ITB syndrome is a fairly common problem, often associated with running. “ITB” stands for “illiotibial band”, which is a band of fibrous tissue that runs from the illium (on the outside of your hip) to the outer part of the knee joint at the top of the shin bone (tibia). The mechanics of the muscles inserting into the ITB means it is susceptible to overuse injuries, particularly if there are any weaknesses or faulty movement patterns involved. Pain will often present towards the outside of the knee where the band can rub over a small sack of fluid, called a bursa. Both the tendon and the bursa can get inflamed and cause pain, and this is frequently noticed towards the end of a run and after completing the run.
Treatment initially involves rest, ice, possibly accompanied by soft tissue release and/or acupuncture. This will quickly progress onto strengthening, stretching and functional training to ensure any underlying causes are addressed. Remember, do not run through the pain as it will only get worse. A little rest and treatment as soon as you feel it can get you back on track with your training as soon as possible.
Patellofemoral pain refers to pain in the patellofemoral joint – let’s start with a bit of anatomy.
The femur is the thigh bone and this sits on top of the tibia (the shin bone), and in front of that sits the knee cap, known as the patella. The patella sits in a groove at the front of the femur, and it is where the femur and patella meet that is known as the patellofemoral joint.
The patella is what is known as a sesamoid bone, which is a bone inside a tendon. Think of it as a floating bone, with muscles that insert in and around the patella. This means that it is susceptible to being pulled one way or the other
So how does pain originate from there?
Pain tends to present as a form of inflammation in the joint. Think of it like an excess or cumulative amount of pressure that can lead to pain and inflammation. For example, if the knee cap gets pulled a little to one side, usually towards the outside of the joint. This means the contact area between the joint surfaces of the patella and the femur is reduced, so the same amount of pressure goes through a smaller area and this leads to pain. Think of it like standing on a pebble as opposed to a nice smooth wooden floor.
So how do we correct it?
Well that depends on the underlying cause. We will aim to reduce the symptoms as quickly as possible and minimise your time off your chosen sport or activity. Symptom treatment may come in the form of foam rolling, acupuncture, massage or taping. This will be accompanied by some simple exercises in order to address biomechanical issues. One approach may be to work on the timing and strength of the quadriceps muscles – but the best approach will become clear after the assessment.
This will then be progressed to some more functional strengthening so you can easily incorporate the exercises into your normal routine, and you may be surprised at how little time this will take.
Achilles tendinopathyThe Achilles tendon is the tendon that connects the calf muscle to your heel bone. Achilles tendinopathy is an umbrella term that describes a problem with this tendon, but generally this can be either an inflammation (tendinitis) or a structural remodelling problem related to long-term overuse (tendinosis). The inflammatory problem has previously been overdiagnosed as it now appears that a tendinosis is far more common. It is often seen in runners due to the repetitive nature of the sport which can lead to lots of overloading of the tendon and surrounding tissues, particularly if there is not enough rest included as part of the training programme. A thickening of the tendon can often occur which can feel like a small (or sometimes much larger!) lump on the Achilles.Following diagnosis, treatment tends to involve a specific strengthening and stretching programme along with soft tissue treatment techniques, mobilisations of the ankle and sometimes acupuncture. As it begins to improve, focus will be shifted towards functional re-training as well as identifying any problems that may have predisposed the injury in the first place, such as tight or weak muscles either near the Achilles or further up the leg. The training programme will also be adapted in order to avoid a recurrence in future. This will not necessarily involve a reduction in training quantity but will likely involve some increased variety and should also lead to improved performance. Whether it is elite level sport you want to return to or just get back to doing some jogging, the condition is very treatable and the sooner you get it seen to, the quicker you can get back to your running.