iliotibial band friction syndrome

What is iliotibial band friction syndrome?
It is a condition characterized by pain localized over the lateral
femoral epicondyle that occurs during vigorous walking, hiking or
running. The pain is usually relieved by rest and by walking with the
knee held in full extension. However, when ambulation and knee flexion
are resumed, symptoms return.



What is the iliotibial band (ITB)?
The iliotibial band is a tendinous extension of the fascia covering the
gluteus maximus and tensor fascia latae muscles proximally. It descends
distally to attach to the lateral condyle of the tibia. It also sends
fibers to the lateral aspect of the patella (knee cap). Essentially, the
ITB is the linkage between the pelvis, upper leg, and lower leg.
Pathology to any structure linked to one of these areas may cause ITB
contracture.



What is a possible cause of iliotibial band friction syndrome?
Overuse may cause shortening of the ITB. The knee goes from flexion to
extension and excessive pressure from the ITB causes friction over the
lateral femoral epicondyle. This repeated motion produces inflammation
of the underlying structures and causes pain.




What are the facts concerning iliotibial band friction syndrome?

• Pain localized over lateral femoral condyle
  
• Discomfort initially relieved by rest
  
• Pain may radiate toward the lateral joint line and proximal tibia
  
• Worse if a person continues to run
  
• No symptoms of internal derangement
  
• Symptoms frequently develop during downhill running
  
• Inadequate stretching program
  

Which anatomic factors may be associated with iliotibial band friction syndrome?

• Hip abduction contracture (ITB tightness)
  
• Genu varum (Bow legging)
  
• Heel and foot pronation
  
• Tight heel cords
  
• Internal tibial torsion (Inward rotation of the leg)
  

What are the treatments of iliotibial band friction syndrome?

• Rest
  
• Ice
  
• Stretching of iliotibial band
  
• Instruct a person to avoid hills, shorten stride, and run on alternate sides of road
  
• Anti-inflammatory medicine
  
• Orthotics (if appropriate)
  
• Ultrasound
  
• Contrast baths
  
• Local steroid injection
  

What are the different stretching techniques?
There are two different stretching approaches: self-stretching and stretching with an outside applied force.
Note: The individual pictured in these exercises is tight.



Self-stretching:

• Starting position: Upright standing.
  Action: Cross involved leg behind uninvolved leg in
  standing position, with a stretched leg behind, and lean to the
  uninvolved side until a stretch is felt over outside of involved hip.
  
• Starting position: Lying on your back with arms to the sides.
  Action: Lift your involved leg over the other leg
  placing your opposite hand on the back of the stretched thigh. Keep your
  arm on the involved side extended out to the side and both shoulders
  flat. If possible, try to straighten the knee of your stretched leg to
  accentuate the stretch.
  
• Starting position: Sit comfortably with your legs out in front of you.
  Action: Put the foot of the involved knee flat on
  the ground on the outside of the other straight leg. Reach over your
  stretched leg with your opposite arm, so that your elbow is on the
  outside of your stretched thigh. Slowly turn your head and look over
  your stretched side shoulder, at the same time, turn your upper body
  toward the same side. Keep your hips flat on the floor at all times.
  Note: If you do not feel the stretch, bend your opposite knee, placing the foot next to your stretched hip.
  
• Starting position: Lying on your back with your legs straight.
  Action: Bend the knee of the involved limb, and
  while holding it with your both hands, pull it toward your chest and to
  the opposite shoulder.
  

Stretching with the outside applied force:

• Ober's stretch
  Starting position: Sidelying with the stretched thigh on top.
  Action: The patient is positioned lying on the
  uninvolved side, and the hip and knee of the bottom limb are flexed into
  the chest and held tightly in this position. The hip of the limb to be
  stretched (upper) is flexed and abducted than extended with the knee
  flexed. The therapist will stand behind the patient placing one hand on
  patient's pelvis for stability and the other hand on stretched knee
  while applying downward pressure.
  
• Reverse Ober's stretch
  Starting position: Sidelying with the involved side on the bottom.
  Action: The patient is positioned lying on the
  side, and the hip and knee of the top limb are flexed. The hip of the
  limb to be stretched (lower) is extended and the knee is slightly
  flexed. Therapist will stand behind the patient placing one hand on the
  patient's pelvis to stabilize it. The other hand is placed under the
  involved knee. The therapist pulls in an upward direction on stretched
  limb (lower), more hip extension may be required to tension the ITB.
  

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