Q: As a long-distance runner, I like to increase my miles and run outside this time of year. But I recently developed knee pain on the outside of my knee. What do you suggest?
You’re not alone! Long distance running is an ideal way to enjoy Minnesota in nice weather. But, with the increased miles, comes increased risk for injury.
Interestingly, the knee is one of the largest joints in the human body, with more volume, surface area, and cartilage, than shoulder and hip. It also has the greatest susceptibility to injury, wear and tear, and inflammation.
Common causes of knee pain include, osteoarthritis, meniscal tear, ligament injury, patellofemoral pain syndrome, popliteal cyst, bursitis, stress fractures, and referred pain syndromes.
But, one of the most common running injuries is iliotibial band syndrome, which occurs in 15 percent of knee overuse injuries. Iliotibial band syndrome, also known as IT band syndrome, can cause pain on the outside of one or both knees. It is especially common in long-distance runners, but also occurs in athletes who cycle, ski, row, or play soccer, lacrosse and basketball.
People who are just starting to exercise can develop IT band syndrome too.
How it happens
The iliotibial band is a strong, thick band of tissue that runs down the outside of the thigh from the hip to the top of the shin. During activity, the leg bends and straightens, and the IT band moves over the outer edge of the thighbone, called the femur. Research suggests that over time, the repetitive bending and straighten of the knee that happens during running can cause the IT band to compress and irritate underlying structures and tissues, creating pain and irritation.
We’ve seen patients at our downtown clinic present with this condition while training for running races and triathlons. It may start with an aching sensation on the outside of the knee shortly before your workout ends. But, as the condition worsens, pain may start earlier and persist even after the exercise has ended.
To prevent this condition, you can run on more even surfaces and try different shoes. (If running on a track or slanted surface, be sure to run in both directions.)
Rest, the best medicine
The fastest route to recovery is rest. Don’t run through the pain. Pain relievers help reduce pain, as does daily icing — 15 minutes every two hours — but place a towel between the ice and skin to prevent frostbite! In the initial stages of the injury, you will need anywhere from a few days to a few weeks of time off for the initial inflammation on the outside of the knee to calm down. If your case is severe, however, you may need up to six weeks.
The good news
If, in fact, your IT band is the problem, you are probably not going to be sidelined all summer. Once the pain subsides, focus on prevention. There are simple exercises that have been proven to prevent IT syndrome.
Keep running because it’s healthy, but make sure you’re listening to your body’s signs. If rest, ice and the other supportive measures don’t improve the pain after six weeks, it’s best to consult a provider who can help you determine the underlying cause using X-ray and MRI scan if needed.
Good luck on your upcoming races!
Michelle Napral is a nurse practitioner at the University of Minnesota Health Nurse Practitioners Clinic, 3rd Street & Chicago. Send questions to [email protected].