Iliotibial Band Syndrome Iliotibial Band Syndrome (ITBS)(ITBS)

What is it?What is it?

DiagnosisDiagnosis

TreatmentTreatment

PreventionPrevention

StretchesStretches

Iliotibial BandIliotibial Band

A thickening of the fascia that runs up the outside (lateral) thighA thickening of the fascia that runs up the outside (lateral) thigh

Connects to 2 muscles at the hip (Gluteua Maximus and Tensor Connects to 2 muscles at the hip (Gluteua Maximus and Tensor Fasciae Latea) and then down below the outside of the knee to the Fasciae Latea) and then down below the outside of the knee to the tibia (shin bone)tibia (shin bone)

The Primary function is to provide stability to the lateral knee while The Primary function is to provide stability to the lateral knee while standingstanding

It helps to maintain hip extension in standing and hip/knee flexion in It helps to maintain hip extension in standing and hip/knee flexion in running and walkingrunning and walking

The IT-Band moves forward at the knee as the knee extends and The IT-Band moves forward at the knee as the knee extends and slides backward at the knee as the knee flexes, but is tense in both slides backward at the knee as the knee flexes, but is tense in both positionspositions

http://www.endurancesports.com/itbs.asp

Iliotibial Band SyndromeIliotibial Band Syndrome

ITBS is an overuse injury that may be ITBS is an overuse injury that may be sustained by physically active people as a sustained by physically active people as a result of training errors, anatomical result of training errors, anatomical factors, or functional characteristics. factors, or functional characteristics.

Iliotibial Band Syndrome Jerry M. Linenger and Karen Maxwell Williams - NASA

CausesCauses

Training ErrorsTraining Errors

Anatomical FactorsAnatomical Factors

DynamicsDynamics

Training ErrorsTraining Errors

Abruptly increasing running mileageAbruptly increasing running mileage

Running on uneven surfacesRunning on uneven surfaces

Running on slippery surfacesRunning on slippery surfaces

Running too many hillsRunning too many hills

Improperly using a varus wedgeImproperly using a varus wedge– Varus heel wedges can be used to reduce Varus heel wedges can be used to reduce

pronation and supination by angling heel bone pronation and supination by angling heel bone either medially or laterally and when running. either medially or laterally and when running.

Contributing Anatomical Contributing Anatomical Factors Factors

Prominent lateral femoral epicondyleProminent lateral femoral epicondyle

Tight iliotibial bandTight iliotibial band

Excessive genu varumExcessive genu varum

High arch in footHigh arch in foot

High Q angleHigh Q angle

Restricted range of motionRestricted range of motion

Difference in leg lengthsDifference in leg lengths

DynamicsDynamics

Above-average maximal foot pronationAbove-average maximal foot pronation

High maximum velocity of pronation during High maximum velocity of pronation during support phasesupport phase

Excessive intoeing during the support Excessive intoeing during the support phase of the running stepphase of the running step

Excessive rearfoot movementExcessive rearfoot movement

DiagnosisDiagnosis

Renne TestRenne Test– Stand with all body weight on the affected leg. Stand with all body weight on the affected leg.

Stinging pain is felt on the lateral epicondyle when he Stinging pain is felt on the lateral epicondyle when he or she flexes the knee approximately 30 degrees.or she flexes the knee approximately 30 degrees.

Noble compression test Noble compression test – Lay on your back and the affected knee flexed 90 Lay on your back and the affected knee flexed 90

degrees. Pressure is applied to the lateral femoral degrees. Pressure is applied to the lateral femoral epicondyle as the patient extends the leg at the knee. epicondyle as the patient extends the leg at the knee. Patients with ITBS experience stinging pain at Patients with ITBS experience stinging pain at approximately 30 degrees of flexion approximately 30 degrees of flexion

TreatmentTreatment

Stage one involves resting the knee, Stage one involves resting the knee, stretching the bandstretching the band, applying ice, and , applying ice, and taking anti-inflammatory drugs. taking anti-inflammatory drugs.

Stage two includes a local steroid Stage two includes a local steroid injection, phonophoresis, and podiatric injection, phonophoresis, and podiatric evaluation. evaluation.

Stage three involves surgical intervention Stage three involves surgical intervention for refractory cases. for refractory cases.

PreventionPrevention

GaitGait– The stride should be as much inline with the direction The stride should be as much inline with the direction

of travel as possible, especially in longer distance of travel as possible, especially in longer distance workouts. Avoid uneven terrain.workouts. Avoid uneven terrain.

Avoid rapid rampup of training mileageAvoid rapid rampup of training mileage– The intermediate runs between long runs are The intermediate runs between long runs are

importantimportant

Proper footwear Proper footwear – Reduces lateral strain on the kneeReduces lateral strain on the knee

Stretch after warmupStretch after warmup

StrechesStreches

The Figure 4 StretchThe Figure 4 Stretch– While StandingWhile Standing– Take the affected leg Take the affected leg

and place your foot and place your foot above the knee of the above the knee of the other legother leg

– Hold onto something Hold onto something for balancefor balance

– Slowly ‘sit’ bending Slowly ‘sit’ bending your unaffected legyour unaffected leg

The Side IT BandThe Side IT Band StretchStretch

StretchesStretches

http://crossroadsmedicalmission.org/education/ortho/patello-femoral.html

Using a foam roller, lie on your side with lateral hip on the foam roller. Roll back and forth to loosen up muscles on outside of the hip.

http://www.therapeuticassociates.com/events/lower-quadrant-stretching-exercises/