ITB and knee pain in runners

Running

Our NU Moves Physio team recently debated the current beliefs surround the ITB and how it can give you lateral (or outside) knee pain which is also referred to as ITB syndrome. Here is a simple take home message from a complex discussion.

* The diagnosis of ITB syndrome can be made clinically without investigations

* The lateral meniscal cartilage of the knee needs to be considered as a possible source of pain which may require MRI imaging. A clinical assessment will predict if this is likely.

* The most common cause of the problem is an increase in the amount of running or ‘load’ on the knee. Treatment of acute ITB syndrome must include initially managing the load to help reduce inflammation.  This is usually via modifying the running program.

* The hip is the key to controlling this problem. Most importantly the strength and timing of the gluteal (buttock) muscles need to be sufficient to hold your pelvis and leg stable enough during running. Secondarily having enough flexibility in the hip flexor muscles often helps get the gluteal muscles functioning better.

* Rolling the ITB is a common form of treatment utilised if tightness is perceived as part of the problem. If rolling gives you relief of pain associated with running or any other exercise then we cannot argue with that however understanding the reason behind why it may or may not help is the challenging part. Roll it if it helps you but make sure you start your rehab at the hip.

Exercise can help osteoarthritis

water exercise

Do you know anyone who suffers from osteoarthritis? It occurs when the cartilage that lines the bones in your joints breaks down through trauma or age. It is most common in weight bearing joints such as your hips, knees and ankles. The greater the compressive forces placed through these joints – the greater the inflammatory response, pain and stiffness. Being overweight increases the compressive forces on our joints, making weight bearing challenging and exercise painful. Once you get arthritis pain it then becomes harder to exercise.

What is the best management of being overweight and having osteoarthritis?
There is a common misconception that weight loss occurs through exercise and physical activity. Recent studies looked at the effect of diet and exercise on weight, inflammation (measuring markers in the blood), joint compressive forces, pain, function, mobility and quality of life in people with osteoarthritis. The study reports that in fact a combination of diet and exercise provided the greatest loss of weight (10%) compared to exercise alone (2%). The group with combined diet and exercise management also experienced a better reduction in joint inflammation and pain, as well as improved function, mobility and quality of life compared to the exercise alone group.

What type of exercise is best?
A separate study looked at types of exercise undertaken in individuals with osteoarthritis. The study found that the best type of exercise for pain relief alone is water based exercise. The type of exercise most beneficial to improve function was a combination of strengthening and flexibility exercises alongside a low impact form of physical activity e.g. aqua aerobics or walking.

The general advice that can be provided based on these articles is valuable but everyone is different in the type of arthritis through to what exercise program will give the best results. If you or someone you know are suffering from osteoarthritis the best approach it to start with personalised research based advice on how to reduce pain, increase strength or decrease weight. Our physio’s at NU Moves are experts in exercise for arthritis.

* Uthman OA, van der Windt, et al. Exercise for lower limb Osteoarthritis: Systematic review incorporating trial sequential analysis and network meta-analysis. BMJ 2013; 347: f5555

* Messier SP, Mihalko SL, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults with Knee Osteoarthritis. JAMA 2013; 310 (12):1263-1273.