The iliotibial band is a broad band of tendon that runs from the hip down the outside of the thigh and attaches to the tibia (shin bone) on the outside of the leg just below the knee.  This tendinous band passes over a bony prominence on the outside of the knee called the lateral femoral epicondyle and is prone to friction in this location.  Friction is greatest at 20-30 of knee flexion (bending) which is the angle of the leg when the foot hits the ground when running.   Therefore the condition is common among runners.  The condition is more common amongst individuals who:

• Have bow legs (genu varum)
• Feet over pronate (roll inwards/flatten) when walking/running

Symptoms

• Pain of the outside of the knee just above the joint line
• Pain aggravated by running especially downhill
• Pain worst at 20-30 degrees of knee flexion (bending)
• Pain aggravated by pressing into the knee when bending and straightening leg

What you can do

• Rest and avoidance of aggravating activities e.g. downhill running
• Apply ice therapy to reduce swelling
• Stretch the illiotibial band regularly

What we can do

• Use deep tissue massage and myofascial release techniques to reduce tension in illiotibial band
• Stretch iliotibial band
• Prescribe stretches for iliotbial band
• Prescribe exercises or orthotics to correct overpronation of feet

The knee contains two crescent shaped peices of cartilage that attach on top on the tibia (shin bone), one on the medial (inner) aspect and the other on the lateral (outer aspect).  These menisci function to

• Create an enhanced fit between the femur (thigh) and shin bone
• Act as shock absorbers
• Improve the flow of synovial fluid (a type of lubricant) with the joint capsule
• Transmit force between tibia and femur

The lateral meniscus is less prone to injury than the medial meniscus as it is less firmly attached to the adjacent structures and can therefore ‘get out of the way’ in the event of a sudden forceful impact.  The classic mode of injury occurs when the knee rotates forcefully whilst weight-bearing.  Injury to the meniscus typically progress as follows

• Immediate pain with difficulty in fully extending (straightening) leg
• Swelling appears within 24-48 hours
• Symptoms resolve within 2 weeks
• Recurrent mini episodes of the above sequence of events when the knee gives way when twisting.

Meniscal damage can also result from wear and tear as we get older causing the cartilage to become rough and frayed – more common in middle and old age.

Symptoms

• Pain on the lateral (outer) aspect of the joint at the joint line
• Swelling (possibly warm) all around knee joint
• Reduced range of flexion (bending) possibly limited to 90 degrees
• Inability to fully straighten knee
• Clicking noise (crepitus)
• Knee giving way
• Pain aggravated by weight bearing
• Pain aggravated by walking on uneven surfaces as knee cannot fully straighten and becomes unstable

What you can do

Apply RICE (Rest, Ice, Compression, Elevation) procedure
Gentle exercise to maintain quadriceps strength
Glucosamine supplement can be taken 1500mg/day

What we can do

• Performance of special tests (McMurrays and Appleys grind) to confirm diagnosis
• Prescription of exercise to restore full range of motion
• Prescription of exercise to maintain muscle balance around knee
• Prescription of exercise to maintain proprioception (balance)

If conservative treatment fails then surgery may be necessary.

The lateral collateral ligament (LCL) connects the femur (thigh bone) and the head of the fibula (the bone on the outside of the shin).  It is a narrow strong cord of with the diameter of a thin pencil that functions to prevent the knee from collapsing outwards when a force is applied to the inside of the knee.  The LCL is usually injured by a direct impact to the inner aspect of the knee whilst weight-bearing.  The LCL is not connected to the lateral meniscus so injuries to the ligament do not usually damage the meniscus.

Symptoms

• Pain on the lateral aspect of the joint at the joint line.
• Some swelling possible on lateral aspect of joint
• Inability to fully extend (straighten) leg
• Inability to flex knee (bend) knee more than 90 degrees
• Giving way of knee
• Pain aggravated when walking on uneven surface as knee has less stability
• Pain aggravated when walking when pushing off through toe on same leg

What you can do

• Apply RICE (Rest, Ice, Compression, Elevation) procedure

What we can do

• Flushing – massage technique to reduce swelling
• Deep friction massage over ligament to boost circulation and stimulate healing
• Prescription of exercises to strengthen surrounding muscles and stabilise joint