Due to the nature of the sport and the amount of training, runners face a host of injuries and overuse conditions. These are the main ones I see in my practice
- Patellofemoral syndrome/pain
- Patellar tendonitis
- Bony bruise/stress fracture
- Meniscal tears
- Chondral/cartilage lesions
I will only discuss the first 3 as the last 2 are discussed under their own headings.
PATELLOFEMORAL SYNDROME / PAIN
This is the most common condition seen in runners. It is essentially pain in the front of knee with no obvious pathology. The causes are multi-factorial but overuse is very important. It is more common in long distance runners and generally results from a tired quadriceps muscle.
There is never any fluid or swelling in the knee and when there is, it is important to have an MRI to rule out or diagnose a cartilage lesion in the knee.
The mainstay of treatment is rehabilitation, with the main focus being on eccentric quadriceps strengthening and core stability exercises. Staying away from the inciting cause is also important. This condition gets better with exercise but overuse exercise.
In a small percentage of patients, surgery is needed. These are usually in refractory cases where a cartilage lesion is diagnosed.
Patella tendonitis is inflammation that occurs in the patella tendon (just under the kneecap). It is also known as jumper’s knee. It is caused by overuse and putting too much strain through the patella tendon and is common in jumping sports (such as tennis, volleyball) and running. It can however occur due to an acute injury (sudden hard contraction of the quadriceps muscle causing a tear in the tendon).
- Ice and anti-inflammatories
- Avoid precipitating cause
- Rehabilitation is cornerstone of treatment with specific attention paid to eccentric quadriceps training and core stability exercises. This is the most important.
- Cortisone injection into the inflamed area
- PRP injections (see PRP section)
- Extra-corporeal shock wave therapy
- Surgery (rare)
These injuries heal better with movement so rest is not advocated
ITB (ILIOTIBIAL BAND SYNDROME)
The iliotibial band is a band of fibrous tissue that runs down the outside of the leg. It arises from the hip and runs down to insert on the outside of the tibia just below the knee joint. This band adds to the stability of the outside of the knee.
ITB syndrome occurs when this band is irritated as it runs over the lateral epicondyle (outside of the end of the femur). At the lateral epicondyle, the ITB runs over bone and muscle and a bursa (cushion) ensures easy gliding over this area. However, due to numerous causes listed below, this bursa can become inflamed leading to pain with movement. This is essentially a friction syndrome and due to overuse (training too much or increasing intensity too soon). It is extremely common in runners.
- Over training
- Short or tight ITB
- Running on cambered surfaces
- Wrong running shoes (worn or anti-pronation shoes) causes the leg/foot to be pushed inwards
- Downhill running
The main symptom of ITB syndrome is pain on the outside of the knee. It is normally a sharp pain that comes on with exercise and usually gets better with rest or stopping the activity, but begins again when one starts the activity again (even after a prolonged period of rest).
One normally does not get any swelling but there may be some over the inflamed area on the outside of the knee.
Physical examination usually only yields pain to palpation on the outside of knee. Importantly, there is no increased fluid (effusion) in the knee. The rest of the examination is normal.
There are many other causes of pain on the outside of the knee, but the most important ones to exclude are a meniscus tear on the outside of the knee or a lateral collateral ligament injury. Examination may be sufficient to exclude these conditions, but sometimes an MRI is needed.
Treatment options include:
Applying an ice pack for 15-20 min 4 times a day can help to relieve pain and settle the inflammation
Taking anti-inflammatory medications such as celebrex, arcoxia will help reduce the inflammation
Specifically paying attention to stretching exercises of the ITB and myofascial releases via massages will help to release the ITB especially when tight. Core stability exercises are also of great importance
- Eccentric exercises
Eccentric exercises not only help to stretch out the ITB but also condition it and the rest of the leg muscles to become a controlling force and absorb the forces put through it
- Cortisone injection
May be indicated and help when the above does not help. Helps relieve the inflammation
- PRP (Platelet Rich Plasma) injections
See section on PRP in Biological healing. Stimulates healing of the inflamed bursa and tendon by injecting growth factors around the area.
In very rare circumstances, surgery may be needed when all the above options have failed. The surgery undertaken is to make a small cut in the ITB which not only releases the ITB but also the friction on the bursa.
Prevention is key.
- Gradually build up your exercise intensity and frequency
- Avoiding the exercise that caused it in the first place
- Avoiding running on cambered surfaces
- Correct shoe wear (be careful of being told that you over-pronate and need anti-pronation shoes)
- Stretching the ITB before exercise
- Maintaining a good core stability
- Cross training