Runners Knee on the other hand is found in those who run because every time we land on our foot, in a single leg stance, we use our hip muscles to help stabilise us.  Now how does this make sense?  You are probably thinking how does the hip affect the knee pain in those with Runners Knee?  Well, the pain you feel on the outside of the knee is likely to be coming from the IT Band.  The IT band is a long fibrous form of fascia that originates from the hip region and runs down the outside of the leg and attaches onto the knee.

But how is this affected?  As I have already mentioned, when you run, each time you go into a single leg stance, your hip muscles help stabilise the whole body, including the knee.  The aim of this stabilisation is to keep the knee as close to the mid-line of the toes.  In order to do this, the hips must pull the knee outwards.  This is achieved by the hip contracting and pulling on the IT Band, which then helps keep the knee neutral.

When the hip is not strong enough to do this though, the IT Band takes over and compensates by trying to pull the knee outwards.  It is important to understand here that this is not the job of the IT Band.  The IT Band should be the anchor point of the hip muscles.  The hip should pull the IT Band, not the IT Band pulling.  This is what can lead to the pain we feel in the lateral part of the knee.  See the picture below – the picture on the left  shows what we want it to look like whereas the picture on the right shows the knee collapsing inwards.

When managing IT Band issues, the key is to perform a full assessment of WHY the issue is occurring.  Usually it is a result of overloading in training and the hip muscles become Hypertonic (which means very tight) and therefore lose their contractability due to lack of nutrients/oxygen reaching the required area.  If this is the cause then soft tissue work to the area may help to ease/relieve the muscle and create a happier environment for the blood to flow better.

Following on from this, it could be that simply reducing the volume can be enough for the body to recover enough to restore homeostasis and enable you to carry on performing.  Usually though, this intervention only has short term benefits and ultimately when you come to increasing your load again you can find the symptoms come back again, and sometimes come back worse.

In most cases though your assessment will reveal some very interesting findings and ones which good interventions can be applied to in order to help reduce the symptoms.  One of the biggest findings I see, from my own clinical experience, is the knee of the affected leg turning inwards or ‘collapsing inwards’.  As discussed previously, the hip muscles job is to pull the knee outwards through the fixation of the IT Band.  We now know that sometimes this driving force is not utilised and instead the IT Band does the work to compensate.

When we have knee pain as a result of this finding, a big intervention is to work on ensuring the stability of the knee through the use of the hip muscles.  There are some very specific exercises to do which can encourage better recruitment of the hip muscles and being guided through these to show what should be felt and where is an excellent starting point.

It is important to note too that the management of this condition should not involve complete removal of the one thing that bought this on, and that is running!  The skill is in getting the loading strategy correct with optimal loading and better movement mechanics.  If you can combine these together then the outcome should be very good.

I recently saw a young runner who was suffering from this condition.  The young athlete was competing at National Standard so getting their management programme correct was key.  Through structured planning and organisation, with specific exercises which were adapted and reviewed on a regular basis, we were able to fully restore their pain levels to normal and at the same time managed to improve their running ability (more likely through a better managed training programme – which was supported by a new rehab regime).

The bottom line here is that this condition can be painful and hard to manage, but with expert help and guidance, as well as a determination to succeed and get better, then the turnaround can be very good and the outcome even better.  Being able to run faster for longer is going to be great in any runners eyes!