PFPS and ITBS, WTF?

Have you ever heard a runner say, “I have runners knee”?  Patellofemoral pain syndrome (PFPS), also known as “runners knee” is the most commonly reported running injury and pain is located under the knee or on the inner side of the knee.  It is likely related to poor mechanics such as increased hip adduction (thigh bone moving inward towards the center of the body) and hip internal rotation creating malalignment of the lower extremity joints (Noehren et al., 2010).  Have you ever seen pictures of yourself, or your friends, running and it looks like the runner is knock-kneed or very little space between the knee of the leg that is in contact with the ground and the leg that is in swing?  Hello weak hip abductors! Now it is true that some women have what is called a larger Q-angle (thank you, child-bearing hips!), so the way their thigh bone comes out of the pelvis will be more angled if you will. But you have read about weak hip abductors in my previous blog posts.  Refresh your memory by reading the gluteus medius and piriformis blogs!

Iliotibial band syndrome (ITBS) accounts for 12% of all running related injuries (Strauss et al., 2011).  ITBS is typically characterized as pain on the outer side of the knee. ITBS is quite interesting because most have accepted the theory that ITBS is a friction syndrome or a rubbing between the bottom portion of the iliotibial band and a bony projection on the end of the thigh bone next to the knee. This area of friction is referred to as the impingement zone.  Other theories that cause ITBS exist that make sense and are supported in peer-reviewed scientific literature.  For example, the iliotibial band is not a lone structure, but is connected to a thickened portion of the lateral fascia lata, a fibrous tissue that wraps around all the musculature composing the thigh (think sausage casing) and anchors into the femur (thigh bone) (Fairclough et al., 2007).  At the other end of the iliotibial band, it is attached to the tensor fascia latae (TFL) muscle, which is guess what??? That’s right, another hip abductor and internal rotator! Okay, it aids in hip flexion too. 

In a study of 24 distance runners with ITBS, Fredericson and colleagues (2000) noted that all legs afflicted with ITBS had strength deficits in both the gluteus medius and the TFL and, more important to my readers, correcting the strength deficits lead to resolution of the problem.  In a lecture by physical therapist Dr. Brent Brookbush, he said, “In my clinic, 9 out of 10 cases of ITBS are from a tight/overactive TFL muscle, not from an impingement at the site of pain".  So, all those people that try to foam roll their iliotibial band really aren’t doing a darn thing, because the problem is up higher on the hip and should be foam rolling/applying pressure with a therapeutic device on the TFL.  These types of strength deficits can be determined by chiropractors and physical therapists through manual muscle testing.  Movement screenings that I offer my runners can also be predictive/prehab for the above issues.  Just one of many reasons to hire Run With Gina in your quest for the best half/full marathon training and racing experience possible.

Fight ON!
Coach Gina

Runner Image: Rosy Castro

References:
Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N.,…Benjamin, M. (2007).  Is iliotibial band syndrome really a friction syndrome?  Journal of Science and Medicine in Sport, 10, 74-76.

Fredericson, M., Cookingham, C.C., Chaudhari, A.M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S.A. (2000).  Hip abduction weakness in distance runners with iliotibial band syndrome.  Clinical Journal of Sports Medicine, 37(4-5), 437-439.

Noehren, J., Scholz, J., & Davis, I. (2010).  The effect of real-time gait retraining on hip kinematics, pain, and function in subjects with patellofemoral pain syndrome.  British Journal of Sports Medicine, 45, 691-696.

Strauss, E., Kim, S., Calcei, J., & Park, D. (2011). Iliotibial band syndrome: Evaluation and management.   Journal of American Academy of Orthopaedic Surgeons 19, 728-736.