CausesAnatomy/Biomechanics: The iliotibial band is a thick band of tissue that extends from the thigh(femur)down over the knee and attaches to the tibia. When the knee bends (flexion) andstraightens (extension), the iliotibial band slides over the lateral femoral epicondyle,the bony part of outer knee. Iliotibial band friction syndrome refers specifically to thelateral knee pain related to irritation and inflammation to the point at which the bandcrosses the lateral femoral epicondyle. This type of irritation occurs when the knee isflexed at approximately an angle greater than 30 degrees, because the iliotibial bandshifts posteriorly behind the lateral femoral epicondyle. During extension, the bandshifts back anteriorly in front of the lateral femoral epicondyle and it is this motionthat causes friction between the iliotibial band and the lateral femoral epicondylewhich leads to irritation and inflammation within the iliotibial band. Symptoms:Iliotibial band friction syndrome is a condition not unique to runners, it and itssymptoms are now frequently seen in cyclists, weight lifters, skiers and soccerplayers.
The most obvious sign that you have ITBFS is the pain felt usually duringexercise. Runners will describe the pain on the outside part of the knee or lowerthigh. The degree of discomfort runs from dull aching sensation to a sharp stabbingpain. The pain is not localized so most suffers cannot put their finger on oneparticular spot. Suffers will generally use the flat of their hand to describe thelocation of the pain. One easy self test to know if you might have ITBFS, is the pointof tenderness test.
A patient with ITBFS will exhibit extreme point of tenderness atabout 2 cm over the outside part of the knee when flexed at thirty degrees. Anothercommon symptom is a ?creaking? noise during activity, this noise mostly occursduring weight bearing exercise like weight lifting. This is because during weightbearing activities the additional pressure and compression forces the contraction ofthe knee joint. This leads to elevated friction over the lateral epicondyle andincreased pain. One important factor about ITBFS is that it is a problem not insidethe knee joint, but around it, which makes more easily distinguishable and treatable.
PreventionCommon Training Errors/Training Modifications:Iliotibial band friction syndrome is an overuse injury caused by extensiverepetitive friction of the iliotibial band. The most frequent oversight runners andathletes make is over doing it or over training. This can be controversial because ifyou wish to compete at highly competitive levels what is over training? This shouldbe decided by the athletes themselves who should know when to make the rationaldecision of knowing when to stop. Another predisposing factor for the developmentof ITBFS is training error and abnormal biomechanics. Many runners make themistake of only running on one side of the road. Most roads are higher in the centreand slope off on either sides.
The foot on the outside part of the road is lower thanthe other. This causes the pelvis to tilt to one side and tightens the iliotibial bandoccurs, naturally increasing friction. Runners must always remember to try whenpossible to run on flat terrain, this will greatly reduce the chances of acquiringITBFS. As running on flat terrain reduces friction, highly shock absorbing footwearis also needed.
In runners with normal feet, the force of running is dissipated by thefoot. However, if you have a minor abnormality in your foot anatomy, like high orlow arches, the shock from the force of the foot strike is primarily passed directly tothe knee. A good pair of shock absorbing shoes will decrease the pressure, inturnallowing the muscles and tendons surrounding the knee, chiefly the iliotibial band tobe more relaxed reducing friction. Shoe mileage should also be considered forserious runners or athletes. After about 500 miles or 800 kilometres most shoes loose60% of their initial shock absorption capacity. As some one jogging leisurely ortraining competitively, both should participate accordingly, knowing when not toover do it, and knowing to implement good training habits like appropriate footwearand stretching before and after performance.
If these aspects of sport along withothers are followed avoiding ITBFS should be easily accomplished. RehabilitationTreatment:In establishing an appropriate treatment program, the severity of the presentinflammation must first be determined. Once the injury is properly assessed and thediagnosis taken into consideration, the athlete may be placed into one of the threephases of iliotibial band care. The first phase of care is the Immediate Phase. This is the phase in which thepain and inflammation must be controlled along with any poor training habits, whichsome I already discussed are corrected.
Achievement of these goals require areduction of activity and the proper administration of oral anti-inflammatories. If thetrainer sees fit, many alternate treatments may be implemented. Such as ice, heat,ultrasound, and electrical stimulation. It should also be noted that stretchingexercises which are extremely important to combat any excessive iliotibial bandtightness are conducted in this phase. The second phase, or the Short Term Phase becomes a consideration only ifthe painful symptoms have not yet resolved within approximately 10 days of theprevious treatment. All the previous treatment should be continued with the possibleaddition of a physician administering steroid injections, in two week intervals.
Further restriction of activity may be necessary. If deconditioning of the athletebecomes a concern during this phase, he/she can participate in other activities likeswimming or cycling, as long as the activity remains pain free. The third and final phase, the Long Term Phase is seen as an optimisticalstage. This phase begins only after the pain and inflammation symptoms haveresolved.
This phase is typically in close association with the athletes return to sport. During this stage, it is very important to prevent any reoccurrence of the resolvedsymptoms. So a gradual return to play with extensive specific stretching exercisesboth before and after workout is essential. If at this point pain and inflammation hasnot significantly reduced, a return to play is not a good option yet. Your trainer orphysician should recommend further rest or surgery as a last resort.
Surgery:Surgery is contemplated and seen only after many attempts of non operativemeasures failed to relieve symptoms. Surgery is usually only required for thoseindividuals who are unwilling for many reasons, some very valid to modify theirsports participation. The surgery consists of making a 2cm incision in the posteriorfibres of the iliotibial band. This loosens the tendon some what but mostly allows forspace for the band to pass over the lateral femoral epicondyle without much of thefriction.
Iliotibial band friction syndrome (ITBFS) is an overuse injury that is mostcommon in those athletes that entertain highly repetitive running sports. It is seen in avariety of athletes from soccer players to cyclists. It is the inflammation of iliotibialband as a result of friction with the lateral femoral epicondyle. The injury is easilydetectable and the proper treatment and rehabilitation should be diagnosed. Theinjury should be first be treated in a conservative manner by initiating the progressionof rest, stretching, and the moderate use of medications only if directed by aphysician.
If all conservative attempts fail to achieve results then surgery might haveto be necessary. After doing this research paper I have learned a number of things,but most importantly I believe I have learned what that pain on the outside of my leftknee that I have been experiencing for the last few months is. Health and Beauty