What is Iliotibial Band Syndrome
Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners, with an incidence as high as 12% of all running-related overuse injuries. Iliotibial band syndrome is believed to be from a repeated frictional rub of the ITB sliding over the outer aspect of femoral epicondyle. Low mileage runners usually improve with an uncomplicated course of therapy and appropriate stretches; however, higher mileage, competitive runners usually need more comprehensive management. The ITB is a tendonous continuation of the tensor fascia lata muscle which starts from the hip and attaches to part of the gluteus medius, gluteus maximus, and the vastus lateralis muscles. The ITB helps the tensor fascia lata abducting the thigh and assists in decelerating adduction of the thigh. It can also act as a stabilizer of the knee.
What Causes Iliotibial Band Syndrome
Iliotibial band syndrome occurs when the ITB impinges against the lateral epicondyle just after foot strike in the gait cycle. Increased mileage and knee flexion/extension weakness is related to the braking forces when running. Iliotibial band syndromecan also be related to foot pronation and leg length inequality. The leg length inequality can be secondary to a true anatomical disparity or brought on by running on uneven surfaces. Hip abductor weakness may be a factor in iliotibial band syndrome. A study of 24 long distance runners revealed significant weakness in the hip abductors on the affected side of the iliotibial band syndrome. After 6 weeks of rehab focused on strengthening the gluteus medius, 92% of the runners were pain free.
Iliotibial Band Syndrome Treatment Options
One of the major symptoms of iliotibial band syndrome is usually a sharp pain or burning pain on the outer aspect of the knee. Runners usually start out pain free, but develop pain after a specific time or distance. Knee exams are usually normal except for local tenderness with occasionally swelling over iliotibial band insertion. Sometimes crepitation, snapping or mild pitting edema can arise over the insertion.
During the initial phase of iliotibial band syndrome, ice is applied locally to reduce inflammation. Activity modification is critical to ease the continued irritation to the insertion. After the acute phase, contract-relax exercises and foam rollers are used to lengthen the shortened iliotibial band. With iliotibial band syndrome stretching should also be performed on the iliopsoas, rectus femoris, and gastronomies-soleus muscles if restricted. Pelvic drops or step-down drops can help to avoid excessive hip adduction or internal rotation. Using interferential current, acupuncture, kinesio taping with attention to the gluteus medius muscle promotes healing and stabilization of the iliotibial band syndrome. Custom orthotics can improve patella tracking and functional mechanics of the lower extremities when running. Chiropractic manipulation to improve the alignment of the spine and knee can also make a difference when indicated.
this article on iliotibial band syndrome is informational and not to be used to diagnose or treat any medical condition