis
- Imaging in case of treatment failure: MRI shows fluid seam between iliotibial tract and bone
- Tests and signs: Renne, Ober, Noble
Symptoms
- Pain initially only after running
- 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
- Frequent: pain first when running for a long time, then when climbing stairs, then when walking
- Reproducibility through running
- only rarely signs of inflammation
Complications
- Recurrence tendency, injury cycle
Therapy
- Cryotherapy (ice packs), alternating baths, heat packs
- Anti-inflammatory plasters or ointments
- Training break: avoid triggering pain. Possibly temporarily switch to pain-free sports
- Strengthening the pelvic-stabilizing hip muscles, abdominal and back muscles
- PT: myofascial release, transverse friction, fascia roll
- Stretching the ITB-associated muscles
- Phonophoresis (ultrasound with anti-inflammatory agent)
- Check running style, running shoes, muscles, foot and axes. For bow legs: insoles. No excessive pronation support
- Rarely surgically through a Z-shaped incision to lengthen the TI
- Prognosis: Healing after 6-8 weeks. Resuming training too early can lead to the injury cycle
- Shock wave therapy
- Local infiltration with cortisone or platelet-rich plasma
- Slow return to training with warm-up and stretching exercises