Iliotibial band syndrome

Tensor fasciae latae muscle

Origin: Spina iliaca anterior superior

Insertion: iliotibial band

Actions: Hip > ABD, FLEX, INT ROT

Gluteus maximus muscle

Origin: Dorsal surface of the sacrum and facies glutea of the ilium

Insertion: Upper fibers > iliotibial band, lower fibers > tuberositas glutea of the femur

Actions: Hip > EXT, EXT ROT, upper fibers > ABD, lower fibers > ADD

Iliotibial band insertion: lateral tubercle of the tibia (tuberculum of Gerdy, after French surgeon Pierre Nicolas Gerdy [1797–1856]).

Iliotibial band syndrome is a common overuse syndrome especially in long distance athletes. There are a lot of factors that can cause this syndrome, both biomechanical and training, but the exact cause is not completely understood.

When an athlete is running his foot touches the ground about 3000 times per mile. After running for 10 times he has touched the ground 30000 times. The force required to lift his body weight while running is about 3 times this weight. So, if someone weight 70 kg he will need to exert force to lift 210 kg. This means that his leg joints and muscles are loaded with extreme forces during exercise.

Biomechanics

The iliotibial band (ITB) provides the knee with stability. When the knee is in flexion over 30 degrees, the ITB is moving dorsally behind the lateral epicondyle of the femur. When the knee is extended, the ITB is moving ventrally in frond of the lateral epicondyle of the femur. This movement irritates the ITB and the bursa that lies under the insertion of it and attaching on the periosteum of the lateral epicondyle of the femur (Running News, Margaritis, 2008).

       

Research has shown that the joint capsule of the knee is folding at the point of attachment of the ITB and it is this structure that is inflamed in the ITB syndrome and not the ITB itself (Running News, Margaritis, 2008).

Causes

The ITB syndrome is an overuse syndrome which appears when the body's natural healing mechanism do not have enought time to heal the micro-damages at the point. However, there are a lot of risk factors that can increase the chances of it to appear. Here are some major causes (Running News, Margaritis, 2008):

1. Uneven leg lenght > causes variations in the function and position of the hip abductors and the pelvis bone increasing tension on the ITB

2. Genu varum > increases tension on the ITB

3. Foot overpronation > causes tibial internal rotation and hip adduction increasing tension on the ITB

4. Week hip abductors > causes increased hip adduction and internal rotation increasing tension on the ITB

5. Myofascial limitations > tight hip flexors and/or extensors and rotators increase tension on the ITB

Assessment

The pain is located at the lateral side of the knee, but it may also appear in the hip. Pain increases with running, hip and knee active flexion, hip active or passive adduction. Palpating the region can also reproduce the symptoms.

Special tests to reproduce the symptom:

Ober test > positive if the hip remains abducted.

Thomas test > positive if the knee off the bed is not flexed more than 70 degrees or hip cannot be adducted more than 15 degrees.

During assessment, the iliopsoas, the rectus femoris, the gastrocnemius and the soleus muscles should be also assessed for tightness or weakness.

How to protect yourself against the ITB syndrome

• Avoid running on hard surfaces
• Avoid running in descending surfaces
• Avoid extreme increases in your training session
• Have proper running shoes and buy new ones every 300-400 miles of training
• Stretch your legs during and after your training
• Increase knee, hip and pelvis muscle strength

Physical therapy for ITB syndrome

Acute phase - inflammation (2-5 days):

- reduce inflammation putting ice at the region for 10-15 minutes, 2 times per day

- avoid movements that reproduce the symptoms and take some rest

- add light stretching of the ITB to avoid contractures during the healing process

Later phase - proliferation (up to 6 weeks):

- facilitate fibers' normal alignemnt and prevent abnormal activation to become habitual

- increase blood flow to the region through passive activation, static stretching, gentle isometric activation with very minimum or no loading and open chain exercises, massage, and electrotherapy

- strengthen the hip abductors and external rotators, the quadriceps and the cuff muscles

- stretch the ITB and the hip adductors, extensors and internal rotators

Remodelling phase (up to 1 year):

- rebuild all locomotive properties and put the patient back to his/her daily life as functionally as possible

- use passive, active and isometric activation

- work with coordination, proprioception and functional activation

- suggested methods: ballistic stretching, PNF, dynamic stretching, weights in closed chain

- strengthen the hip abductors and external rotators, the quadriceps and the cuff muscles

- stretch the ITB and the hip adductors, extensors and internal rotators

References:

• Brody TL, Carrie MH. Therapeutic Exercise: Moving Toward, Function. 3rd ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2011.
• Running News. The iliotibial band syndrome. Anastasios Margaritis. c2008 [cited 2008 November 28]. URL: http://www.runningnews.gr/item.php?id=4930.
• Schuenke M, Schutle E, Schumacher U. Thieme Atlas of Anatomy: General Anatomy of the Musculoskeletal System. New York: Thieme Medical Publishers, Inc.; 2006.

Always visit your personal GP, Orthopedic MD or PT before trying anything yourself that may worsen the situation.