Ilio-Tibial Band Ilio-Tibial Band SyndromeSyndrome

The band The band originates at the originates at the lateral iliac crest lateral iliac crest and extends and extends distally to the distally to the patella, tibia, and patella, tibia, and biceps femoris biceps femoris tendontendon

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Features of ITB syndromeFeatures of ITB syndromeLateral knee pain Lateral knee pain Frequently seen in runners or cyclists (overuse) Frequently seen in runners or cyclists (overuse)

due to slides over the lateral femoral due to slides over the lateral femoral epicondyle epicondyle during repetitive flexion and during repetitive flexion and extension of the extension of the knee knee MRI shows distal iliotibial band becomes MRI shows distal iliotibial band becomes thickened and that the potential space deep to thickened and that the potential space deep to the iliotibial band over the femoral epicondyle the iliotibial band over the femoral epicondyle becomes inflamed and filled with fluid becomes inflamed and filled with fluid

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Potential risk factors Potential risk factors

Preexisting iliotibial band tightness Preexisting iliotibial band tightness High weekly mileage High weekly mileage Time spent walking or running on a trackTime spent walking or running on a trackInterval training and Interval training and muscular weakness of: knee extensors, muscular weakness of: knee extensors,

knee flexors, and knee flexors, and

hip abductorship abductors

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Differential Diagnosis of Differential Diagnosis of Lateral Knee PainLateral Knee Pain

Biceps femoris Biceps femoris tendinopathytendinopathyDegenerative joint Degenerative joint diseasediseaseLateral collateral Lateral collateral ligament sprainligament sprainLateral meniscal tearLateral meniscal tearMyofascial painMyofascial pain

Patellofemoral stress Patellofemoral stress syndromesyndromePopliteal tendinopathyPopliteal tendinopathyReferred pain from Referred pain from lumbar spinelumbar spineStress fractureStress fractureSuperior tibiofibular Superior tibiofibular joint sprainjoint sprain

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Physical Assessment Physical Assessment findingsfindings

Pain localized 2 cms above joint linePain localized 2 cms above joint lineWorse when standing with knee flexed 30Worse when standing with knee flexed 30ººMultiple trigger points in the vastus lateralis, Multiple trigger points in the vastus lateralis, gluteus medius, and biceps femorisgluteus medius, and biceps femoris

Demonstrable weakness of the musclesDemonstrable weakness of the muscles

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Ober's test Ober's test

Assess tightness of the iliotibial band: Assess tightness of the iliotibial band:

Client lies down with the unaffected side down Client lies down with the unaffected side down and and the unaffected hip and knee at a 90the unaffected hip and knee at a 90ºº angle angle

If the iliotibial band is tight, the client will If the iliotibial band is tight, the client will have difficulty adducting the leg beyond the have difficulty adducting the leg beyond the midline and may experience pain at the lateral midline and may experience pain at the lateral knee knee (arrows)(arrows). .

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TreatmentTreatment

Activity modification, massage, and Activity modification, massage, and stretching and strengthening of the stretching and strengthening of the affected limb affected limb Anti-inflammatory medicines and stretching Anti-inflammatory medicines and stretching

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Stretches of the right Stretches of the right iliotibial band iliotibial band

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Weight-bearing exercises for Weight-bearing exercises for strengthening of the right gluteus strengthening of the right gluteus

medius musclemedius muscle

(A) The patient (A) The patient stands on a platform stands on a platform and lowers the left and lowers the left leg toward the leg toward the ground slowly. ground slowly. (B) Through (B) Through contraction of the contraction of the right gluteus right gluteus medius, the patient medius, the patient then elevates the then elevates the leg, returning the leg, returning the pelvis to a level pelvis to a level position. position.