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ITBS is the most common cause of
lateral (outside) knee pain in runners. It is believed to be a result of
recurrent friction of the band sliding over the femoral epicondyle (where the
long femur bone widens and it forms the knee joint). It is mostly felt just
after foot strike when the knee is flexed at less than 30 degrees. It can also
cause pain in the hip area (clicking hip syndrome).
Symptoms
Pain is felt as an ache over the
outside aspect of the knee aggravated usually by running.
Initially pain is present after
running a certain mileage, typically late in the run, but as it progresses it
will occur earlier on. Downhill running is particularly aggravating and it may
also be felt running uphill and climbing stairs. Tenderness is felt 1-2cm above
the joint line, a little crepitus (crackling sensation) may be felt. Repeated
bending and extending the knee may reproduce symptoms. One diagnostic test a
therapist will use is called Obers which will reveal if there is any tightness
in the ITB. The cause how ever may becoming from the ITB fascia, shortening of
the tensor fascia lata or gluteus maximus, another problem may be excessive over
development of vastus lateralis (outer quad muscle). All will put an extra
tensile load onto the ITB. Another test is the noble compression test.
Causes
Muscle
imbalance
Biomechanical
- foot pronation, excessive lateral tilt of pelvis
Downhill running
Increased mileage
Change in running surface
Running on the same side of
crowned road
Leg length discrepancies - (true
or environmentally induced training on crowned roads)
Inadequate warm-up
Health experts have found that runners with a
weakened or fatigued gluteus medius muscle in
the hip are more likely to end up with ITB syndrome.
This muscle controls outward movements of the hip.
If the gluteus medius isn't doing its job, the thigh
tends to turn inward. This makes the knee angle into
a knock-kneed position. The ITB becomes
tightened against the bursa on the side of the knee.
This is also called a valgus deformity of the
knee.
(Picture
from Orthopod)
People with bowed legs may also be at risk of
developing ITB syndrome. The outward angle of the
bowed knee makes the lateral femoral condyle more
prominent and can make the snapping worse. This
condition is also called a varus deformity of
the knee.
Other possible cause of lateral
knee pain may include;
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Anatomy
The iliotibial band is a thick
band of fascia that crosses the hip joint and extends distally to insert on the
patella, tibia, and biceps femoris tendon.
The ITB is a continuation of the
tendinous portion of the tensor fascia latae muscle. It travels down the side of
the thigh separating the quads and hamstrings. It helps the movements of
abduction (lifting the leg outward) but more importantly controls and
decelerates the movement adduction.
(www.aafp.org/afp//AFPprinter/20050415/1545.htmlpicture
reference)
The distal fibers become thicker
at their attachment on the gerdy's tubercle next to the tibial tuberosity
(outside of the upper tibia). The band drops posteriorly behind the lateral
femoral condyle with knee flexion, then snaps forward over the epicondyle during
extension. (picture). A bursa rest between the ITB and the lateral condyle. This
protects the tendon form friction.
Treatment
1. Reduction of inflammation
with the aid of ice.
2. Massage therapy aimed at
correcting excessive tightness in the ITB and related structures.
3. Frequent stretching of the
tight structures surrounding the ITB - tensor fasciae latae, hip flexors,
hamstrings, lat quads.
  This
stretch can be furthered by taking the left arm above head and bending upper
body over the right side
4. Strengthening of the lateral
stabilisers if appropriate.
Exercise
for strengthening of the
right gluteus medius muscle
in a weight-bearing
position. (A) The patient
stands on a platform and
lowers the left leg toward
the ground slowly. (B)
Through contraction of the
right gluteus medius, the
patient then elevates the
leg, returning the pelvis to
a level position (taken from
www.aafp.org/afp//AFPprinter/20050415/1545.html)
5. In severe cases a cortisone
may be needed, only when conservative measures have been tried.
6. If conservative management
fails surgery may be required to release the ITB.
7. Correction of predisposing
factors i.e. reducing downhill running, correcting biomechanical abnormalities.
Ice massage may be useful before
and after running.
Return to full training should
be gradual with no return of symptoms
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