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 it’s 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:
• TFL – the tensor fascia lata – generally causes issues when it is hyeractive and hypertonic.
• Gluteus Medius – tends to cause more issues when weak and/or not activating properly.
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:
“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.“.