knee ILLIOTIBIAL BAND SYNDROME

DEFINITION:

An inflammatory process occurring as a result of friction of the illiotibial band (ITB) with movement. The illiotibial band is a thick fibrous tissue spanning from the pelvis to the tibia. (See illustration).
The ITB sits in front (anterior) to the lateral femoral condyle when the knee is in extension and behind (posterior) to it when the knee is flexed past 30 degrees.

MECHANISM OF INJURY / HOW IT OCCURS:

Results from repetitive flexion and extension of the knee.
Often seen in runners and cyclists. The ITB is highly susceptible to friction with knee flexed 20 degrees at foot contact with ground (heel strike) while running.
Poor strength and flexibility can result in this syndrome.

SYMPTOMS:

Pain to outer (lateral) region of knee where ITB attaches.
Pain aggravated with cycling and running, especially on banked surfaces or downhill.

DIAGNOSIS:

Pain to pressure along ITB. More specifically with pressure over the lateral femoral condyle with knee at 30 degrees flexion.
Tight ITB on examination.
Walking with a stiff leg gait (decreases rubbing/friction and hence pain).

TREATMENT/REHABILITATION:

Rest, ice, and anti inflammatory medications (NSAIDs) are initial treatment modalities utilized.
Therapy to help stretch the ITB and strengthen the Tensor fascia lata (TFL). (See exercises for Illiotibial band syndrome).
Swimming and cross training to stay fit while recovering.
Avoid running on slopes and therefore alternate directions when running on a track.
Possible shoe inserts (orthotics) if significant pronation.
Cyclists may need to adjust seat so as to avoid increasing stretch on ITB. May need to adjust cleat to avoid excessive internal rotation. (See bicycle set up recommendations).