I have a horrible pain in my outer left knee.

I have been running 5ks for several years - recently added a couple miles on trail and road running - switch shoes a lot too - the last 5 months I have a horrible pain in my outer left knee after 4 miles (like clockwork!!) - recently I did the Turkey Trot 10K in Detroit and lasted 5 miles and a quarter and the same pain kicked in - brings me to a halt. Is this IT band pain? If so, how come I am able to run pain free for 4 or so miles and THEN the pain kicks in? Why wouldn't it start sooner? Shelley

It does sound like you maybe dealing with ITB pain. This is a very common injury in the running community and can often be easily taken care of with the proper intervention. ITB pain or tendonitis is a repetitive or an over use type injury, this is why it takes several miles before pain is felt. If your car has a low tire it takes a while for the tread to wear uneven, the same with the ITB. If abnormal stresses are introduced into the knee and ITB it will take several miles and time to cause it to become painful and inflamed. Once you take away the stress (stop running) the pain goes away!

What you need to do is figure out why abnormal stress is being introduced into the ITB and knee. The most common reason is over pronation of the foot which causes excessive medial rotation of your lower leg which pulls on the ITB. Since you have been experimenting with different shoes you may want to make sure you are stick with shoes that fall in the motion control category (especially if you know that you have flat feet). If you already have several shoes that you like but they fall into the stability or cushion categories you can try adding an insert such as a power step for added stability. The crew at running fit can help you assess your shoes and any proper inserts that may be helpful.

Another very common reason for ITB pain is pelvic asymmetry and tight gluteal/lateral hip musculature. This can be caused by a number of reasons but in your case the recent addition of trails to your training is probably the culprit. Trail running requires a much great recruitment and utilization of your core and hip stabilizers compared to road running. You may have developed excessive tightness of Tensor Fascia Latae (the muscle that attaches to the ITB at the hip) and the deep gluteal musculature which also have attachments to the ITB. You want to make sure to add stretches that emphasizes these key muscles: Tensor Fascia Latae, Gluts and the Piriformis.

Try these interventions and if you dont get relief I would get an evaluation by a physical therapist. They can assess for any abnormal gait and running patterns and look for any pelvic asymmetries that may cause these same symptoms.

Good luck and feel free to contact me with any questions or stop into our free running clinic that we hold every 1st and 3rd Thursday of the month!

Brandon Lorenz, MPT
Great Lakes Institute of Manual Therapy

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