Runner with knee pain for a long time

Patient

Q: I am a 32 yr old active female. I used to be an avid runner, but while training for a marathon about 5 years ago, I started having knee pain in one and then both knees. It's outside pain, sharp and shooting. Does not hurt at all when I walk. So I quit training and have never been able to run even 3 miles again without the pain. I have even gone 2 years without running, gotten new (professionally fitted) shoes, and every time I try to run again, it's back in full force by the 2nd mile. And then sore for the rest of the day. Are my running days officially over??

Doctor

A:    According to your description , it is not an uncommon cause of knee pain in runners the Iliotibial band friction syndrome (ITBFS). It is considered an overuse syndrome that usually is treated successfully with  conservative measures. Iliotibial band friction syndrome (ITBFS) typically is observed in people who exercise vigorously. The overuse creates stress that the body cannot repair, and soft tissue breakdown occurs. In runners, as yourself, friction occurs near or just after foot strike during the contact phase of the gait cycle. Downhill running reduces the knee flexion angle and can aggravate ITBFS, while sprinting and fast running increase the knee flexion angle and are less likely to cause the syndrome. Biomechanical and training factors play a large role in the development of ITBFS. The basic principles of treatment include control of inflammation, modification of activity, and correction of underlying problems. Medical therapy: Medical therapy consists of non steroidal anti-inflammatory medication (“motrin”, “aleve”) with adjunctive physical therapy. These drugs reduce the inflammation in the soft tissue.  Injection of corticosteroid can be used when conservative attempts to control inflammation fail. Activity modification: Examine recent changes in your training, such as duration and intensity of exercise. I strongly recommend that you keep your physical activity to a level at which pain is not generated. Local ice massage can help you: Apply to the knee for no longer than 15 minutes. Ice compresses or cold packs can be used for up to 20 minutes each time. Give it a try with these measures for about 3-4 weeks and see how it goes; the most important is give you enough healing time so this does not become a repetitive stress injury.

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