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The knee
The iliotibial band, the “windshield wiper” syndrome
Also known as “runner’s knee,” iliotibial band syndrome is the very expression of the interaction between the foot and the knee in motion. The pain sits on the outer side of the knee, where a tendinous band rubs against the bony prominence of the femur. Behind this friction lies a functional gait disorder, Functional Hallux Limitus.
The “windshield wiper” syndrome, or runner’s knee
Painful iliotibial band syndrome, also called the “windshield wiper” syndrome or “Runner’s Knee,” is the very expression of the interaction between the foot and the knee in motion. It appears mainly when running, hence its designation as the runner’s knee.
The pain sits electively on the outer side of the knee, where a tendinous band rubs against the bony prominence of the femur (the lateral condyle) and creates inflammation, a bursitis. This friction sweeps from front to back as the knee flexes and from back to front as it extends, hence the name windshield wiper syndrome.
Anatomy of the iliotibial band
The iliotibial band owes its name to its anatomical appearance, similar to a blind strap 3 to 4 cm wide. It originates on the iliac crest, at the pelvis, and inserts on the lateral tibial plateau. This structure works as a true lateral guy wire and stabilizes both the hip and the knee.
Certain morphologies can predispose to the syndrome: knock-knees or bowlegs, natural hyperlaxity, a lack of muscular flexibility or a prominent bony contour. But since this syndrome appears in motion, above all when running or walking downhill, it is natural to look to biomechanics for the explanation.
The decisive role of FHL
FHL is present in every case of painful iliotibial band syndrome and plays a major role in the onset of the pain. The foot striking on the outer edge of the heel and the stronger impact place extra tension on the band, and the friction forces become greater. The repetition of the movement creates, between the tendon and the bone, an inflammation of the gliding plane: a painful bursitis.
The mechanism
The exaggerated supination at foot strike, induced by FHL, increases the impact on the outer edge of the heel and the tension in the lateral guy wire. With every stride, the band rubs harder against the lateral condyle of the femur. It is the repetition of this friction, not an abnormality of the band itself, that eventually inflames the gliding plane.
Management
Stopping the sport involved usually resolves the symptoms, but they recur when the activity is resumed. The pain is sometimes stronger the day after exercise and can be accompanied by a transient limp. The conservative treatment proposed for FHL is most often effective.
For runners, a movement analysis on a treadmill and a dynamic podiatric assessment can prove useful for continuing the activity under the best possible conditions.
Understanding through video
A video looks in detail at iliotibial band syndrome and its link with FHL.
Painful iliotibial band syndrome
Recurring runner’s knee?
Look for the underlying FHL
If the pain on the outer side of your knee returns every time you go back to running, the mobility assessment at the Centre du pied can objectively identify a possible FHL and adapt management accordingly.
At a glance
Other name
runner’s knee
Typical profile
runners
Location
outer side of the knee
Mechanism
friction over the lateral condyle
Width
3 to 4 cm
Underlying cause
Functional Hallux Limitus
Further reading
Related pages
Patellofemoral syndrome
The other major painful knee syndrome linked to FHL, at the front of the knee.