I was asked recently what the most common injury is that I treat in my clinic. Most would expect me to answer this question with low back pain, neck pain or headaches. Although I do see many of those conditions, one of the most common conditions I treat is knee pain in the semi competitive runner. Usually these patients run recreationally, and occasionally enter 10K, ½ marathon and marathon races. While ramping up the mileage these patients begin to experience knee pain that begins mid way through the run increasing in intensity until they are forced to stop due to the severity of pain.
Running produces substantial force and shock to the joints, bones and soft tissue of the lower extremity through repetitively loading and unloading of those structures. Every time the heel strikes the ground, a force of 5-10 times the athlete’s body weight must be absorbed by the soft tissue such as muscles, tendons, ligaments and cartilage. Over time, this repetitive cycle can wreak havoc on those tissues. The most vulnerable of the at-risk structures are the hamstrings, meniscus and Iliotibial Band (ITB).
The ITB is of specific interest because it is one of the most common conditions that plague the recreational and competitive runner. The ITB is a fibrous tissue that runs down the outside (lateral) side of the upper leg from the hip to the knee. One of the ITB’s main functions is to stabilize the knee joint. Increased mileage means increased workload for all of the structures involved in running including the stabilizing ITB. The increase in activity often results in increased tension in the ITB that will ultimately change the mechanics of the knee joint. In the case of a tight ITB, the knee is constantly being pulled in one direction resulting in a lateral and torsion load on the knee joint that will wear out the other structures of the knee. Think about driving your car when the wheel alignment is off. The car will always be pulled to one side of the road, so you have to steer in the opposite direction. After hundreds of miles of slightly “turning to the left”, the tires are going to wear out far quicker than if the wheels were aligned properly. Not only does this lead to injury and pain symptoms, but performance declines as well. The body must expend energy to overcome an intrinsic force resisting proper knee motion before it is able to expend energy to perform the intended task, in this case running.
Many runners are great about maintaining their strength and flexibility, and others are not. However, most runners, ingeneral, forget to stretch their ITB. It is a simple structure to stretch, but not in the classic sense. Most people view stretching as a ‘position and hold’ type maneuver. While this is appropriate for many muscles, the ITB is a certain exception. Because there is not a large range of motion associated with the ITB, it is very difficult to place the body in a position that will lengthen ITB. The most effective way to stretch the ITB is to “roll it out
”. This is accomplished by placing a foam roll (think rigid pool noodle) on the ground. Orient your body so that the outside of your leg is on top of the foam roll and the foam roll is perpendicular to the leg.
Hold your upper body off the ground with your arms and move your body back and forth over the foam roll so that the rolling like a rolling pin on the ground.
Foam rolls are inexpensive and can be purchased from most sports supply stores or our clinic for $20. They are also available at most gyms and fitness centers.
Rolling out the ITB in conjunction with stretching the hamstrings and quadriceps on a regular basis goes a long way in keeping the recreational and competitive runner fast and pain free.