ITB Syndrome. Normal Anatomy Origin – Gluteus Maximus – Gluteus Medius – Tensor Fascia Latae – Ilium Insertion – Lateral Femoral Condyle – Tibial Infracondylar

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SLAP Lesions

ITB SyndromeNormal Anatomy

OriginGluteus MaximusGluteus MediusTensor Fascia LataeIlium

InsertionLateral Femoral CondyleTibial Infracondylar TubercleNormal AnatomyContinuation of TFL tendon

Thickened aspect of lateral fascia

Non-contractile structure

PathologyFriction of ITB against femoral epicondyle with repeated flexion and extensionCompression of distal ITB against lateral femoral condyleIrritation of lateral structuresFatConnective tissueITB Bursa

Mechanism of InjuryITB Compression

Impingement Zone30 degreesEccentric TFL Eccentric Glute MaxStance phase

Repetitive movementLong distance runningCyclingHill walkingMechanism of InjuryPosterior fibre irritation

Irritation of Lateral Synovial recess

Periosteum inflammation

Insufficient recovery

ClassificationCompressionLateral structuresITB itselfLateral condyle

Tissue IrritationSynovial recessBursaCyst?Inflammation presence in condition

?Anterior-Posterior movement or snapping

Lavine, 2010Associated PathologiesPFPS

Lateral ligament injury

BursitisSubjectiveLateral knee pains

Increase throughout activity

Some pain on bending activities

Increases with repetition

Can have swelling

?Tightness sensationObjective - KneeObservationLocal swellingIncreased Q angleValgusAnterior pelvic tilt

ROMFull ROMPain at 30 degrees flexion

Objective - KneeSquat/Single Leg SquatPain at 30 degreesWeight shiftValgus

PalpationDistal ITB tendernessLateral condyle tendernessITB tension

Objective - HipDecreased abductor strength

Contralateral Pelvic Drop

Dynamic Knee Valgus

Fredericson et al, 2000Objective - FootExcessive calcaneal eversion

Lack of supination

Tibial Internal Rotation

Ferber et al, 2010Special TestsObers & Modified Obers TestSide lyingFix pelvisTake hip into extensionRelease hipPositive if does not pass midline

Noble Compression TestPatient supineFlex knee to 90 degreesAdd compressionExtend kneeSymptoms approx 30 degrees

14Further InvestigationMRI

ManagementReduce pain

Reduce insertional compression

Correct imbalances

Improve kinetic chain functionConservative - ManagementMcNichol et al, 198194% improvement conservative treatment

NSAIDs0-7 days with treatment

CryotherapyPain relief

Schwellnus et al, 1991Conservative - ManagementTissue Release

Foam rollingTFLAdductors

Soft tissue techniquesMassageNot DTFNot Stretching

Schwellnus et al, 1992Chaudry et al, 2008Conservative - ManagementMuscle ActivationClam shellsHip abductions

StrengtheningBand WalksHip thrustsTibialis posterior

Cambridge et al, 2012Conservative - ManagementBiomechanicsMovement patternsSingle leg squatFMS

Gait assessment/re-educationStride widthCadence

FootwearOrthoticsRamp angles

Conservative - ManagementAdjunctsAcupuncture

Electrotherapy

Supports

Taping

Conservative ManagementReduce pain, swellingPrepare tissuesRestore Normal ROMActivate musclesCorrect Movement PatternsSurgical - ManagementLateral ReleaseTransect posterior halfBursa removalRelease of lateral retinaculum

InjectionCorticosteroid30% improvement

Gunter & Schwellnus, 2004Drogset et al, 1999ReferencesCambridge ED, Sidorkewicz N, Ikeda DM, McGill SM. (2012). Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech. 27(7); 719-24

Chaudry H, Schleip R, Zhiming J, Bukiet B, Maney M, Findley T. (2008). Three-Dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 108; 379-390

Drogset JO, Rossvoll I. Grontvedt T. (1999). Surgical treatment of iliotibial band friction syndrome. A retrospective study of 45 patients. Scand J Med Sci Sports. 9; 296-298

Ellis R, Hing W, Reid D. (2007). Iliotibial band friction syndrome A systematic review. Manual Therapy. 12; 200-208

Ferber R, Noehren B, Hamill J, Davis I. (2010). Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic & Sports Physical Therapy. 40(2); 52-60

Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. 10(3); 169-175ReferencesGunter P, Schwellnus M. (2004). Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. British Journal of Sports Medicine. 38; 26972

Lavine R. (2010). Iliotibial band friction syndrome. Curr Rev Musculoskelet Med. 3; 18-22

McNicol K, Taunton J, Clement D. (1981). Iliotibial tract friction syndrome in athletes. Canadian Journal of Applied Sport Science. 6(2);7680

Schwellnus M, Theunissen L, Noakes T, Reinach S. (1991). Anti-inflammatory and combined anti-inflammatory/analgesic medication in the early management of iliotibial band friction syndrome. South African Medical Journal. 79; 6026

Schwellnus M, Mackintosh L, Mee J. (1992). Deep transverse frictions in the treatment of iliotibial band friction syndrome in athletes: a clinical trial. Physiotherapy. 78(8); 5648

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