Uphill jog from here

Many runners experience ITB syndrome - a gradual build-up of pain and tension on the outside of the knee. Mike Stewart explores what you do about it.

As the name would suggest, runner's knee most commonly affects runners.

Its medical name is iliotibial band friction syndrome (or ITB syndrome). The most common symptoms include pain on the outside of the knee aggravated by running, especially downhill.

Sufferers often start their run pain-free, but after 15 minutes or so, start to feel a gradual build-up of pain and tension on the outside of the knee.

The pain gets progressively worse and often stops the individual from finishing a run. Once rested, the pain subsides but will return again if running is attempted.

It's a frustrating condition, and if left alone does not settle with time.

Anatomy

The iliotibial band is a sheath of thick, fibrous tissue extending from the pelvis to below the knee on the outside of the leg. There are attached muscles which control the position and tension of this band.

The pain appears to come from the band irritating the tissue between it and the outside of the femur.

Causes

There are a number of factors that may contribute to this disorder:

* Tightness and/or thickness of the iliotibial band

* Weakness of the hip muscles, especially gluteus medius

* Posture issues affecting the hips and legs, especially individuals with bandy knees

* Excessive pronation or rolling in of the foot

* Overuse or overloading in the training schedule

* Muscle and soft tissue tightness affecting the band position and tension

* Different leg lengths

* Continually running on cambered road surface

Management

A physiotherapist is experienced in the thorough assessment of running and lower limb biomechanics. A full biomechanical and muscle balance assessment will identify any issues.

Your running shoes will be reviewed and a treatment strategy worked out for your individual needs. You may get prescribed and fittted into an orthotic - a device that controls your foot motion and posture during the stance phase of running.

Your programme may also include strengthening, stretching and changes to your training schedule. Most cases of this condition respond well to physiotherapy and should allow you to get back to running in the streets pain-free.

Mike Stewart is a physiotherapist at the Oamaru Physiotherapy Clinic.

He has postgraduate qualifications in manipulative physiotherapy and sports medicine and is a registered physiotherapy acupuncturist.

He toured as a physiotherapist with the Maori All Blacks for 14 years until 2008.