Runner's knees

from Wikipedia, the free encyclopedia
Classification according to ICD-10
M76.3 Tract-iliotibial scouring syndrome (Iliotibial band-syndrome)
ICD-10 online (WHO version 2019)
Ilio-tibial band syndrome (ITBS)

The runner's knee or ilio-tibial ligament syndrome (ITBS) or tract syndrome is a widespread pain syndrome that occurs due to overuse of the musculoskeletal system, especially in runners .

anatomy

The iliotibial tract is a strip of fascia that pulls down from the iliac crest, supports the muscles as an extensive tendon-like covering on the outside of the thigh and is anchored to the head of the tibia . The iliotibial ligament plays an important role in the human stance due to the principle of "tension belts", as it reduces the bending stress on the thigh bone. In addition, the iliotibial tract, like the Achilles or patellar tendon, could act as an "elastic energy store" in that it can store and release energy like a rubber band when it is lengthened.

For a long time, the pain-causing mode was seen in the fact that the iliotibial band rubs against the protrusion of the joint of the thigh ( epicondyle) , similar to a rope on the edge of a rock. Recent research suggests that the epicondyle presses on the tract and see pressure rather than friction as the cause. In the same way, especially in long-distance runners, this can lead to overloading and irritation of the periosteum and the bursa . The pain syndrome itself is known to many runners and cyclists and, as tractus syndrome, the most common in pain in the area of ​​the outside of the knee joint.

While in the Anglo-American language area a distinction is made between the Runner's Knee ( Chondromalacia patellae ) and the Iliotibial Band Syndrome , in the German language area both are referred to as " runner's knee".

causes

The ultimate cause of the pain syndrome is permanent strain on the musculoskeletal system, as is common in long-distance running or cycling. It is favored by leg axis deviations (bow or knock knees) and foot misalignment, such as those that occur in the long term. B. after ankle sprains (= twisting ankle) can occur. Furthermore, weakness in the pelvic stabilizers can promote the occurrence of ITBS. The unloaded hip sinks and there is excessive tension on the tract. Over- supination of the foot when running, different leg lengths and shortened, inflexible muscles, especially on the outside of the thigh, are further anatomical factors that can favor a runner's knee. On the other hand, too frequent training sessions on sloping roads, building up training too quickly and too many fast training sessions are methodological causes of a runner's knee.

Symptoms

The sharp pain in the runner's knee can become so severe that it makes running impossible and even normal walking is severely impaired. The pain is often only observed when walking for a long time, then when climbing stairs and then also when walking. The pain, which can emanate from muscles, tendons, capsule and joint cartilage, is usually indicated as stabbing on the knee joint or on the outside of the knee. This happens e.g. B. when "stepping into a hole" or a fall. However, redness and swelling are rare.

diagnosis

The clinical picture can be diagnosed relatively easily by a doctor, even without imaging procedures such as X-rays or magnetic resonance imaging . The area in which the iliotibial tract slides over the thighbone is painful to feel.

In less clear-cut cases, ITBS should be differentiated from knee joint damage with similar symptoms. In addition to other tendinitis , meniscus damage and arthrosis can also cause similar complaints in the outer knee joint in this area .

Therapies

In the case of acute pain, cryotherapy ("ice packs"), anti-inflammatory ointments or plasters and a break from training are very helpful. Stretching exercises for the tract and strengthening exercises for the pelvic stabilizers and the abdominal and back muscles have a preventive effect. Good running shoes , warming up and stretching exercises before prolonged exposure can also prevent the occurrence of pain syndrome. In addition, it is advisable to use physiotherapy to prevent recurrence by using myofascial techniques and relaxing the muscles. After six to eight weeks, the injury has usually healed.

If the knee is reloaded too early or too heavily, this can lead to a so-called "injury cycle". Insoles or adapted running shoes may be helpful in the case of leg axis deviations.

Cortisone can also be injected as an anti-inflammatory .

surgery

As a further measure, if all of the therapy measures listed above have failed, there is still the possibility of an operative intervention . The tract is lengthened by a Z-shaped incision and thus relieved. Another procedure is the removal of the inflamed tissue between the iliotibial band and the epicondyle by means of a jointoscopy .

Risk factors

A knee misalignment , especially as a genu varum ( bow leg), can favor a runner's knee. Furthermore, inflexible and shortened tendons on the outside of the thigh and a shortened tract can be risk factors for favoring a runner's knee. In general, people are often affected who walk often and for a long time or who put intense strain on the knee at high frequency.

See also

literature

  • M. Fredericson, C. Wolf: Iliotibial band syndrome in runners: innovations in treatment. In: Sports Med. 35/2005, pp. 451-459, PMID 15896092 .
  • RH Miller et al. a .: Lower extremity mechanics of iliotibial band syndrome during an exhaustive run. In: Gait Posture. 26/2007, pp. 407-413, PMID 17134904 .
  • JM Stirling et al. a .: Iliotibial Band Syndrome.
  • R. Ellis et al. a .: Iliotibial band friction syndrome - a systematic review. In: Man Ther. 12/2007, pp. 200-208, PMID 17208506 .
  • J. Fairclough et al. a .: The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. In: J Anat . 208/2006, pp. 309-316, PMID 16533314 .
  • V. Akuthota et al. a .: Iliotibial band syndrome. In: WR Frontera, JK Silver (Ed.): Essentials of Physical Medicine and Rehabilitation. Hanley & Belfus Publisher, Philadelphia PA 2002, pp. 328-333.
  • SP Messier u. a .: Etiology of iliotibial band friction syndrome in distance runners. In: Med Sci Sports Exerc. 27/1995, pp. 951-960. PMID 7564981
  • P. Gunter, MP Schwellnus: Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomized controlled trial. In: Br J Sports Med. , 38/2004, pp. 269-272, PMID 15155424 .
  • JW Orchard et al. a .: Biomechanics of iliotibial band friction syndrome in runners. In: Am J Sports Med. 24/1996, pp. 375-379, PMID 8734891 .

Individual evidence

  1. ↑ G. Lindenberg et al. a .: Iliotibial band friction syndrome in runners. In: Phys Sports Med. 12/1984, pp. 118-130.
  2. ↑ M. Louw, C. Deary: The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature. In: Phys Ther Sport Feb / 2014, pp. 64–75. PMID 23954385
  3. ↑ JC Holmes et al. a .: Iliotibial band syndrome in cyclists. In: Am J Sports Med. 21/1993, pp. 419-424, PMID 8166785 .
  4. ↑ U. Wegner: Sports injuries: symptoms, causes, therapy. Schlütersche, 2002, ISBN 3-87706-632-1 , p. 108, limited preview in the Google book search
  5. ↑ P. van den Boasch: My marathon training: From beginner to finisher. Meyer & Meyer Verlag, 2007, ISBN 978-3-89899-278-7 , p. 163. Restricted preview in the Google book search
  6. ↑ EF Ekman et al. a .: Magnetic Resonance Imaging of Iliotibial Band Syndrome. In: Am J Sports Med. 22/1994, pp. 851-854.
  7. ↑ M. Martens et al. a .: Surgical treatment of the iliotibial band friction syndrome. In: Am J Sports Med. 17/1989, pp. 651-654, PMID 2610280 .
  8. ↑ DP Richards et al. a .: Iliotibial band Z-lengthening. In: Arthroscopy . 19/2003, pp. 326-329, PMID 12627161 .
  9. ↑ CH Cowden, FA Barber: Arthroscopic treatment of iliotibial band syndrome. In: Arthroscopy techniques. Volume 3, number 1, February 2014, pp. E57 – e60, doi : 10.1016 / j.eats.2013.08.015 , PMID 24843846 , PMC 4017954 (free full text).