Q) I wonder if you can help me to work out what is wrong with my right knee. I am in training for the three peaks challenge so I have been increasing the amount of hill walking I am doing. Last week on the way down from my longest walk so far I developed sharp pain on the outside of my right knee. It hurt every time I bent my knee and meant that I had to limp my way down. Even though there was no swelling I iced my knee that evening. It was still really stiff and painful the next day but got much better over the next 2 or 3 days. The main problem now is that I still get the pain when I’m coming down stairs. I should be doing another long walk this weekend and want to know if I am doing any damage by continuing.

A) Hello. I can certainly help to point you in the right direction.

Assuming that you did not sustain any twisting type of injury or other trauma to your knee that day, the problem you are describing sounds like it could be arising from your iliotibial band. Commonly referred to as the ITB and this type of problem is often known as ITB friction syndrome. It is most common in runners but could easily be provoked by somebody suddenly attempting to increase their training.

The ITB is a very strong soft tissue structure running down the outside of your thigh to your knee. If this is tight or if it becomes tight during activity it can become irritated in the region of the knee that you describe.

There are several reasons why it may become tight or irritated and I will list some of these here for you now so that you can work out which, if any apply to you;

• Foot posture ( if your foot rolls in, overpronates, it will increase tension through the ITB)
• Weakness of the hip muscles, particularly gluteus medius ( these muscles are responsible for controlling the leg posture and if weak will allow the thigh to roll in excessively and tension the ITB)
• Alteration in your training (surface, amount, inclines, declines and camber)
• Type of footwear

There are some simple things that you can do to help settle this down. In the short term ice to settle down any irritation/inflammation is a good idea (this is most effective in the first 72 hours after onset of symptoms). Relative rest. By this I mean you should modify your training. I don’t think that another hill walk this weekend is a particularly good idea but you could use the cross trainer at the gym, swim or do a longer, faster flat walk to continue to maintain your training benefits.

In order to get you coping with the hills again you will need to consider strengthening your glut med, stretching your ITB and addressing your foot posture. A Chartered Physiotherapist will be able to guide you through this process.

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