How to Avoid Posterior Tibial Tendonitis and Ileotibial Band Syndrome in Runners

I know this sounds like an odd combination of injuries to be discussing at the same time; but it is not uncommon to see a patient that has a weak posterior tibial muscle, and subsequent posterior tibial tendonitis that causes IT band syndrome in the same leg due to excessive pronation and dorsiflexion causing stress on the IT band at the knee level. It is also not uncommon to see a runner with a weak and tight IT band that allows increased inward movement of their thigh which causes increased pronation at the ankle, stressing the posterior tibial tendon leading to tendonitis.

So how can we control this unpleasant duo injury? Control the pronation of the foot and ankle with a functional foot orthotic device or taping, strengthen the posterior tibial muscle in your lower leg, stretch the IT band, and work on core balance exercises.

Here are some simple exercises to get you started:

First and foremost, warm up for about 5-7 min with a bike, elliptical or simply brisk walking.

All exercises will strengthen your dorsiflexion and inversion power as well as working on single leg balance.

1.     Walk on your heels with your ankle pointed upward and toes outward exaggerating the movement. It looks quite silly but it fatigues the PT muscle rapidly. A “normal” runner should be able to walk this way for about 2 minutes without aching pain. If you start with 30 sec at a time and then repeat 3 times to start. The next time add 15 sec and so on until you can perform this motion for 2 minutes. If you feel any sharp pain, then stop and try again in a few days.

2.     Eccentric knee squats. The goal is to perform 4 of these. Stand facing a wall with your feet should width apart and your toes a few inches from the wall. Bend at the knees keeping your back straight so that your knees lightly touch the wall. You may need to adjust the distance to the wall to perform this. Return to your starting position and start to squat again, but move your knees outward so that you are effectively pronating your feet as you squat point. This is the action your feet perform in the stance phase of running. It puts a force on the PT muscle and the IT band. This strengthens the tendon as well as the IT band. Come back to the starting position and repeat four times. If at any point you have sharp pain, stop. It will take a few days to weeks to perform these easily. When this happens, try one leg at a time.

3.   Balance and eccentric reaches with your knees. Stand on your right foot, about an arm’s-length from a wall and flex your left knee so that your shin is about parallel to the floor. Bring your left knee forward, while remaining with your back straight or slightly backward from the hips, until it touches the wall. Keep your hips over the right foot. Finish by returning to the starting position. Next, perform the same motion but this time move your knee slightly to the left as you move it forward. This will cause the right foot to pronate. Then back to the starting position and do the same movement moving your knee this time to the right. This will cause the right foot to supinate. Perform this 5 times then switch feet.

4.     Dynamic Posterior tibial exercises. Begin by facing the wall again. With your weight on your right foot and your right knee slightly flexed (like you are landing while running), lift your left thigh up parallel with the floor and use your hands on the wall for support. Rock forward until you feel a calf stretch, then lean left and pronate your right foot. Then, as part of a continuous motion, lean toward the right, crossing your left leg over your right leg so that now your foot is supinated. Without stopping, cycle back and forth 4 times then shift to the left foot.

5.     Towel crunches. Sitting in a chair, place your foot flat on a towel and crunch your toes grasping at the towel for 25 repetitions. Then switch feet.

When you are comfortable going through all of these exercises with your body weight, then start adding small hand weights to increase your strength. You should perform these simple exercises before you run at least 3 times a week to become a stronger more efficient runner! 

Let’s try to avoid the duo of PT tendonitis and IT band syndrome!

Patellofemoral Pain Syndrome in Runners: Pain in the Knee!

Knee Pain Slowing Your Run to a Crawl? You may have patellofemoral syndrome.

What is patellofemoral pain?

Patellofemoral pain a.k.a. chondramalacia patella is the most common running-related knee problem. If you have this condition, you feel pain under and around your kneecap and often swelling of the area under the knee cap may occur. The pain can get worse when you are running or when you sit for a long time. Pain can also be associated with a “crunching” sensation when the knee is put through range of motion. You can have pain in only one knee, or you can have pain in both knees. It usually starts as a minor knee pain after running that progresses to pain when you get up in the morning, pain during or after exercise then pain all the time. Prompt intervention can decrease the period of disability form this injury.

The exact cause of patellofemoral pain is hard to define. It has been described as having something to do with the way your kneecap (called the "patella") moves on the groove of your thigh bone (called the "femur"). Contributing factors include overuse and overload of the knee joint (too much, too soon, too fast syndrome), biomechanical problems and muscular imbalance or weakness. Often it is associated with an extremely flexible foot type and over-pronation (rolling in of your foot). It is more common in women than men and this is due to the “Q angle” of woman’s hips putting more stress on the knee. Weakness of the vastus medialis or the inner thigh muscle has also been implicated as a cause.

What can I do to help my knee mend and relieve the pain ?

Take a break from running and any other activities that can cause a lot of pounding on your legs. Practice relative rest activities like swimming, biking, or the elliptical trainer which supports your body weight and puts less stress on your knees. As your knees feel better, you can slowly go back to running. It is important to do this slowly, and increase the amount of time you run by only about 10-20% a week.

Physical therapy is the mainstay of treatment. It is imperative to work on the muscle imbalances that led to injury as well as stretching your hamstrings and strengthening your quadriceps. Strengthening is very important because your quad muscles control the movement of your kneecap and this is the most recognized cause of this syndrome.

Talk to your podiatrist about your running shoes and orthotics; it would help to bring your shoes in for the doctor to see, proper running shoes can really help knee pain. Orthotics are often needed to decrease excessive foot motion that causes stress on the knee. Even just a simple arch support insert can be helpful. Although custom orthotics are considerably more expensive than off-the-shelf devices, they last much longer and provide more support or correction. For hard core runners, the durability is important. Many people wear out a store purchased device in just a few months when a custom device can last for 2 to 3 years. In some cases, however, an over-the-counter device can be just as effective, particularly when combined with a stretching and exercise program.

Ice your knees for 10 to 20 minutes after activities, this can ease the pain and speed up healing. To keep your hands free, use an elastic wrap to hold the ice pack in place. An anti-inflammatory medicine like ibuprofen may also help, however this should not be used to “get through” your workouts.

Will I ever be able to run again?

Be patient! Keep exercising to get better. Patellofemoral pain can be hard to treat, and your knees won't get better overnight, some people are lucky and get better quickly but it might take six weeks or even longer for your knee to get better. Very few people need surgery to relieve their knee caps instability. Remember, you'll be less likely to get this pain again if you continue to strengthen and avoid “too much, too soon, too fast syndrome!”. Even though the cause of patellofemoral pain syndrome remain uncertain, the good news is that most patients do well with conservative treatment, particularly if they maintain a disciplined approach.