IlioTibial (IT) band Syndrome

IT band Syndrome is an overuse injury of connective tissue present at the lateral aspect of thigh it runs along the outer part of thigh extending from pelvis to tibia covering both hip and knee joint when this connective band or tissue rubs against bony prominence due to overuse activities leads to inflammation and irritation of this band causing symptoms. It is also known as ITBFS ( IT Band Friction Syndrome).

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EPIDEMIOLOGY

ITBS is the most common cause of lateral knee pain in runners. Studies show incidence of ITBS in athletes, especially Runners with an incidence as high as 12% of all running – related injuries. US Marine Corps soldiers undergoing basic training reported the incidence of ITBS among this group to vary from 5% to 22%

CLINICAL FEATURES AND PATHOPHYSIOLOGY

The ITB is the amalgamation of fascia formed by the tensor fascia lata and the gluteus medius and minimus muscles. The ITB is a wide, flat structure that originates at the iliac crest and inserts at the Gerdy tubercle on the lateral aspect of the proximal tibia. This band serves as a ligament between the lateral femoral condyle and the lateral tibia to stabilize the knee. The ITB helps in the following 4 movements :

Abduction of hip

Internal rotation of the hip when the hip is flexed to 30°

Knee extension when the knee is in less than 30° of flexion

Knee flexion when the knee is in greater than 30° of flexion

The ITB is not connected to bone as it runs between the Gerdy tubercle and the lateral femoral epicondyle. This lack of attachment allows it to move anteriorly and posteriorly with knee flexion and extension, this movement may cause the ITB to rub against the lateral femoral condyle, causing inflammation.

Patient with ITBS presents with an insidious onset of lateral knee pain that is present during running.

Early in the  injury, the pain usually resolves after running or during rest

The athlete is able to pin point location of the lateral knee pain to approximately 2 cm above the lateral joint line.

Pain aggravates when the athlete climbs stairs or runs downhill.

Pain may develop with any activity that places the knee in a weight-bearing position at approximately 30º of knee flexion.

Pain at rest and is usually associated with severe tendinitis.

Point tenderness is noted upon palpation of the lateral femoral epicondyle, as well as with palpation of a site 2-4 cm above the lateral joint line and at the Gerdy tubercle.

Pain may be elicited with knee flexion to 30° when varus stress is applied to the knee.

Swelling of the band and structures

PHYSICAL EXAMINATION AND DIAGNOSIS

Ober Test

In this test  patient is side lying with test side facing up

Knee may be extended or flexed to 90° or 30°

Hip in slight extension

The test leg is abducted, then allowed to lower the leg i.e adduction towards the table

Inability to perform adduction indicates tightness of IT band.

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PHYSIOTHERAPY MANAGEMENT

Treatments such as ultrasound, friction massage, and ice may also be used to calm inflammation in the IT Band. Iontophoresis, in which physiotherapist uses a mild electrical current to push anti-inflammatory medicine to the sore area to relief inflammation.

Myofascial Release also helps to loosen up the tight fascia or band

Kinesiotaping also helps in  providing relief from pain, swelling and inflammation

Rehabilitation Exercise Regime includes

Standing IT band stretch

Side leaning IT band stretch

Side bending IT band stretch

Standing Calf Stretch

Hamstring Stretch on wall

Quadriceps Stretch

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