Wiper syndrome, Maissiat strip syndrome, fascia lata bursitis and even “runner’s knee” are some of the names given to this knee pain. The last one tells you that this is the first cause of knee pain in the jogger. You must therefore know this lesion!
How do you get wiper syndrome?
While running, you are alternately leaning on the right leg and then on the left leg and this movement is repeated over kilometers. These two parameters help you to understand why this injury is so frequent and so specific to running. To prevent your pelvis from tipping over when only one leg is in contact with the ground, there is a lateral shroud that pulls in the opposite direction to your body weight.
At the top, it consists of a large muscle layer, the gluteus maximus at the back and the tensor of the fascia lata at the front. The combination of these two contractile structures is called the “gluteal deltoid”. Indeed, in comparative anatomy, the latter is the equivalent of the deltoid of the shoulder.
Lower down, the gluteal deltoid becomes a long flat tendon that joins the outer surface of the knee. This is the famous Maissiat strip also called “fascia lata”! And then you understand that the fascia lata is stretched by the tensor of the fascia lata. So don’t tell me the anatomy is complicated and incomprehensible!
When this musculotendinous set comes into tension, it comes into contact with the lower end of the femur. There is a small, very thin pocket here that encourages slipping, called a “serous purse”.
If you multiply the strides, the bending and extending movements of the knee cause the large tendon to rub against the bony relief of the femur, like a windshield wiper. The purse gets irritated, tries to adapt by secreting lubricating fluid. In fact, it starts to swell, so we call it “bursitis”.
Do you have windshield wiper syndrome?
Knee pain specific to running
If you have knee pain, especially on the outside of your knee, and run, you have a 9 in 10 chance of developing wiper syndrome.
Of course, this probability is not enough! The diagnosis must be refined to eliminate other neighbourhood lesions and offer you effective treatment.
Usually, you don’t have any pain in other sports, this injury is really inherent in repeated one-legged support and repetitive movement. This way, you don’t have any pain on your bike or the rower. Normal, your pelvis is placed on a seat and does not need to be stabilized by the gluteal deltoid. Even on elliptical, it is rare that you are embarrassed. Of course, you don’t have a saddle but the other foot stays on the pedal and that’s enough to reduce mechanical stress.
Even more typical, you don’t suffer in football or tennis. In all recreational sports including running and lateral movements, movements are not sufficiently repetitive to cause pain. Classically, you can see a footballer playing football easily while he is limping during his physical preparation on the track.
Beginner’s injury or caused by increased training volume
If I take your interrogation more closely, you tell me that you have been running for a short time, a few weeks or a few months. In the same context of overwork, you may have been practicing for a long time but have quickly increased your mileage for a longer than usual competition.
Under these conditions, the traumatic mechanism is not an accumulation of microlesions within the tendon. It is more likely to be a fatigue alteration of the subtle coordination mechanisms during your support phase. We will come back to this in the context of treatment and prevention.
Your knee pain occurs after a few minutes of jogging. It is all the earlier as bursitis is voluminous. The more you run, the more you suffer! You tend to keep your knee in extension. Sometimes you prefer to shorten your exit. Back to everyday life, the pain disappears quickly.
This chronology characterizes bursitis, it differs from that of tendonitis. If you were a victim of the latter, you would then be in pain at the beginning of your jogging. With the warm-up, the pain could disappear and sometimes return at the end of the session and persist on a daily basis. Often, you have hollow feet and arched legs, a bit like a cowboy on his horse.
Your doctor has two tests to make the diagnosis. The first one tries to reproduce the pain by performing a mini-squat on one leg, the second one consists in pressing on the bursitis. These two signs are not very sensitive. Indeed, they are often negative despite an authentic bursitis while running. To facilitate your examination, do not hesitate to jog in the morning or the day before in the evening of your consultation. However, you should be aware that wiper syndrome is mainly a diagnosis of interrogation.
What are the possible knee pains in a runner?
An expert sports doctor quickly diagnoses fascia lata bursitis. However, it has discreetly but effectively researched and then eliminated what are known as “differential diagnoses”.
- Outer meniscus lesion: a crack, wear or cyst in the small cartilage wedge between the femur and tibia
- Arthrosis between the tibia and femur on the outer compartment of the knee
- Fatigue fracture of the femur or tibia near the knee
- Suffering from a small joint between the fibula and tibia, just below the knee
- Tendonitis of the biceps of the thigh on its insertion in the fibula
- Biceps breakdown at the junction between muscle and tendon
- Tendinitis of the fascia lata at its point of attachment to the tibia… Yes, this lesion exists but it is much more exceptional than bursitis of the facia lata and the pain is 3 to 4 cm lower!
- Suffering from a branch of the sciatic nerve
When there is a diagnostic doubt, your sports doctor prescribes additional tests: radiography, ultrasound, nerve conduction test (EMG) or MRI. It makes its choice according to the other hypotheses considered. Most often, it is MRI that is necessary. Indeed, it is not uncommon for bursitis to be so voluminous that it descends opposite the external meniscus and suggests a lesion of the latter.
To perform an MRI, make an appointment with your doctor on DoctorAnyTime.
How to treat wiper syndrome?
Choose the right running shoes
If you have support problems, arched legs or flat feet, a pair of corrective soles is recommended. It is made for you by a sports podiatrist. Be careful, depending on your morphological or functional defects, the reliefs are completely different.
Any confusion leads to a worsening of your symptoms. So, before starting the procedure, it is a good idea to check your running shoes. Indeed, if they are too worn or unsuitable, they accentuate your support anomalies. All you have to do is change them or choose them well.
If you have arched legs and hollow feet, you will then gladly choose a model called a “supinator”. If, on the other hand, you have a hypotonic flat foot, you will prefer a pair for “pronators”.
In any case, these arrangements are very often effective if you take care to gradually get back into the race. The standard protocol is very simple. Anyway, you kept in shape by pedaling, swimming or doing cardiotraining on an elliptical or rowing machine.
You then have to integrate a little running into your training. After you put your bike down, go jogging. As you get off your elliptical, get up on the mat a little. Start with 5 minutes, add 5 minutes per session. At the rate of 3 weekly sessions, you do a real 30-minute jog after 2 weeks.
During the recovery phase, a few physiotherapy sessions are sometimes welcome. Their objective is to remove the tendon from the lower end of the femur. In theory, ultrasound and laser contribute to this. But beware of overly energetic massages that can aggravate bursitis. The main purpose of rehabilitation is to restore more tonic support, without contorting the knee.
Reinforcement is strongly recommended. A few months later, when you have forgotten your pains… you also forget your soles in your old pair of shoes. And the pain doesn’t recur! You have absorbed the increase in your workload. Even at the end of the outing, your supports are better controlled and more tonic, your fascia lata no longer rubs! Thus, wiper syndrome is often treated with a pair of temporary soles, it is not always necessary to renew the prescription the following year!
Infiltration of anti-inflammatory corticosteroids
On the other hand, it happens that the footwear strategy is not enough. Bursitis is so big that treating the cause is no longer enough! A vicious circle has thus begun: the more the fascia lata rubs, the bigger the purse gets and the bigger it gets, the more the fascia lata comes into contact with it. In these circumstances, an infiltration of anti-inflammatory corticosteroids is very often effective. It is preferably performed under ultrasound to inject the skin tangentially to the skin, just between the tendon and the bone, in the area of irritated friction.
As you can see, the bite does not occur in the tendon structure and does not weaken the fibres. The product dries the bursitis and you can gradually resume the run. Thus, after 5 days without sport with the legs, follow a protocol comparable to that proposed for the soles. Infiltration and correction of supports work together to relieve you. All you have to do then is to design a program that is a little more humble.
The surgical operation
Exceptionally, the cocktail soles-infiltrations is not enough to cure you. An operation is necessary. It mainly consists of cleaning the space between the bone and the tendon. The surgeon then finds fibrous tissue with adhesions that inevitably hinder the sliding. If the lesion has been dragging on for several months, then the operator often describes hard, thick and irregular bursitis. This structure, often compared to a dry apricot, attaches the tendon with each passage. Even more rarely, the posterior part of the tendon blade is frayed and your surgeon must regularize it. Less wide, it will no longer rub against the relief of the femur.
At 1 month after this procedure, when the scar is well closed and the inflammation is soothed, you can pedal. 2 months after the operation, you climb on an elliptical. At 3 months, you trot. At 4 months, you return to a complete program.