Image Source: health.com.
The Myth:
The common misunderstanding is that runner’s knee is a problem at the knee. This goes back to one of the more pervasive misconceptions of the human body: the one that says “the pain signals the source of the problem“. This couldn’t be further from the truth in this instance.
What is runner’s knee, then?
We’re mostly told that the IT (iliotibial) band is tight and it’s pulling on the insertion, causing pain and the potential for tendonitis. The treatment is commonly to work the IT band to “release” it.
Only part of this is actually true. It’s certainly true that the IT band is tight. The thing is, it should be in order to perform its role of stabilizing the knee. We don’t want to change that. In other words “we don’t want to loosen it!“. Because the IT band is non-contractile, if you loosen it, it’s permanent – and it means your knee will be destabilized. The great thing is, it’s almost impossible to change its length through manual therapy. The band is too strong and let’s not even mention the fact that it’s uniformly attached to the full length of the femur.
So now that we know this, please abandon all attempts to lengthen said IT band.
It’s not that runner’s knee doesn’t involve the IT band, it’s just not its fault! Who’s fault is it then, you ask? It’s the fault of the musculature that merges with the IT band and pulls it in different directions. Muscle tissue has the ability to develop greater tension, based on its level, type and technique of activity (or inactivity). Tension in the musculature in turn pulls on the IT band. Without the ability to change length, the IT band can’t absorb this pull, and must therefore pass it onwards to a tissue that can absorb it by changing length. (Thus ensues pain at the knee).
The two main culprits:
There are many muscles that are continuous with the IT band and therefore exert some degree of force on it. They may all contribute to runner’s knee in some way, but there are two main muscles you need to know about in particular. The first muscle exerts the greatest amount of influence over the additional pull on the IT band. The second muscle is the most common cause for the first muscle becoming problematic and therefore combined, are the ones most likely to be causing runner’s knee. You’ll notice, they’re not at or even near the knee:
Image Source: nutrition8020.wordpress.com.
• TFL – the tensor fascia lata – generally causes issues when it is hyperactive and hypertonic.
• Gluteus Medius – tends to cause more issues when weak and/or not activating properly.
The Solution:
Redirect your attention to massaging and training these two muscles. The chances are strongly in your favour for relief if you do. Here is a guide to show you how to access those muscles for self massage and isolation in a sustainable way:
Release of the TFL:
Note: My recommendation would be to only utilize the static portion of this release – don’t move around too much.
Strengthening Gluteus Medius:
Bonus myth:
“Runner’s knee is from an inflamed bursa under the IT band”. There isn’t a bursa there! 🙂
For more reading like this, check out these blogs: “Just Because It Hurts Doesn’t Make It A “Deep Tissue Massage”.” & “You Probably Think There Are 4 Quadriceps Muscles. Think Again.“.
Very interesting, I amazed by one of your first comments “the pain signals the source of the problem“ and am curious if that applied in other human realms outside our physical body. Secondly I am also curious, I use to think that strength training a muscle would create tightness in the muscle, so prior to this article I would have thought “only stretch the glut med and TFL”, I am now under the impression that strengthening does not necessarily create uncomfortable tension. If you have any insight around that would love to hear!
Very handy article, thank you!
Jose! 🙂 Thanks for your comment here. It’s a really common thing for us to “chase pain”, and yet, most commonly, the source of the issue is NOT at the site of pain. Pain is a very cerebral event, and can have very little or even nothing to do with the severity or location of injury. With reference to your question about whether this is transferrable outside the human body, i’d have to be given an example to contemplate. My response depends on how we view and discuss the “mind”. If we see the mind as something outside the body, the yes, it would be, because our mind plays a really big roll in how we experience pain. The placebo effect is a legit thing and our mind plays a big roll in that.
Ahhh, love that thought! The conception that strength training only causes tightness is a fallacy – we need to rethink what tension is and when it’s too much or not enough. Over-training can cause greater tension (especially when not using a full range of motion), but so does under-training. I wrote a blog about this a few years back, which I need to go back and refine with some more updated knowledge, but it’s a start: https://navina.ca/blog/2016/09/28/key-painfree-right-amount-tension/
This was super interesting. I’m going to forward this along to a couple of my clients for sure. I think we all catch ourselves from time to time just saying things we’ve been told instead of fully understanding them. IT y’all is one of them for me. Great and simple info to make lasting changes!