Fighting Fit

Help! My knees are packing up!

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I recently ran a half marathon. Subsequently, my right knee took a bit of a knock all around, particularly on the outside. It has been two weeks, and it is not getting any better. Could you please give me an advice on this? – SAMSON XULU, SANDTON


Answer
Knee pain in runner’s can have many causes and the main aims of management should be based around attaining a proper diagnosis from the proper specialist such as a sports physician or orthopaedic surgeon.
Some relief will be found in simple treatment principles of PRICE (protection/rest/ice/compression/elevation) where implemented appropriately and as necessary. However, if the exact cause is not determined and corrected, the underlying issues will remain and symptomatic treatment will only provide relief for a period of time before the condition becomes problematic again.



Pain on the outside of the knee could be from various structures in or around the knee. Joint surface cartilage, menisci or ligaments may be involved but the most common disorder in runner’s causing pain on the outside of the knee is iliotibial band (ITB) syndrome.



The ITB is a thickened fascia, which extends from the pelvis and passes over the lateral femoral condyle on its way to attaching to the proximal aspect of the tibia.



ITB syndrome is a common overuse injury especially in runners and cyclists, presenting with pain over the lateral aspect of the knee. It is thought to be a friction-based condition, where the ITB tendon runs anterior to posterior across the lateral femoral condyle, causing inflammation to the underlying bursa.


However, recent research has challenged these traditional views and re-studied the functional anatomy and biomechanics. Anatomically they have shown that the ITB is fixed to the distal femoral shaft and thus back and forth movements are unlikely to occur. Biomechanically, an unfortunate narrow vector is created with poor pelvic and gluteal instability, which when combined excessive internal tibial rotation, a lateral to medial compression of a highly innervated fat pad occurs between the ITB and the femoral condyle.



Management of the ITB syndrome is either conservative or surgical. Conservative measures include correction of any underlying biomechanical disorders, to correct the instability of the pelvis and core as well as any internal tibial rotation that exists. This would be achieved with the help of a biokineticist and a podiatrist. ITB stretches before and after exercise are useful and can be incorporated into any warm up and cool down regimen. Physiotherapists can help to relieve the pain in the area and surrounding structures.


The use of oral non-steroidal anti-inflammatories (NSAIDS), analgesics or infiltrating the affected area with cortisone will be at the discretion of the attending sports physician or orthopaedic surgeon. If these conservative measures do not improve the condition with rehabilitation after an 8-12 week period, surgical intervention is then the decision of the orthopaedic surgeon.



Modern Athlete Expert
Gavin Shang: Sports Physician at the Rosebank Centre for Sports Medicine and Orthopaedics in Johannesburg. Holds a Masters degree in Sports Medicine and has worked with numerous top local and international sports people over the years.

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