It’s June and those of us ‘occasional runners’ are out in force enjoying the sun, the lush greenery, and those 20-something temperatures. That is, until that sharp, nagging pain in the side of your knee puts a damper on things. What is that and why does it happen?
To be fair – it could be one of a dozen conditions. Today, I’m going to explore some bigger picture functional anatomy that can play a role in all of these conditions. I hope to have you come away with a better understanding of how anatomy impacts running. Let’s start, as Osteopaths do, with the anatomy on the outside of the leg just above the knee joint.
The Knee Joint
The first thing that might strike you is the lack of muscle. The outside of the knee is largely made up of ligaments, fascia, tendons, and the bursas (which separate them). Muscles are needed to produce movement and since the knee joint hinges back and forth, the muscles are located at the front and back of the joint. Side to side motion is prohibited and prevented by heavy ligaments and fascia. The largest structure here is called the iliotibial band (or IT band) – a key player in today’s discussion.
Technical Bit: The IT band is a thickening of the fascia of the thigh and has attachments to the TFL and glute max muscles (as shown above). This means that the IT band is really just a rope that connects the big pelvic bone (Iliac bone), glute max, and TFL muscles to the lower leg. When it becomes tensioned, it performs many small motions: slightly abducts and flexes the hip, compresses the lateral knee, and externally rotates the tibia relative to the femur. This tension becomes pathologic when it cannot release – often referred to as a “tight IT band.”
The Tibialis Anterior
The tibialis anterior muscle is responsible for ‘dorsi flexion’ which is the act of pulling your foot up toward your head. You can activate it by walking around on your heels. Give it a try and locate your own tibialis anterior!
As illustrated in this picture, the tibialis anterior muscle blends seamlessly at the top into its own tendon, which is continuous with the iliotibial tract (IT band). Take a second to trace with your finger across the two highlighted structures. Now, on your own body, we can envision a line going from the inside of the foot and continuing up in a spiral to the outside hip. The key is that this muscle spirals! As we know the shortest distance between two points is a straight line, not a line that spirals around the outside of a cylinder (thigh and leg). What this all means is: when these muscles become overly tight, they shorten and rotate the leg out such that the toes point out impacting your gait.
Barefoot Running (and why I like it)
This sheds light on the recently popular barefoot running movement. Running with no or minimal footwear reduces/eliminates heal strike (simply because it would hurt!) and shifts to a forefoot or midfoot strike. You may think this is just trendy jargon with no real difference, but I promise a point is coming! Similar to walking on your heels, a heel-strike running gait requires tibialis anterior to do all the muscular work, while running on the balls of your feet uses your much larger (and more appropriate) calf muscles. To sum it all up, a heavy heel strike overworks and tightens the tibialis anterior muscle, which irritates its tendinous attachments. Recall, that these attachments are continuous with the IT band, and contribute to its dysfunction! Thus, barefoot running can actually help by shifting the load from your tibialis anterior to your calf muscles and bypass this problem all together.
How to Improve Your Run This Weekend
This has big implications on how we run and warm up. When we stretch and mobilize, we need to think about the whole line! Stretching and foam-rolling the TFL, glutes, and the IT band are a great place to start, but including the muscle and fascia of tibialis anterior is also very important.
Step 1: Can you sit on your shins with your toes pointed behind you? If not, start there! This is best done without shoes.
Step 2: To up the ante, place a yoga tune-up ball or lacrosse ball under your shin in the meaty part of your tibialis anterior. You can find this by locating your tibial tuberosity (that big boney bump on the front of your knee) and moving one inch outwards and down.
Step 3: Move the ball around slowly until you identify the spot of most discomfort. Slowly let your weight onto the ball. Breathe and relax. In 30 seconds, move the ball to the next most-uncomfortable spot. Repeat 3 times, or as many times as needed on both sides.
As a seasoned runner progresses and becomes more ‘seasoned,’ they accumulate tools to help them prevent and overcome injury. I hope this post helps you in that journey, and for help with your specific and very individual body, don’t hesitate to ask your Sprout practitioner.
Aaron Coulthard, M.OMSc, Osteopathic Practitioner