The Iliotibial Band Syndrome (also known as
ITBS or Iliotibial Band Friction Syndrome
) is a common overuse injury among runners affecting the musculoskeletal structures of the outer thigh and knee. It causes pain on the lateral side of the knee during running.
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What it is and what you can do
The iliotibial band (also called ITB or iliotibial tract) is a long and thin sheath of fibrous connective tissue that connects and surrounds the muscles located at the lateral thigh. It is very strong and is avascular- lack of blood vessels or blood supply. Originating from the anterior superior iliac spine- part of the pelvis, the iliotibial band extends down attaching into the lateral thigh to the knee. The ITB is also connected to the gluteus maximus (buttock muscle) and tensor fascia latae. The ITB then acts to synchronize the muscles to be able to stabilize the knee during activities.
The ITB crosses over a bony protruberance, the femoral epicondyle as it passes the knee. Upon knee flexion and extension, the ITB moves anteriorly and posteriorly and snaps on the femoral epicondyle thus, produce friction between the two. When there is too much friction, the ITB and its surrounding areas will be irritated and will result to inflammation.
What is ITB Syndrome?
The Iliotibial Band Syndrome develops when there’s excessive and repetitive flexion and extension of the knee. Hence, irritation, swelling and inflammation occur. Then, the ITB will not work properly thus, movement of the knee will be painful. This injury commonly affects athletes such as long distance runners or marathoners, tri-athletes, footballers and cyclists.
Another cause of ITBS is not enough flexibility of the ITB. As a result, there is an increased pressure and tension on the ITB when an individual is in the stance phase of running. Other risk factors that may lead to the development of ITBS include hip adductor weakness, genu varum (bow legs), leg length discrepancy, over pronation, gluteal muscle weakness, excessive hill training specifically downhill and myofascial restriction.
Symptoms and Treatment
Symptoms of ITB Syndrome
The symptoms of ITBS include:
· Tenderness on the lateral or outer side of the knee
· Lateral knee pain (most common symptom) aggravated by activities like running
· Popping sound at the knee (rare)
· Pain that radiates from the knee up to the hip
· Pain when bending the knee, usually at a 45 degree angle
ITBS can be mistakenly diagnosed as patellofemoral pain syndrome, hamstring strain, meniscal injury or lateral collateral ligament injury.
Iliotibial band syndrome can be diagnosed through the patient’s symptoms plus physical examination and can be confirmed further through scans like MRI and CT scan. Physical examination is performed to determine the underlying cause of ITBS. This includes strength testing and special tests such as Ober test and modified Thomas test.
Treatment for ITBS
ITBS can be treated through conservative managements. The first line of treatment is usually to address the symptoms of ITBS. Surgery is very rare.
Since ITBS is caused by repetitive movements, the initial treatment for ITBS is RICE which stands for rest, ice, compression and elevation. In some cases, anti-inflammatory drugs like Ibuprofen and steroid injections can help reduce pain.
If symptoms get worse and were not addressed by RICE, physiotherapy is needed. Physiotherapy will focus on pain reduction, flexibility and return to function. To reduce pain, hot compress, TENS (Transcutaneous Electrical Nerve Stimulation) or therapeutic ultrasound are used. Since one cause of ITBS is decreased ITB flexibility, proper stretching is necessary to increase the flexibility of ITB. Stretching of the gluteal muscles, quadriceps, hamstrings, gastrocnemius and soleus are also incorporated in physiotherapy. When symptoms are improved, physiotherapy can now progress to strengthening and endurance exercises targeting the hip abductors and knee flexors and extensors. Joint mobilization and soft tissue massage may also be included to the program.
The patient must continue to do the exercises that were taught in physiotherapy at home for maintenance purposes. Runners will be educated with the correct running and landing techniques and proper footwear as well as accessories.
Surgery is considered when all conservative managements fail. Iliotibial band release and resectioning of the posterior portion of the ITB are some of the surgical techniques used to treat severe cases of ITBS. Post op rehabilitation is still needed before a patient can return to his/her pre-morbid status.
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