HEALTH Knees, niggling and nasty


Andrew O'Brien

The injury of the month seems to be iliotibial band friction syndrome. Staff in the pharmacy, my wife’s friends, patients attending the clinic with back pain, every runner I speak to of late casually mentions ‘a bit of a niggle at the outside of my knee’. Even my cousin, who was visiting from London this week, has been off the road with ITB problems since running the London Marathon in April.
To the non-runner, iliotibial band friction syndrome probably sounds like a contagious, and potentially fatal condition. Regular runners who have dealt with the dreaded ITB know that it can be much worse than that. What starts as ‘a bit of a niggle at the outside of the knee’ can rapidly degenerate into a nasty pain that keeps you confined to barracks for weeks at a time and ruins training programmes at a blink.
But what is the ITB, and why does it cause so much dread in the running community?
The iliotibial band is a fibrous strap that runs down the outer side of the thigh, from the hip bone to the outside of the knee, attaching into the top of the tibia. In university, physiotherapy students are taught that the ITB is non-contractile, and acts as a brace along the lateral thigh to stop our legs from collapsing under us when we walk and run. Pain, we are told, comes from a friction effect at the lateral condyle of the femur (the bottom of your thigh bone) when running.
Historically, it was believed that such friction occurred as a result of the knee buckling inwards when running. Conventional wisdom says that the knee buckles inwards either because your feet collapse inwards (known as overpronation) or the glute muscles are too weak to stabilise the pelvis. As a result, the normal course of treatment is to prescribe supportive shoes and orthotic insoles for the feet and strengthening exercises like the clam and single leg squat.
Sadly for runners, and indeed for health professionals who treat them, research has shown that doing a single leg squat will improve a person’s ability to do a single leg squat, but will not change their running mechanics. Similarly, the load produced during a side-lying clam exercise is nowhere near enough when you consider that impact forces when running are more than double your body weight. And as I tell everyone who asks, there is no evidence that supportive running shoes reduce your risk of injury.
What’s the answer, then? Why is everyone I speak to complaining about pain at the outside of the knee? The answer: overstriding. Most runners land too far in front of their body, which sends a shockwave to the knee, results in longer than ideal ground contact times and increases knee joint torque, all major factors in injury risk. No single leg squat or new shoe can correct these things.  
The next obvious question is ‘Should I just run with a shorter stride’? To which the answer is maybe, but not necessarily. For you see, in running there are so many variables it is impossible to give a single answer to such a question. For most people, the reason for overstriding actually lies in their posture: bending at the hips forces you to land further in front of your body to prevent you from falling over. For others, a slow ‘pull’ of the back leg will force them to over-reach at the front. If you run too fast for your ability, a subconscious fear of falling will cause you to apply a brake in front.
Put simply, in order to reduce the risk of the dreaded ITB, runners need to run better, and the easiest way to do so is to remember what your mum told you years ago ‘stand up straight and just slow down a bit!’.Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at