Physio webchat with Paul Hobrough

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Q. Last year I had to defer from marathon one week before due to knee pain. private MRI diagnosed this "soft tissue oedema beneath the iliotibial band at the level of the lateral femoral condyle in keeping with iliotibial band friction syndrome" after 3 months of rest, glute, hip and general leg strengthening - the pain was still there so I had a cortisone injection back in June which was amazing no pain since. I have regularly been running 30+ miles a week since. I am marathon training again - building up my long runs am up to 15 miles, however my knee is very slightly achy again. 

any tips how I successfully train this time around? Am still doing lots of strength/stretching and regular sports massage. Am I always going to have a weakness there? I would be really gutted if the same happens again! Any help gratefully received! - Katy1

A. Once again I don't want to go over old ground and I have spoken in 'some' detail about ITBS earlier in this forum, however you also mention cortisone injections and ask if you will get the issue back again.

Cortisone worked for you, because it took away the last bits of inflammation I suspect, but you were also fixing the underlying issue with some good rehab by the sound of it. It does seem like you are doing a lot right, but there is a great strengthening exercise for TFL which I will add in my article for the next mag, basically stand side onto a step and dangle the uninjured side off the step. On the injured side bend the knee, pronate the foot, but the keep the knee over the middle toe. Drop the hip on the unaffected side and then start to swing this leg slowly back and forth.  25 reps X 3 AM and PM and you will feel stronger and able to run further without pain (I hope)

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