Why does pain occur on the outside of the knee?
When the knee is flexed approximately 30 degrees, the inferior edge of the iliotibial tract is pressed as far as possible against the lateral femoral condyle. It is this angle that occurs when landing in running, so the compression zone is loaded thousands of times during training. Previously, the mechanism was explained by the friction of the tape on the bone, but now it is believed that the fatty layer under the tract, rich in blood vessels and nerves, suffers. Additionally, the load is increased by weakness of the gluteus medius muscle: the pelvis collapses on the supporting leg, the knee goes inward and the tension in the tract increases.
- Compression of tissues under the tract when the knee is bent about 30 degrees
- Weakness of the hip abductors and pelvic depression
- Excessive hip adduction and knee roll-in
- Running along an inclined side or in a circle in one direction
- Sharp increase in weekly mileage
Symptoms
The pain is located strictly on the outside of the knee, just above the joint space, and is described as burning or sharp. It’s not there at the beginning of the workout; it appears after a certain amount of running time and forces you to take a step. Particularly unpleasant are descents and running on uneven surfaces, as well as long, even paces; Fast running with a high knee lift is sometimes easier to bear. Swelling and redness are uncharacteristic, motion in the knee is completely preserved. When the disease is advanced, pain also appears when walking up the stairs.
- Burning pain on the outside of the knee
- Pain appears after a predictable running time
- Increased pain on descents and stairs
- Pain when pressing over the lateral condyle
- Clicking or rubbing sensation when bending
- No swelling or joint blockade
Diagnostics
The diagnosis is made by questioning and examination: the doctor finds the point of maximum pain over the lateral femoral condyle, checks the Noble test, evaluates the elasticity of the tract with the Ober test, the strength of the gluteal muscles and the stability of the pelvis in a one-leg squat. Be sure to look at the shoes, the type of surface and the training diary - this is where the reason is usually found. Ultrasound helps to see tissue thickening and swelling under the tract. An MRI is ordered if it is necessary to rule out a meniscal injury, stress fracture, or other pathology.
- Noble's examination and test
- Ober's test for tract elasticity
- Assessing strength of abductors and single-leg squat
- Ultrasound of the soft tissues of the outer knee
- MRI of the knee joint with an unclear picture
- Shoe and training plan analysis
Treatment and exercises
During the acute period, the running volume is reduced and descents are removed, but it is usually not necessary to completely stop training: swimming, high-saddle cycling and strength work are retained. The basis of recovery is strengthening the gluteus medius and maximus muscles, core muscles and the gradual return of running volumes. Cold after exercise, gentle work with the thigh muscles, and physical therapy help. Stretching the tract itself with a roller provides only short-term relief and does not replace strength exercises. Anti-inflammatory drugs and injections are prescribed by a doctor; surgery is extremely rare.
- Temporary reduction in running volume and avoidance of descents
- Hip abduction exercises: bridge, side lying abduction, walking with an elastic band
- Strengthens core muscles and pelvic stability
- Gradual increase in mileage, no more than a tenth per week
- Physiotherapy and shock wave therapy as prescribed
- Replacing worn-out sneakers, running on a flat surface
Prevention and return to running
To prevent the pain from returning, it is important to change not only your knee, but also your training habits. Increase the volume gradually, alternate directions on circular paths, avoid long runs on inclines, and include two strength training sessions per week with an emphasis on the gluteal muscles. Returning to running is based on the “pain-free” principle: they start with short periods of alternating running and walking and increase them until the pain returns. If at some stage complaints appear again, they are rolled back to the previous volume.
- Gradual increase in load and recovery days
- Two strength training sessions per week for the pelvic and core muscles
- Alternating the direction of running in a circle
- Flat surface instead of sloping roadside
- Timely replacement of running shoes
- Warm up and cool down at every workout