| 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
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.
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.
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Anatomy 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.
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 ITB and other tight muscles.
 
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
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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