Running and Lateral Knee Pain

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Movement Fix Monday | Week 2

I hate when people call lateral knee pain "IT Band Syndrome".

It is such a meaningless term. There can be a huge variety of reasons someone has lateral knee pain that have nothing to do with the IT band other than the fact that it just exists.

Let me tell you a short story about myself. I used to have lateral knee pain that prevented me from running any distance greater than 400m. I would get a sharp pain on the outside of my knee that made my knee feel like it was going to crack and then explode.

I had so much treatment done to it (this was while I was still in business school) and nothing helped. ART, graston, joint mobilizations, etc. None of those worked, not because they aren't effective at what they claim to do, but because they weren't used to treat the underlying reason why I had lateral knee pain.

I eventually learned enough to figure this out myself. I watched myself run and found that I ran with a huge lumbar lordosis (over-extension) and an anterior pelvic tilt.

I immediately changed running from an anterior tilt to a relative posterior pelvic tilt, putting my lumbar spine in relative neutral or maybe slightlyinto flexion. Knee pain was instantly gone. Here is a novel thought: when things work, they actually work.

Everyone loves to blame the IT band for being "short and tight" without ever thinking about the fact that it attaches to the pelvis via the TFL and glute max (and is just a thickening of the overall fascia of the thigh). When someone's thinking does take them that far, they conclude that those muscles need to be rolled out to relieve the "tension". Why don’t we take it a step further and say, "hey, wait, if you tilt your pelvis anteriorly, you are changing the tension through those muscles and connective tissue and it has nothing to do with those muscles or connective tissue themselves, but it's a result of how you are holding yourself". We need to think like that more. That is called the question behind the question or QBQ for short.

If you haven't already, check out the video above to see a basic way you can check for either: over-extension in running or inability of the anterior chain to hold the spine and pelvis in neutral/posterior pelvic tilt when an extension load is applied.

The best cue during running to help with this is leading with the waist or leading with the hips rather than leading with the chest. This is a simple and easy fix that can help the person who has lateral knee pain because they have these other things going on. There will of course be a set of people who don't improve with these cues because that wasn't their underlying condition. They could be weak, have bad ankle range of motion, etc. A fix or treatment or technique change must be applied to correct a dysfunctional movement or technique. You can't apply the same thing to everyone and expect amazing results. That's like guessing "C" on a multiple choice test. You will be right some of the time because there are only so many answers.

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