W125: Advanced Therapeutic Exercises and Ultrasound-Guided Procedures for Iliotibial Band Syndrome John Vasudevan, MD 1* Michael Fredericson, MD 2 Robert Baker, PT, OCS 3 Yin-Ting Chen, MD 4 Eugene Roh, MD 2 Michael Khadavi, MD 2 Jacob Sellon, MD 5 1. Department of Physical Medicine & Rehabilitation, University of Pennsylvania, Philadelphia, PA. 2. Division of PM&R, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA. 3. Emeryville Sports Physical Therapy, Emeryville, CA. 4. Department of Orthopaedics & Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD. 5. Department of Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN. *Course Director
W125: Advanced Therapeutic Exercises and Ultrasound-Guided
Procedures for Iliotibial Band Syndrome John Vasudevan, MD 1*
Michael Fredericson, MD 2 Robert Baker, PT, OCS 3 Yin-Ting Chen, MD
4 Eugene Roh, MD 2 Michael Khadavi, MD 2 Jacob Sellon, MD 5
1.Department of Physical Medicine & Rehabilitation, University
of Pennsylvania, Philadelphia, PA. 2.Division of PM&R,
Department of Orthopaedic Surgery, Stanford University, Redwood
City, CA. 3.Emeryville Sports Physical Therapy, Emeryville, CA.
4.Department of Orthopaedics & Rehabilitation, Walter Reed
National Military Medical Center, Bethesda, MD. 5.Department of
Physical Medicine & Rehabilitation, Mayo Clinic, Rochester, MN.
Iliotibial Band Syndrome: Not just whatbut why John Vasudevan,
MD PM&R Sports Medicine Assistant Professor, University of
Pennsylvania November 2014
Objectives 1.Define the anatomy and pathophysiology of
iliotibial band syndrome (ITBS) 2.Learn the pearls of exam and
treatment, and their supporting evidence 3.Understand common
ITBS: The What 2 nd most common cause of knee pain in runners
Lateral knee pain, insidious, progressive Worse with hills, slower
running speed Initially predictable at certain point of run, but
then progresses Cause: friction of ITB against lateral femoral
condyle Or (less likely) distal insertional pain at Gerdys tubercle
Impingement zone at ~20-30 knee flexion Inflammation of IT bursaif
ITB Anatomy Definition: lateral thickening of the fascia lata
in the thigh, dense fibrous tissue Has superficial and deep layers,
enclosing tensor fascia latae prior to anchoring at iliac crest
Receives majority of gluteus maximus tendon Superficial and deep
layers, enclosing tensor fasciae
TFL/ITB Anatomy Origin: Iliac crest just posterior to the
anterior iliac spine Insertion: lateral femoral condyle, lateral
retinaculum of knee, lateral patella, and Gerdys tubercle on
lateral tibial plateau Innervation: superior gluteal, L4, L5, S1
Action: hip flexion, abduction, internal rotation
IT Bursa? Anatomic Findings: ITB is firmly anchored to lateral
femoral condyle More medial-lateral translation rather than
anterior- posterior No bursa identified, but fibers integrated in
fat pad between ITB and lateral femoral condyle Conclusion: Pain
may be from compression of fat, not sliding over bursa Fairclough
2006; Falvey 2010
IT Band & Bursa Fredericson 2011; Fairclough 2006
IT Bursa arising from lateral recess of knee joint Jelsing
ITBS: The Why Anatomic Static: leg length discrepancy, genu
varum, pes planus Dynamic: Tight TFL/ITB, weak hip abductors, tight
heel cords, excess femoral/tibial internal rotation Training
Considerations Cambered surfaces Downhill running Strauss 2013;
Gaps in the Evidence No clear evidence to support: Stretching
the ITB (role of TFL in ITB lengthening) Strengthening the Gluteus
Medius Trigger Point Therapy BUT we suggest that strengthening will
fail if myofascial restrictions persist Limited Evidence to
support: NSAIDs and corticosteroid for short-term relief No study
comparing US-guided to landmark-guided Surgical treatment options
ITBS: Treatment Strauss 2013
Conclusions 1.While evidence-base is limited or conflicting,
outcomes with conservative treatment are very encouraging
2.Consider distal AND proximal factors 3.Dont just ask what, but
why and what else to optimize results and prevent recurrence
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