This runner has been experiencing right outer knee pain for almost 2 years. During the physical exam, and in particular her gait analysis, I could visualize why. Her right hip shows some mild instability at impact, influencing the knee to collapse slightly inward. This does not happen on the left.
When the knee joint collapses like this, the in...side of the knee joint gaps while the outside of the knee gets pinched. The IT Band (ITB) that runs from the top of the hip down to the outside of the knee will often become irritated at the knee when there is too much friction of the ITB on the bony anatomy just underneath it. There is also a highly sensitive fat pad in between the ITB and the bones that also gets inflamed. This whole process is called IT Band Friction Syndrome.
I often hear that, after seeing another physician or massage therapist, the patient reports that they were told their IT Bands "were the tightest they've ever felt." Since they were so tight, that must be the problem. This is an incomplete assumption: The IT Band isn't designed to be loose. Its a functional link from the knee to the hip, where energy must be transferred efficiently from one point of the chain to the other. It also serves as an insertion point to other muscles in the hip and protects the outer portion of the knee and quadricep muscles (the vastus lateralis). If there is weakness in the hip, this will cause compression at the knee, making it difficult for the IT Band to properly move around the bony anatomy, causing a repeated friction site.
Icing the inflamed site and foam rolling the entirety of the ITB above the knee and into the hips are commonly advised. A portion of the ITB that needs to be addressed is a muscle referred to as the TFL (Tensor Fascia Latae). This muscle is actually the beginning of the ITB and is integral to it's function. Comprehensive treatment of this disorder includes a full physical examination in order to arrive at a complete diagnosis. Then the usage of laser, Active Release, Graston, and specific rehabilitative exercises can efficiently calm the inflammation site and effectively strengthen the weaknesses that are causing the friction in the first place.