Iliotibial Band Friction Syndrome

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Iliotibial Band FrictionSyndrome

• Shaun K. Riebl

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Fascia

• connective tissue that surrounds many muscles
  within the body
• deep and subcutaneous (superficial) blend at knee
• Deep strength
• Fascia lata
• deep fascia of the thigh originating above the
  abdomen and inserting at the tubercles about the
  knee reinforced laterally by additional vertical
  fibers forming the IT tract.

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Ilitotibial Tract/BandIT Band

• Stretches from the iliac tubercle to Gerdys
  tubercle, or the lateral condyle of the tibia
• Furthermore, it is the union of the tensor fascia
  lata and gluteus maximus muscles that form the IT
  band

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Fascias of the leg
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Functions of the IT Band

• Lateral knee joint stability
• Flexor, abductor, and medial rotator of thigh
• Impact on pelvis twist laterally, flex, and
  abduct
• Keeps extended knee in extension and flexed knee
  in flexion (Kaplan, 1958).
• protects the knee joint in conjunction with the
  vastus lateralis when varus forces (laterally
  directed) are experienced (Terry, Hughston,
  Norwood, 1986).

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IT Band Friction Syndrome(ITBFS)

• Overuse injury!
• How?
• IT band is anterior of the lateral femoral
  epicondyle when the knee is extended but upon
  flexion the band moves rearward over the
  epicondyle.
• Inflammation resulting from consistently sliding
  across an exaggerated epicondyle
• Entrapment from increased stride length decreases
  space between IT band and lateral epicondyle

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ITBFS

• Bursa can impede smooth motions of IT band across
  the epicondyle
• MRI show significantly thicker IT bands in those
  with ITBFS (Ekman, et al., 1994)

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Pain and ITBFS

• Sharp and debilitating, approximately two
  centimeters above the joint line during exercise
• Repetitive flexion and extension motions
  (climbing or descending stairs, walking downhill,
  running, skiing, or cycling)
• Some have to stop activities, while others can
  continue
• Walking stiff-legged (severe cases)

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ITBFS and Cycling

• IT band is pulled posteriorly on the upstroke and
  anteriorly on the downstroke up to 4,800 times
  an hour (Holmes Pruitt, 1993)
• poor cleat alignment, leg length discrepancies,
  internal tibial rotation while pedaling,
  excessive hill climbing, increased mileage, and a
  seat position too high and/or too far forward
  (poor bicycle fit) (Holmes Pruitt, 1993 Holmes
  and Pruitt, 1994 Pruitt, 2001)

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ITBFS and Runners

• Approx. 50 all knee injuries to runners (Noble,
  1980)
• Development
• Increased mileage too soon without adequate rest
• Running surface
• Shoes
• Stride length
• Misalignments of the foot (Southmayd Hoffman,
  1981)
• Muscle imbalances

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ITBFS and Runners cont.

• Fredericson, Guillet, DeBenedictis (2000)
  tests utilized to assess flexibility deficiencies
  in the rectus femoris, iliopsoas, tensor fascia
  lata, soleus, and gastrocnemius muscles in those
  with ITBFS

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ITBFS in Runners cont.

• Fredricson, et al. (2000) and Noble (1980)
• With a subject lying supine and the knee flexed
  at 90 degrees, the patient extends their knee
  with pressure applied to the lateral epicondyle
• If pain is reported as the knee approaches 30
  degrees, the test is considered positive

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ITBFS Treatment

• Conservative
• Ice and anti-inflammatory drugs
• Assess shoe wear (gt500mi replace) orthotics
• Change running surface
• Physiotherapy
• Other activities

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ITBFS Treatment cont.

• Severe cases
• Steroid injections
• 2 week intervals
• No more than three injections
• Surgery
• Release of IT band with transverse incision
• Recovery
• Individual variation

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ITBFS Treatment cont.

• Stretching
• With the knees extended and about one to two feet
  from a wall, cross affected leg over non-injured
  leg while keeping the feet planted and if the
  person leans the shoulder into the wall, the
  like-side IT band is stretched (Barber Sutker,
  1992)
• Fredricson and colleagues
• standing stretch
• supine rope stretch
• stretching the IT band with a foam bolster

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IT Band Standing Stretch
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IT Band Supine Rope Stretch
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IT Band Stretch with Foam Cylinder
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ITBFS Treatment cont.

• Strengthening Exercises
• Initially non-weight bearing
• Side-lying leg lifts
• Single leg step-downs
• After strength, flexibility, and confidence
  returns, more aggressive rehabilitation can
  proceed with an eventual return to normal
  athletic activities.

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IT Band ITBFS Conclusions

• The IT band is a blend of the tensor fascia lata
  and gluteus maximus originating from the iliac
  crest and inserting just below the knee at the
  lateral epicondyle of the tibia (Gerdys
  tubercle)
• IT band has many functions about the knee joint
• ITBFS is an overuse injury (excessive
  flexion/extension of knee) resulting from
  continuous traversing of the lateral femoral
  epicondyle
• Observed in many sports, but predominant in
  running
• Results from training errors and biomechanical
  misalignments

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IT Band ITBFS Conclusionscont.

• Treatment
• Conservative ice, anti-inflammatory drugs, and
  physical therapy
• Serious steroid injections and surgery
• Recovery is individualized
• Stretching and Strengthening exercises
• Gradual return to normal activities

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References

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   syndrome. Sports Medicine 14(2) 144-148.
2. Ekman EF, Pope T, Martin DF, Curl WW. 1994.
   Magnetic resonance imaging of iliotibial band
   syndrome. The American Journal of Sports Medicine
   22(6) 851-854.
3. Fredericson M, Guillet M, DeBenedictis L. 2000.
   Quick solutions for iliotibial band syndrome. The
   Physician and Sportsmedicine 28(2). Retrieved
   September 6, 2005, from http//www.physsportsmed.c
   om/issues/2000/02_00/fredericson.htm
4. Holmes J, Pruitt AL, Whalen N. 1993. Iliotibial
   band syndrome in cyclists. American Journal of
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5. Holmes J, Pruitt AL, Whalen N. 1994. Lower
   extremity overuse in bicycling. Clinics in Sports
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6. James SL. 1995. Running injuries to the knee.
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7. Kaplan EB. 1958. The iliotibial tract. Journal of
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8. Moore KL Dalley AF. 1999. Clinically orientated
   anatomy. 4th ed. Baltimore Lippincott Williams
   Wilkins. p. 523, 568, 618.
9. Noble CA. 1980. Iliotibial band friction syndrome
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10. Pruitt AL. 2001. Andy Pruitts Medical Guide for
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11. Southmayd W, Hofman M. 1981. Sports Health The
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12. Terry GC, Hughston JC, Norwood LA. 1986. The
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