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DIY Diagnosis: Runner’s Knee Vs. Iliotibial Band Syndrome

  • By Mackenzie Lobby Havey
  • Published February 26, 2016

How to tell the difference between two of the most common knee injuries.

It’s no secret that knee injuries are one of the top ailments triathletes run (literally) into. Issues can range from a persistent ache to a season-ending problem. To both treat and prevent these types of injuries, you must first properly diagnosis them. In most cases, the two main conditions that afflict triathletes are iliotibial band syndrome (ITBS) or patellofemoral pain syndrome (PFPS), aka “runner’s knee.

Where Is The Pain?

Discomfort in the front of the knee is usually caused by PFPS. “Symptoms include pain under the kneecap, especially when going down stairs, grinding or popping of the kneecap, and discomfort while sitting in a flexed knee position for a prolonged period of time,” explains Ann Wendel, a physical therapist and licensed athletic trainer in Virginia.

While ITBS can present as far up as the hip, most athletes experience issues farther down the chain. “ITBS is most commonly experienced as pain in the lateral or side of the knee, usually just above the knee joint,” says Wendel. “The outside of the knee might be tender to touch and appear swollen.”

What’s The Cause?

The causes of both PFPS and ITBS are often associated with strength deficits that affect your stride or errors in training. “There appears to be a relationship between weakness or mistimed firing strategies of the gluteus medius and maximus muscles and both PFPS and ITBS,” Wendel says. Put simply, when certain muscles aren’t strong enough to do their fair share of the work during running, it forces others to compensate, which can lead to knee injuries.

The other commonly cited cause for these knee problems is increasing your running mileage too quickly or changing other training variables abruptly. “The general recommendation is to avoid increasing weekly mileage by more than 10 percent per week,” suggests Wendel. “Your body needs time to adapt to increased mileage.”

What To Do

If you’re having trouble identifying the cause of your injury, a physical therapist should be your first stop. Not only can they assess strength imbalances, they can also analyse your gait for inefficiencies.

When it comes to knee injuries, backing off of running is generally a step in the right direction. “Typically some sort of modifications need to be made to the training program when an athlete is having pain,” says Wendel. “However, the most important thing is to address the underlying cause, which may require a running analysis and implementation of specific drills to improve form.”

Indeed, by getting to the root of the issue, you’ll be able to bulletproof your body from future injuries. For instance, if you suspect that a weak core is putting extra strain on your knees, starting a strength program that focuses on that area can help you skirt knee pain. Or perhaps a tight IT band is the cause. In that case, a simple regimen of foam rolling may serve as both treatment and prevention. It’s all about doing the detective work to find out what’s causing the problem in the first place.

Wendel also suggests being purposeful about where and how you run. “Mixing up running surfaces may change the stresses on the legs and will help you avoid running on the banked side of the road during every run,” she says.

She also adds, “Landing with a bent knee and reducing over-striding can reduce forces through the knee. There is also some evidence that increased trunk lean may help reduce stress on the patellofemoral joint, but little is known about the long-term implications of this strategy.”

Whether you rely on a PT or are able to self-diagnose, be sure to exercise caution when jumping back into training. Utilising that 10 percent rule when increasing mileage will help keep you from ending up right back on the bench.

The Basics

Where is the pain? Front of the knee
What it is: Patellofemoral pain syndrome (PFPS, or “runner’s knee”)
Symptoms: Pain under the kneecap, especially when going down stairs; grinding or popping of the kneecap; and discomfort while sitting in a flexed knee position for a prolonged period of time

Where is the pain? As far up as the hip, but typically on the outside of the knee
What it is: Iliotibial band syndrome (ITBS)
Symptoms: Pain in the lateral or side of the knee, usually just above the knee joint; the outside of the knee might be tender to the touch and appear swollen.

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