The runner’s knee is an irritation of the iliotibial ligament. It is also known as an iliotibial ligament syndrome (ITBS) or tractus syndrome. The iliotibial ligament is a tendon plate that attaches to the outside of the knee joint and grows into the lateral hip muscles.
It is a strong tendon plate and helps to keep the pelvis in a straight line when walking. During the running movement, this tendon plate constantly moves over the outer bony projection of the thigh bone. Due to a lack of trunk stability and a missing stabilization of the pelvis, this stress can be increased by additional tensile load.
This can lead to irritation and inflammation – the runner’s knee. In addition to the knee joint, it is also important to keep the hip joint movable in a runner’s knee. If the mobility of the hip is restricted, the iliotibial ligament can be further stressed.
First of all, the joints should be prepared for the movement. 1). For example, the knees can be pulled slowly and alternately from a standing position towards the chest.
This mobilizes both the knee and the hip joint and is more gentle than walking on the spot. 2). Slow lunges to the front, back and sides can also mobilize the joints.
3). Hip circling or even circling the knee joints are also good exercises to mobilize the joints. If available, devices such as bicycle ergometers or crosstrainers can be used to warm up the muscles of the lower extremity.
Jumping jacks or running on the spot (for example with knees pulled up) are of course also very good mobilization exercises, but can already be too demanding for the iliotibial ligament with an existing runner’s knee and may cause increased pain. It is particularly important to mobilize restricted movement directions according to the findings. For such restrictions, specific exercises can be arranged for the patient during therapy.
Further exercises can be found in the article Mobilization exercises. Once the muscles, tendons, ligaments and joints have warmed up, the elasticity of a runner’s knee should be improved by means of a detailed stretching program for all knee and hip muscles. The back thigh muscles, the front thigh muscles, the hip flexors, as well as the buttock muscles and the abductor muscles should be stretched.
The adductors of the hip also tend to shorten and should then be included in the stretching program. In physiotherapy, an individual stretching program can be tailored to the patient. By stretching the muscles, the tendons are also lengthened, the connective tissue structures are mobilized in their sliding bearings and blood circulation is promoted.
The elasticity of the tissues improves and they become more resistant. In addition, the mobility of the joints is improved and movement sequences can be executed more smoothly. A light stretching before and after the running load (at the warmed up knee) can reduce pain and prepare the tendons for the following load.
Adductors Stretching exercises for the adductors are for example from a widely straddled position, the feet look forward, with the hands or even with the elbows to the ground to come. The position is held for 20 seconds and then slowly released. AbductorsIn a standing position, you place one leg stretched out in front of the other, pushing your hips outwards and your upper body towards the supporting leg.
The stretching should be on the outside of the thigh. Ischiocrural groupThe rear thigh muscles can be stretched from the supine position. One leg remains on the ground for a long time, the other is stretched and lifted to the chest with the foot pulled tight.
The back and neck remain relaxed on the floor. The stretching can be felt on the back of the leg. Buttock musclesThe buttocks can be stretched from the same position.
The right leg is folded over the left so that the lower lower leg rests on the thigh of the left leg. The hands reach through the hole between the right and left leg and from the outside around the left leg and pull it to the burst. The knee of the right leg pushes down outwards.
The stretch should be felt in the right buttock and the outer right thigh. Front of thigh (quadriceps)When standing or in lateral position pull one leg with the heel towards the buttocks while the other remains stretched. Additionally push your hip forward so that the pull on the thigh increases.More stretching exercises can be found in the article Stretching exercises and ITBS-Iliotibial Band Syndrome.
Since the pelvic instability of the runner’s knee in particular contributes to further stress on the iliotibial ligament, this must be improved. For this purpose, the hip is trained rather than the knee joint. In the one-legged position, the side of the standing leg must provide support so that the pelvis on the side of the raised leg does not sink down.
If the pelvis is not sufficiently stabilized and it sinks, the pelvis exerts pull on the iliotibial ligament on the side of the standing leg. The holding work is primarily performed by the hip abductors on the side of the supporting leg. These can be trained in isolation in a strengthening program.
1). For example, the stretched leg can be lifted from the lateral position. It is important to train only from the hip and not from the back.
To avoid this, the upper leg is stretched down from the lateral position and the pelvis is rotated slightly forward to the floor. The heel lifts first and remains the highest point. The extent of movement is not great, the effort should be felt in the upper thigh and buttocks.
2). However, it is also important to train the pelvic stability physiologically, i.e. in the form in which they are also used in everyday life. Lunges, knee bends or the one-legged position can be favourable starting positions.
With the help of Therabands, pulling resistance can make the exercises more difficult. The use of weights can also be used to strengthen the stabilizing muscles. In addition to stabilizing the hip, if the leg axes (knock-knees, bow legs, etc.)
have changed, this axial malposition should be compensated for by muscles as well as possible in order to ensure that the physiological position of the joints is subjected to as little stress as possible. You can find exercises for this in the article physiotherapy exercises knee. With a runner’s knee, coordination exercises are also part of the training program.
In order to optimize the physiological process during running, the individual knee and hip muscles should work together as well as possible. During training, reaction and balance can be practiced and running on uneven ground can be trained. The one-legged stand trains the reactivity of the hip joint stabilizing muscles particularly well, and can thus improve the responsiveness of these muscles during running training.
From the one-legged stand, balls can be rolled forward or backward with the “free” foot, and objects can be lifted, so that you almost have to move into the standing scale. Coordinative training can be done with or without aids. Good tools to make training more difficult are balance pads, a trampoline, therapy spinning tops or even therabands, balls or similar.
The aids should only be used when the exercises can be mastered safely without aids. Special exercises can be found in the article Coordination and balance exercises. The tendon plate at the outer knee joint is located very superficially and can therefore be treated very well by manual massage grips.
In the runner’s knee, the area on the outer thigh can be irritated and painful. Gentle massage grips can, even if they are initially unpleasant, improve the pain in the knee in the long term. Tendon tissue is less well supplied with blood than the muscles.
The massage stimulates the trophics in the massaged area and improves the blood circulation. Irritations and inflammations can heal better. The massage should be pain-adapted, slight pain may occur, but it should not be too unpleasant.
The massage should be done on the outer thigh. 1). Kneading (approximately where the lateral trouser seam is) across the thigh and also slight strokes with the thumb along the thigh can relax and mobilize the tendon and surrounding muscles.
2). At home, hedgehog balls or massage balls are ideal. Pain points can be treated by so-called transverse frictions.
These are punctual stretches across the course of the tendon and can sometimes be quite painful. They are often used in physiotherapeutic treatment of the runner’s knee to treat the tractus iliotibialis. A separate massage program for home use can be discussed with the therapist if necessary.
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