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Iliotibial Band Syndrome
Aka: Iliotibial Band Syndrome, Iliotibial Band Tendonitis, Iliotibial Band Friction Syndrome
- Epidemiology
- See also Running Injury
- Second most common knee problem in runners
- Accounts for 12% of Running injuries
- Risk factors
- Running downhill
- Running on hard surfaces (e.g. track)
- Running long distances
- Low body fat
- Varus malalignment
- Iliotibial band tightness
- Cross-over or supination during Running gait
- Excessive foot pronation and internal tibial rotation
- Not supported in studies
- Pathophysiology
- Microtrauma injury to iliotibial band
- Irritation of distal iliotibial band
- Excess friction, impingement at lateral femoral condyle (esp. with knee flexed to 20 to 30 degrees)
- Usually due to repetitive flexion and extension
- Symptoms
- Initial characteristics
- Non-focal, diffuse lateral knee ache
- Later characteristics
- Sudden onset of sharp or stinging lateral Knee Pain
- Pain occurs during knee flexion (late swing phase)
- May require stopping Running
- Localized pain at fixed distance in miles
- Provocative: Repetitive knee flexion and extension
- Running downhill
- Stair climbing
- Running with longer stride
- Prolonged sitting with flexed knee
- Cycling
- Signs
- Provocative Tests
- See Noble's Test
- See Ober's Test
- Tenderness at 2 cm above (proximal to) lateral joint line
- Tenderness at lateral epicondyle of femur
- Pain on standing with knee flexed to 30 degrees
- Muscle Strength (weakness risk IT Band Syndrome)
- Knee extensors and flexors
- Hip abductors
- Differential Diagnosis
- Plica Injury
- Popliteus Tendonitis
- Medial meniscus or lateral Meniscus Injury
- Management: Initial reduction in acute inflammation
- Acute measures
- RICE-M
- Cold Therapy
- NSAIDs for 10 days or less
- Relative rest until pain subsides
- Avoid repeated knee flexion and extension activity
- Cross-train with swimming
- Phonophoresis or Iontophoresis
- Iliotibial Band coticosteroid Injection
- Rarely indicated
- Consider for ambulatory pain longer than 3 days
- Inject maximally Tender Point over femoral condyle
- Management: After acute inflammation resolves
- Stretching (Described for affected right leg)
- Stand with right leg crossed behind left
- Lean forward and to left, with arms stretched out
- Gluteus medius strengthening (for affected right leg)
- Start after Stretching is no longer painful
- Standing position
- Right foot on raised platform (2-3 inches up)
- Left foot on floor
- Keep right knee locked in full extension
- Motion to repeat
- Slowly lower left foot to floor
- Raise left foot to Pelvis level
- Feel this in the right gluteus medius
- Modify Running training regimen
- Run on flat, non-banked surfaces
- Vary pace
- Gradually increase distance if no pain
- Stop Running for persistent pain
- Modify Bicycle fit
- Consider adjusting saddle height, pedal system
- Orthotics
- Adjust shoe for excessive lateral wear
- Surgical release of posterior 2 cm of IT Band
- Indicated if refractory to conservative measures
- Relieves pressure point over lateral epicondyle
- Course
- Resolves within 6 weeks on consistent rehab program
- References
- Arnold (2018) Am Fam Physician 97(8): 510-6 [PubMed]
- Khaund (2005) Am Fam Physician 71(8):1545-50 [PubMed]
- Fredericson (2000) Phys Sportsmed 28:53-68 [PubMed]