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Iliotibial Band Syndrome

Iliotibial Band Syndrome (ITBS) is one of the most common injuries among runners, triathletes, cyclists and others. While it is often seen in athletes we have treated  many non athletes with this condition as well.

The iliotibial band (ITB) is a thick fibrous band of connective tissue that begins at the lateral aspect of the pelvis and runs down the outside of the upper leg to just below the knee. While the band is not contractile in and of itself, its development from the tensor-fascia-latae (TFL) muscle anteriorly and the glute medius and minimus posteriorly allow it to act as a stabilizer and abductor of the lower extremity.

When the knee is bent the ITB is positioned behind the femoral epicondyle. When the knee straightens the IT moves across and anterior to the femoral epicondyle.

ITBS is an overuse injury that causes the band to rub across the lateral prominence of the femoral epicondyle. This friction of the band rubbing across the bone causes irritation and inflammation of the ITB. This overuse injury may be attributed to poor training programs (a greater increase in mileage or intensity than the body can adapt to), poor biomechanics, running on banked surfaces, lots of downhill running, muscle weakness or poor flexibility of the soft tissues.

ITB is the most common cause of lateral knee pain in runners and cyclists. ITB often presents initially as pain, tightness or even snapping on the outside of the knee when the knee bends during walking or other activity. Edema (swelling) may be evident in the area as well. As the symptoms progress walking down stairs or downhill can become unbearable.

Diagnosis of ITBS is attained by a thorough history and physical examination. The examination should include palpation, orthopedic tests, range of motion testing of the lumbar spine, hips, knees and ankle as well as observation of biomechanics of movement in the regions. Imaging such as xray and MRI are typically not necessary.

Treatment of ITBS should initially address any inflammation and then work to correct any biomechanical problems, strength deficits or motor control issues.

Inflammation may be treated with rest, ice or anti-inflammatories. Soft tissue work such as ART or massage, along with stretching or foam rolling may be used to improved mobility and flexibility. Muscle activation and strength training exercises are then used along with biomechanical training are the final piece of the puzzle to ensure a full recovery from ITB and decrease the potential for a future episode as well.

When symptoms first present themselves it is imperative to back off on ones training (run less, avoid hills, avoid hard efforts, etc), stretch, cross train or even take a complete rest. You should also look at the mileage in your running shoes, if they have too many miles their support will have broken down and make you more susceptible to injury. If symptoms persist you should consult a healthcare professional that is familiar with running and other sports injuries.

Most cases can be taken care of with conservative care but some serious cases may require a cortisone injection or even surgical intervention. Fortunately, these cases are very rare when the injury has been treated by someone familiar with musculoskeletal injuries.

If you have any questions regarding iliotibial band syndrome or any other musculoskeletal conditions please feel free to contact us at our office.

Michael S. Donia, D.C

Certified Chiropractic Sports Practitioner

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