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Runner with R ITBS knee
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Runner with R ITBS knee - March 2, 2007 1:47:00 AM
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JSPT
Posts: 284
Joined: April 19, 2005
From: Michigan
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Just saw a 25 y/o female runner this AM. We did a video running analysis to examine her form.
She has been in PT for strengthening of the entire lower body and core, but still has R ITB knee pain when running longer than about 20 minutes.
Are there any specific gait items I should look for; excessive IR of the hips, decreased extension, rotation of the tibia, etc.?
Input appreciated.
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JS
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Re: Runner with R ITBS knee - March 2, 2007 9:40:00 AM
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joelkphysio
Posts: 27
Joined: September 25, 2006
Status: offline
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Eversion of the foot thru midstance, and Glut med (trendelenburg) on that R side during midstance. You likely wont be able to pick up much Tibial IR unless you have a CLEAR high speed camera.
Also look at Up and down motion of the head, torso rotation (or lack there of) and watch for the movement at the L arm (to counter balance any movement that may occur at the R leg stance. Sometimes you can fix the uper body (habit) and the lower body will adjust...
hope that helps a tad.
J
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Re: Runner with R ITBS knee - March 2, 2007 2:33:00 PM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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I'm not sure at all what joel wants you do after you watch for what he is suggesting.
How are you sure it's ITB specific? I'm assuming YOU did the lower/core program, and have determined that there are no biomechanicl issues at play. Did you investigate her running habits?
Does she run primarily outdoors or indoors (TM)? Does she run with or against traffic, crowned roads? Footwear?
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Ed, PT, MTB-XC
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Re: Runner with R ITBS knee - March 3, 2007 5:47:00 PM
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Rwantz
Posts: 84
Joined: December 10, 2004
From: Middletown, PA
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I have an appreciation for Ed's thoughts. Has the runner cut down on the things that are making it hurt (hills and repetitive activities). Do they always run against the traffic? Because that is a key thing with ITBFS. They have to learn to change things up. Shoes are probably more worn than they should be. Three months is recommended and they probably have a lot of mileage.
I have had a lot of success with nothing more than rest, heat, a foam roller, and simple strengthening and education. Orthotics are a consideration for some, but not all. Most of the time it is the running habits that are a problem.
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Re: Runner with R ITBS knee - March 5, 2007 12:35:00 AM
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JSPT
Posts: 284
Joined: April 19, 2005
From: Michigan
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Good ideas. I only asked about the biomechanic stuff because the other things you both mentioned have been addressed. The patient is not one of mine, I was only asked to examine the biomechanics of her running stride.
Her treating PT has done a good job of modifying behaviors, providing orthotics, strengthening/stretching involved structures, etc.
Her pain is elicited when running on a treadmill, so the side of the road, etc., is not currently an issue.
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JS
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Re: Runner with R ITBS knee - March 5, 2007 3:42:00 AM
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garyd
Posts: 15
Joined: October 6, 2004
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Remember that ground reaction forces with running are upward of 3-5 times body weight. For strengthening, that would require sufficient external loading. Squats, lunges, step-ups for some base strength in the 3-5 reps range at a relatively high intensity with respect to her REp Max. Following with some eccentric force absorption work with plyometric work to control the GRF at impact.
If she continues with a trendelenberg type pattern at impact and during single leg support, strength work needs more time and focus. Also check her l-spine for any hypomobility, a compensation of trendelenberg is side flexion that can cause some nerve entrapment/irritation and lead to some inhibition of hip musculature.
Gary
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