Runner's Knee pain: possible Iliotibial Band Friction Syndrome

Patient

Q: A couple days after running a half marathon 13-1 miles. i started to have pain directly behind the medial portion of the knee. it is getting better, but still hurts when i run or have it in flexion position. the pain has also starting to progress up the leg. i am running a marathon in 4 weeks. is it safe?

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 drugs (“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 or swelling persists for more than 3 days. 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 this 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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