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Runners knee / ITB syndrome

First steps of improving running performance is all about uncovering any underlying muscle imbalances that will make you vulnerable to injury. It's not about finding a different running technique or changing your shoes or placing your foot down in a different position, we have to understand how your body functions first.   

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Muscle imbalances produce resistance through your joints, and muscles will be forced to perform at an awquard angle. Like a poorly hinged door, movement will feel restricted, further effort would be required to take it through its movement, and overtime it will become weak and susceptible to breaking. If you imagine our bodies as nothing more than levers, you can appreciate that the closer your levers will work towards the most neutral plane of movement, the less resistance you will have. Inturn…the less likely you are to get injured, which means the more robust your body would be, which results in the ability to train harder with confidence. Video Gait Analysis is the ultimate way of becoming visually engaged as to how your very own body is performing. Please don't get sucked in to changing your running style unless you have a clear understanding of your own functional ability. 

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A classic injury we see frequently that demonstrates this perfectly is ‘Runners Knee’ Runners knee effects so many runners (the clue is in the Title!!) and is a perfect example of forces working past their neutral plane of movement. There is rarely a single reason behind any single injury, and the answer certainly doesn’t just come from your running shoes, much against some running shops belief!
One of the main reasons behind runners knee is due to weakness in the Glutes. Glutes play a huge role in not only stabilising your pelvis, but they also keep your legs and knees in line in a neutral plane. Weak glutes will cause knees to ‘fall in’ causing the muscles from the hip down to perform out of their normal range of movement. Over a period of time, the TFL (tenser facai latis) will shorten due to being overworked and pain will present itself around the outside of the knee where the ITband (Ilio Tibula) will start rubbing against the lower part for your thigh bone. Not a pleasant condition for anyone having suffered from it. 


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Prior to this year, the most common advice for rehabbing the ITBand was to use a foam roller. Things have changed a little bit! Although we are still in favour for using a foam roller to improve flexibility, the process is not likely to change the issue, it's more likely to just delay the pain from coming in. The better strategy we would now advise our clients would be looking at functionally strengthening the glute to prevent the knee from dropping in.   

That's why we recommend single leg squats!

Single leg squats are the ultimate exercise to strengthen your glutes inline to the way they need to perform when running – it will increase the effectiveness of your running significantly. The single leg squat can be done in several ways, some people prefer to use a bench behind them to hold their rear leg in position, I prefer to add the element of core balance and perform it from standing. Standing with hips shoulder length apart, bend one leg at the knee so that your toes are pointing to the ground. Lower yourself slowly on your supporting leg as far down as you can go (count for 5 for best results). Your challenge is to stop your knee from turning in at any time. When reached the lowest point, slowly raise yourself up and repeat with the other leg.  Sophie (in the picture) has chosen to add a cross body rotation to challenge the core even more.  

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Single leg squats are a great exercise that not only strengthens your glutes and core and improves your balance, it also is one of the best exercises to build muscle and strengthen your legs. These exercises are therefore ideal for practising out of marathon running season. Practise 3 x a week 12 - 15 reps 3 sets. Single leg squats is always about the technique, I would always prefer to see 6 excellent precision ones than 12 - 15 average ones. It's all about the form!  

Narrow / overcrossing can trigger ITBS too!

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We have found that narrow running gaits and 'overcrossing' can produce ITBS too.  Narrow running gaits and 'overcrossing' causes the glutes to have to work harder to stabilise the pelvis as they can often cross the bodies midline (The foot in fact travels further to make contact with the ground). Athletes who do a lot of track work often evolve to narrow gaits as gaits narrow when turning a corner or an apex. Ladies with a wide Q angle (hips to foot angle) can often be vulnerable too. It is possible to change this running form by mildly widening your running gait. A great drill is to find a line along a road / path / track, and position your feet to land either side instead of running along it. This is a drill that must be practised over time. Stretching out your adductors more frequently would greatly help repositioning foot placement. 

Use these to read further spotlights

Heel Striking
Forefoot running
Minimalist running
Walking lunges
Pelvic instability
Hamstring strengthening
Why stretch
Runners knee ITB
Single leg squats
Glutes, are you standing comfortably?
Squat test
Migrating to a minimalist shoe
Richard Whitehead Paralympic 200m
Medial Shin Splints
The cumulative effect
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