I have been having a recurring problem with my knee / ITB ever since I had a bad crash back in 04. Initially my knee would make a popping (clicking) sound that felt like it was coming from the outside of the kneecap along with pain. Over the years I have stretched, strengthened, rolled on foam rollers and sought professional help. I have been to Doctors, Chiropractors, and Massage Therapists who have all worked on this area (and other problems). They all did an excellent job alleviating my other ailments, but not this one. Given that it hasn’t been bad in the last couple of years, I have ignored it, and lived with it. But, sometimes it gets bad (painful / more painful) again. It pops the most when I do the following… if standing I rotate my foot and leg outwards (toes pointing out) then I contract my hamstrings and bring my foot to my butt (sort of like a quad stretch). It will pop if I don’t rotate foot, but more pronounced “popping” if rotating foot out initially. Overall, it seems so becoming from the low vastus lateralis / ITB area (but that doesn’t necessarily mean it is limited to that area - could be deeper, cus it is hard to mimic pain from massage). Please, if you know what this is and how to get rid of it, help me out. Any surgeons (or sturgeons), sports medicine individuals out there (especially those specializing in knees), please don’t be shy, I am willing to hear what it is (or might be), and how to get rid of it.
IIRC the popping noise is the distal IT band sliding over a bursa outside the knee. Bursitis an issue? The other thing that came to mind is some issue in the hip with internal external rotation of the head of the femur.
Probably not very helpful. I hope you can figure it out and clear it up quickly.
Chris, as I tell my patients, clicking without pain is (usually) normal, clicking with pain is not. With a history of trauma, the most likely diagnosis would be an osteochondral defect on your patella, probably the lateral facet, or on the corresponding trochlear groove (or both). The ITB can “click” too, but it is usually lower near its insertion site. The small bursa can cause a mechanical sensation as the band glides over it. ITB problems at the knee can usually be recreated with pressure, though, and you say massage does not elicit it. First you need a clear diagnosis before treatment will help. A trip to an orthopedic surgeon would be helpful, espcecially if he or she has an interest in sports. Typically, a good physical exam, X-rays (to include a sunrise view of the patella femoral joint), and often an MRI would be expected. Since you can recreate your painful “clicking”, sometimes the diagnosis is simple on clinical exam alone. It’s not simple on a forum. Good luck!
I’m not doc but have had my share of knee issues. It sounds like inflammation or improper knee cap tracking. Could be caused by technique, overuse, or host of other factors. Take an anti-inflammatory, ice it 3x a day, and see a doc. If you want a really good knee doc in NY PM me. I know two of the best in the business, both are team docs for pro sports teams and deal with a lot of elite athletes.
Also known as “merchant’s view”. An X-ray with the knee bent about 45 degrees and shot from top of the knee towards the toes to view the P-F joint. Very helpful for tracking questions and a standard view in an orthopedist’s office. “Sunrise view” sounds better
I went in last week for what sounds like exactly the same issue - ITB flare-ups and a clicking/popping knee, ongoing since last Sept., not caused by trauma (as near as I can remember). Clicks occur at 90d of flexion, regardless of foot rotation. I had tried all kinds of things before going to the doc - stretching, strengthening (incl. glutes), rest, foam roller, etc. Nothing worked.
In my case, the docs (sports medicine at a big 10 school) seem unconcerned about the clicking, and have said that’ll work itself out once we “start working on my hips.” At the moment they’ve focused on my feet, and have modified some off-the-shelf stability inserts with varus wedges. It seems to be working; I’ve gone for a few short runs without issue.
FWIW, research is showing that ITB pain is unlikely to be a friction syndrome, nor is it related to bursitis. In particular, the ITB doesn’t appear to “slide” over anything - It’s attached all along its length, not just at the extents. Interestingly, this means that it’s nearly impossible to actually stretch the ITB (which explains why that hasn’t worked). Fairclough seems to be doing good work in this area, for example:
Fairclough, J., et al. “Is iliotibial band syndrome really a
friction syndrome?” J. Science and Medicine in Sport, 2007.
Fairclough, J., et al. “The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.” J. Anat., 2006.
I’ll relay something the docs told me: “Since it’s recurring pain over a long period of time , it’s more likely to be a biomechanical problem than inflammation.”
Took a look at your photos on your profile and your blog – you are definitely a quad runner. This alone may not be causing, but is certainly making your symptoms worse. Your running technique can use some help.
Your rear leg is flexing too slowly at the hip. Fixing this will help you alot. Forces will be created and absorbed better, and more appropriately.
Not trying to hijack, but that jives with something that was mentioned about me (the “slow flexing at the hip”)… But, I don’t understand what that means. Can you explain? Thanks in advance.
Understand that running is complex, and good running utilizes the extension reflex which is when one hip is flexed faster, the opposite side extends harder. People think that distance running is different than sprinting – this is true only in the amount of force exerted with each stride, but the base technique is the same. The best way to see it is by video which I have both sprinters and distance runners evaluated.
Good running is good running and poor is poor. The reasons Kenyans are so good is their efficiency and technique – THEY ARE NOT MORE AEROBICALLY FIT!
Check out my analysis and it should make more sense.
Since I have a bit of the same issues, and I believe I look like the op too (when running) I got interested in this “quad runner” thing. Could you explain the symptoms and what to do about it? Googling just gave me a lot of motorcycles.
/Erik
The term quad runner is just the term I use so I don’t know if it is universal or not. However, the hamstrings and glutes should be the propulsion muscles in good running and the quad supports and keeps the body from sinking.
Quad running can result in many different types of injuries from foot to ankle to knee to back, so there is no single injury symptom. However, you can see a sample of what a quad runner looks like vs a hamstring/glute runner at the link below.
Hope this helps describe the difference. When you improve the technique, you not only reduce injury risk, but your performance improves dramatically. I reguarly have mid level triathletes improve 4 to 8 minutes on a 10k run.
I’m guessing I’m “quad running” on both legs? Could you give some pointers on how to correct this? I’m not entirely slow (1.25 this race), but I’m never far from triggering my ITB even at 30-40k/week.
Yes you are a quad runner on both sides. Notice that when you have full weight bearing on the right leg, your left side pevis is “droopy” as evidence by your left knee is below your left and you can see the level of your shorts.
When you are full wb on the left, your right side pelvis droops.
Another piece of evidence is your free leg knee (leg that is not bearing weight) is behind the stance knee – also on both sides.
The free side of the pelvis should be higher (trunk strength) than the stance side or at least the same height. Also, the free hip flexion should be much faster. In other words, your knee on the free side should be well past your stance leg at this point. The good news is – you can run ALOT faster than you do now by focusing on technique not just more milage.
This is what I meant earlier when I was refering to the extension reflex. As you flex the hip on the free side faster and stronger, the other leg extends faster and stronger. You were born with this reflex.
This is very common by the way. I bet 99.9% of all runners 5k or longer in the US and western Europe run like this. And it is why African and Middle Eastern, and Asian runners are, as a whole, much better. They do a much better job of utilizing the extension reflex.
Most all runners can make far more improvement focusing on technique more and milage less for much of the training season.
