The knee is a joint with a lot of mobility and not a lot of bony stability. It therefore relies on its ligaments for passive restraint at extreme ranges. All movement between these extremes is greatly influenced by movement around the hip and ankle/foot. It is well known that gluteal muscle weakness, a stiff ankle and over pronation in the foot can lead to knee pain.

Iliotibial band friction syndrome (ITBFS)

This is a common complaint in runners with weak gluteal muscles that allow uncontrolled hip joint and knee joint movements. The iliotibial band consists of a strong tight band of connective tissue that runs along the outside of your thigh, connecting your pelvis to the outside of your knee, just below the joint line. The ITB may get inflamed due to friction over the bone at the outside of the knee as you bend and straighten your knee.

Causes

This increased friction is caused by incorrect biomechanics or muscle length /strength imbalance around the hip, knee and/or foot. Poor shoe ware. Poor sport technique. Running only roads with severe cambers. Increase in intensity or volume of training too quickly. Anatomic variations can cause ITBFS.

Possible signs and symptoms may include:

• Sharp pain on the outside of the knee.
• Pain aggravated by bending and straightening of knee (eg stair climbing).
• Pain in knee during the warm up which often subsides til cooled down or it can escalate to a point where it stops you in your tracks.

Runners knee (patella-femoral pain)

This describes pain which arises from the joint between the thigh bone (femur) and knee cap (patella).

Causes

The main cause of runner’s knee is overuse of the knee with the incorrect biomechanics. This can be from sitting posture, excessive pronation, poor shoes, poor sport technique, muscle imbalance around the hip and thigh.

Main symptoms include:

• Pain under the patella, swelling around the patella.
• Uncomfortable clicking with bending and straightening.
• Pain increases with loaded bending and straightening of knee (eg. Squats, stairs) and prolonged sitting (‘movie goers knee’).

Other common knee injuries

Ligament injuries - There are several ligaments in the knee joint. Injuries to these would usually result from sporting activities where there is a rapid change in direction and/or forced range of movement. Tears of these ligaments often are associated with immediate pain, swelling, bruising and an audible ‘snap’ sound. Knee ligaments are: ACL (anterior cruciate ligament), PCL (posterior cruciate ligament), MCL (medial collateral ligament), LCL (lateral collateral ligament), PLC (posterolateral corner ligaments).

Juvenile knee pain – Osgood-schlatters and sindingh-larsson-Johanson are common growth plate injuries that can result from high impact sports.

Meniscus injury - The knee joint includes of two pieces of cartilage (menisci) between the femur and tibia. A tear in a meniscus can occur suddenly with an uncontrolled twisting movement, like stepping wrong while running or in a tackle.Repetitive strain on a point in the cartilage can lead to degenerative tear.

Tendon injuries/Tendonitis - Injuries to tendons in the knee usually involve the patella tendon, which is situated over the knee cap and inserts onto the lower leg.

Fat pad Impingement

Bursitis

Plica impingement syndrome

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