A regular runner attended Rugby Physio for an assessment of right knee pain and iliotibial band (ITB) tightness that had been ongoing for approximately 6 months.
The pain initially began after the runner increased the frequency of hill running in their weekly training.
They had previously seen a sports therapist who treated the area with ITB massage, however this did not lead to any significant improvement.
Our Assessment:
When the patient attended Rugby Physio on the advice of their GP, we carried out a full lower limb biomechanical assessment. The assessment identified several contributing factors:
- Flattening of the foot arch (flat feet)
- Weakness in the hip and core musculature
- Insufficient knee strength relative to the level of running load
Importance of looking into flat feet:
Flat feet can sometimes develop later in life. This may occur due to overload of the muscles and tendons that support the arch of the foot, combined with stiffness within the midfoot joints, both of which can contribute to a gradual collapse of the arch.
When the arch of the foot drops, the knee can drift inward during running, increasing tension through the iliotibial band along the outside of the thigh. Over time, this increased strain can lead to ITB irritation and knee pain.
Additionally, when the knee moves inward, the hip muscles are placed under greater strain, which can contribute to hip weakness and sometimes associated discomfort in the hip or lower back.
Treatment Approach:
Treatment focused on addressing the underlying biomechanical causes rather than simply treating the painful area.
The rehabilitation programme included:
- Strengthening of the core and hip muscles
- Quadriceps and hamstring strengthening
- Ankle and foot stability exercises
- Progression to jumping and cutting drills to develop dynamic knee, hip and ankle stability
- Manual therapy and joint mobilisation to the lower spine where required
Outcome
After 6 treatment sessions, the patient reported significant improvement and was able to return to running without pain.
Importantly, hill running – which previously aggravated the symptoms – was no longer painful.