Knee Injury

[mishy040379]

I just ran my first 8 miles at about a 10 minute pace 3 days ago. I felt great until just at the end. The outside of my right knee felt weird and I was glad that I was near the end of my 8 mile run. The rest of the day my knee felt bad and uncomfortable to sleep with and the following morning was difficult to walk.
I ran 4 miles yesterday and my knee was still bothering me. Can anyone please help me to diagnose and cure or what can help? Thank you, Michelle
P.S. I have flat feet .I feel that running for me is alot of trial and error. I have tendonitis in both of my legs and that seems to be subsiding and not I have this knee pain. I want to be a injury free runner. could that ever happen?

[Eugene Zeitler]

Hi Michelle,

You don't mention any trauma prior to the knee pain so I assume that it is an overuse injury. The structures that can be implicated on the outside of the knee include the

-lateral collateral ligament (LCL)
-lateral meniscus
-iliotibial band (ITB)

Since there was no trauma it is unlikely that it is the LCL or the lateral meniscus. That leaves the ITB.

The iliotibial band (ITB) is a fibrous tissue running from the hip to
the outside of the knee. With repetitive bending of the knee, friction
can build up between the ITB and the bony prominence of the knee.
Constant irritation to this area causes pain on the outside of the
knee called iliotibial band friction syndrome (ITBFS).
ITBFS is common in runners, and cyclists. In runners, the irritation
is often caused by uphill or downhill running, running on a road
with a pitch or increasing your mileage or intensity too quickly. In the general population, ITBFS can be caused by flat feet, feet with high arches, a short leg, being knock kneed, gait abnormalities, stair climbing or
tight muscles such as the hamstrings, quadriceps, tensor fasciae latae or calf muscles.
Diagnosis of ITBFS is usually based on the patient’s history and
examination. X-rays and MRI studies usually do not provide much
benefit. ITBFS typically responds to conservative treatment within
6-8 weeks. If the patient fails to progress under conservative
treatment, surgical release of some of the fibers of the ITB is a last
resort and can help relieve the pain.
Conservative treatment for ITBFS is varied based on the patient’s
clinical presentation. For individuals with a short leg, a heel wedge
can correct the leg length discrepancy and alleviate the symptoms.
Patients with flat feet, a high arch or knock knees should be fitted
with a pair of orthotics to correct the bony alignment of the feet and
knees. Muscles from the feet to the low back should be assessed to
determine which muscles should be manually treated with Active
Release Techniques or other forms of myofascial release to breakdown any scar tissue caused by the
repetitive friction of running and cycling. Chiropractic manipulation
to the joints of the foot, ankle, knee, hip and or low back makes
sure that these joints are functioning appropriately. Ice and
medication can help reduce the inflammation caused by the friction
between the ITB and the bony prominence of the knee. Runners
may need to decrease their mileage or discontinue running until the
pain and inflammation are under control. Off road running, running
on flat surfaces and using softer running shoes can be highly
effective in reducing the knee pain. I also usually put kinesio tape on the knee & or ITB to help aid in the healing process.
For those individuals who do not completely improve through these
conservative measures, a cortisone injection can decrease the
inflammation in the knee and aid the rehabilitation program. I find that people with ITBFS often have weak hip muscles and this usually affects their stride because the muscles fatigue which than affects the normal running stride. Hope this helps. Remember if your symptoms don't improve you need to seek the help of a professional.

PS-I believe if you talk to most runners injuries are part of the sport. The best way to keep injuries at bay is to do a dynamic range of motion warm-up, cool down post training, stretch away from exercise, use a foam roller on your legs religiously, strengthen your core muscles and balance out a good training and recovery regimen.