Iliotibial band syndrome

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Iliotibial band syndrome
Other namesIliotibial band friction syndrome (ITBFS) [1]
Iliotibial Band Syndrome.jpg
Specialty Sports medicine, orthopedics

Ilitotibial Band Syndrome (ITBS) is the second most common knee injury caused by inflammation located on the lateral aspect of the knee due to friction between the iliotibial band and the lateral epicondyle of the femur. [2] Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. [2] Risk factors in women include increased hip adduction, knee internal rotation. [2] [3] Risk factors seen in men are increased hip internal rotation and knee adduction. [2] ITB syndrome is most associated with long distance running, cycling, weight-lifting, and with military training. [4] [5]

Contents

Signs and symptoms

ITBS symptoms range from a stinging sensation just above the knee and outside of the knee (lateral side of the knee) joint, to swelling or thickening of the tissue in the area where the band moves over the femur. The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time. Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia.

Causes

ITBS can result from one or more of the following: training habits, anatomical abnormalities, or muscular imbalances:

Anatomical mechanism

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Diagnosis

Diagnosis of iliotibial band syndrome is based on history and physical exam findings, including tenderness at the lateral femoral epicondyle, where the iliotibial band passes over the bone. [7]

Treatment

Conservative Treatments

While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. [8] Utilization of corticosteroid injections and the use of anti-inflammatory medication on the painful area are possible treatments for ITB syndrome. Corticosteroid injections have been shown to decrease running pains significantly 7 days after the initial treatment. [9] Similar results can be found with the use of anti-inflammatory medication, analgesic/anti-inflammatory medication, specifically. [9] Other non-invasive treatments include things such as, flexibility and strength training, neuromuscular/gait training, manual therapy, training volume reduction, or changes in running shoe. [2] [9] [3] [10]   Muscular training of the gluteus maximus and hip external rotators is stressed highly as those muscles are associated with many of the risk factors of ITBS. [2] For runners specifically, neuromuscular/gait training may be needed for success in muscular training interventions to ensure that those trained muscles are used properly in the mechanics of running. [2] Strength training alone will not result in decrease in pain due to ITBS, however, gait training, on its own can result in running form modification that reduces the prevalence of risk factors. [3]

Surgical Treatments

Treatments as intensive and invasive as surgery are utilized if several conservative approaches fail to produce results. [9] 6 months should be given for conservative treatments to work before surgical intervention as used. [3]

Epidemiology

Occupation

Significant association between the diagnosis of ITBS and occupational background of the patients has been thoroughly determined. Occupations that require extensive use of iliotibial band are more susceptible to develop ITBS due to continuum of their iliotibial band repeatedly abrading against lateral epicondyle prominence, thereby inducing inflammatory response. Professional or amateur runners are at high clinical risk of ITBS in which shows particularly greater risk in long-distance. Study suggests ITBS alone makes up 12% of all running-related injuries and 1.6% to 12% of runners are afflicted by ITBS. [11]

The relationship between ITBS and mortality/morbidity is claimed to be absent. A study showed that coordination variability did not vary significantly between runners with no injury and runners with ITBS. [12] This result elucidates that the runner's ability to coordinate themselves toward direction of their intention (motor coordination) is not, or very minorly affected by the pain of ITBS.

Additionally, military trainee in marine boot camps displayed high incidence rate of ITBS. Varying incidence rate of 5.3% - 22% in basic training was reported in a case study. A report from the U.S. Marine Corps announces that running/overuse-related injuries accounted for >12% of all injuries. [13]

In contrast, studies suggested antithesis of conventional perception that racial, gender or age difference manifests in different incidence rate of ITBS diagnosis. No meaningful statistical data successfully provides significant correlation between ITBS and gender, age, or race. Although, there had been a claim that females are more prone to ITBS due to their anatomical difference in pelvis and lower extremity. Males with larger lateral epicondyle prominence may also be more susceptible to ITBS. [14]   Higher incidence rate of ITBS has been reported at age of 15–50, in which generally includes most of active athletes.

Other professions that had noticeable association with ITBS include cyclists, heavy weightlifters, et cetera. One observational study discovered 24% of 254 cyclists were diagnosed with ITBS within 6 years. [15] Another study provided data that shows more than half (50%) of professional cyclists complain of knee pain. [16]

See also

Related Research Articles

Running method of terrestrial locomotion allowing humans and other animals to move rapidly on foot

Running is a method of terrestrial locomotion allowing humans and other animals to move rapidly on foot. Running is a type of gait characterized by an aerial phase in which all feet are above the ground. This is in contrast to walking, where one foot is always in contact with the ground, the legs are kept mostly straight and the center of gravity vaults over the stance leg or legs in an inverted pendulum fashion. A feature of a running body from the viewpoint of spring-mass mechanics is that changes in kinetic and potential energy within a stride occur simultaneously, with energy storage accomplished by springy tendons and passive muscle elasticity. The term running can refer to any of a variety of speeds ranging from jogging to sprinting.

Knee region around the kneecap

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

Tendinopathy Bruised tendon

Tendinopathy, also known as tendinitis or tendonitis, is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.

Tennis elbow Condition in which the outer part of the elbow becomes sore and tender

Tennis elbow, also known as lateral epicondylitis, is a condition in which the outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm and grip strength may be weak. Onset of symptoms is generally gradual. Golfer's elbow is a similar condition that affects the inside of the elbow.

Shin splints injury or pain in the lower tibia

A shin splint is pain along the inside edge of the shinbone (tibia) due to inflammation of tissue in the area. Generally this is between the middle of the lower leg to the ankle. The pain may be dull or sharp and is generally brought on by exercise. It generally resolves during periods of rest. Complications may include stress fractures.

Osgood–Schlatter disease osteochondrosis

Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis). It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.

Chondromalacia patellae Human disease

Chondromalacia patellae is an inflammation of the underside of the patella and softening of the cartilage.

Snapping hip syndrome

Snapping hip syndrome, also referred to as dancer's hip, is a medical condition characterized by a snapping sensation felt when the hip is flexed and extended. This may be accompanied by a snapping or popping noise and pain or discomfort. Pain often decreases with rest and diminished activity. Snapping hip syndrome is commonly classified by the location of the snapping as either extra-articular or intra-articular.

Iliotibial tract

The iliotibial tract or iliotibial band is a longitudinal fibrous reinforcement of the fascia lata. The action of the ITB and its associated muscles is to extend, abduct, and laterally rotate the hip. In addition, the ITB contributes to lateral knee stabilization. During knee extension the ITB moves anterior to the lateral condyle of the femur, while ~30 degrees knee flexion, the ITB moves posterior to the lateral condyle. However, it has been suggested that this is only an illusion due to the changing tension in the anterior and posterior fibers during movement. It originates at the anterolateral iliac tubercle portion of the external lip of the iliac crest and inserts at the lateral condyle of the tibia at Gerdy's tubercle. The figure shows only the proximal part of the iliotibial tract.

The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.

Anterior cruciate ligament injury ligament injury near the knee

Anterior cruciate ligament injury is when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, a popping sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

Golfers elbow bone inflammation disease that results in inflammation located in epicondyle

Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle.

Unhappy triad medical condition

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

Greater trochanteric pain syndrome (GTPS), is inflammation of the trochanteric bursa, a part of the hip.

Plica syndrome is a condition that occurs when a plica becomes irritated, enlarged, or inflamed.

Patellofemoral pain syndrome Human disease

Patellofemoral pain syndrome (PFPS), also known as runner's knee, is knee pain as a result of problems between the kneecap and the femur. The pain is generally in the front of the knee and comes on gradually. Pain may worsen with sitting, excessive use, or climbing and descending stairs.

Patellar dislocation injury of the knee

A patellar dislocation is a knee injury in which the patella (kneecap) slips out of its normal position. Often the knee is partly bent, painful and swollen. The patella is also often felt and seen out of place. Complications may include a patella fracture or arthritis.

Knee pain

Knee pain is pain in or around the knee.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

Running injuries affect about half of runners annually. The frequency of various RRI depend on the type of running, as runners vary significantly in factors such as speed and mileage. RRI can be both acute and chronic. Many of the common injuries that plague runners are chronic, developing over a longer period of time, as opposed to injury caused by sudden trauma, such as strains. These are often the result of overuse. Common overuse injuries include stress fractures, Achilles tendinitis, Iliotibial band syndrome, Patellofemoral pain, and plantar fasciitis.

References

  1. Ellis, R; Hing, W; Reid, D (August 2007). "Iliotibial band friction syndrome—A systematic review". Manual Therapy. 12 (3): 200–8. doi:10.1016/j.math.2006.08.004. PMID   17208506.
  2. 1 2 3 4 5 6 7 Baker, Rober L.; Fredericson, Michael (2016). "ClinicalKey". www.clinicalkey.com. Retrieved 2019-11-17.
  3. 1 2 3 4 Neal, Bradley (2016). "Iliotibial Band Syndrome: A Narrative Review". Co-Kinetic Journal. 67: 16–20 via EBSCO host.
  4. "Iliotibial Band Syndrome: Background, Epidemiology, Functional Anatomy". 2019-11-10.Cite journal requires |journal= (help)
  5. Hadeed, Andrew; Tapscott, David C. (2019), "Iliotibial Band Friction Syndrome", StatPearls, StatPearls Publishing, PMID   31194342 , retrieved 2019-11-17
  6. Farrell, Kevin C.; Reisinger, Kim D.; Tillman, Mark D. (March 2003). "Force and repetition in cycling: possible implications for iliotibial band friction syndrome". The Knee. 10 (1): 103–109. doi:10.1016/S0968-0160(02)00090-X. PMID   12649036.
  7. Flynn, Sharon H.; Khaund, Razib (2005-04-15). "Iliotibial Band Syndrome: A Common Source of Knee Pain". American Family Physician. 71 (8): 1545–1550.
  8. Barber, F. Alan; Sutker, Allan N. (August 1992). "Iliotibial Band Syndrome". Sports Medicine. 14 (2): 144–148. doi:10.2165/00007256-199214020-00005. PMID   1509227.
  9. 1 2 3 4 Beals, Corey; Flanigan, David (2013). "A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population". Journal of Sports Medicine. 2013: 367169. doi:10.1155/2013/367169. ISSN   2356-7651. PMC   4590904 . PMID   26464876.
  10. Weckström, Kristoffer; Söderström, Johan (2016). "Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome". Journal of Back and Musculoskeletal Rehabilitation. 29 (1): 161–170. doi:10.3233/BMR-150612. PMID   26406193.
  11. Richards, David P.; Alan Barber, F.; Troop, Randal L. (March 2003). "Iliotibial band Z-lengthening". Arthroscopy: The Journal of Arthroscopic & Related Surgery. 19 (3): 326–329. doi:10.1053/jars.2003.50081. ISSN   0749-8063. PMID   12627161.
  12. Hafer, Jocelyn F.; Brown, Allison M.; Boyer, Katherine A. (August 2017). "Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome". Clinical Biomechanics. 47: 73–78. doi:10.1016/j.clinbiomech.2017.06.006. ISSN   0268-0033. PMID   28618309.
  13. Jensen, Andrew E; Laird, Melissa; Jameson, Jason T; Kelly, Karen R (2019-03-01). "Prevalence of Musculoskeletal Injuries Sustained During Marine Corps Recruit Training". Military Medicine. 184 (Supplement_1): 511–520. doi:10.1093/milmed/usy387. ISSN   0026-4075. PMID   30901397.
  14. Everhart, Joshua S.; Kirven, James C.; Higgins, John; Hair, Andrew; Chaudhari, Ajit A.M.W.; Flanigan, David C. (August 2019). "The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case–control study". The Knee. 26 (6): 1198–1203. doi:10.1016/j.knee.2019.07.015. PMID   31439366.
  15. Farrell, Kevin C.; Reisinger, Kim D.; Tillman, Mark D. (March 2003). "Force and repetition in cycling: possible implications for iliotibial band friction syndrome". The Knee. 10 (1): 103–109. doi:10.1016/s0968-0160(02)00090-x. ISSN   0968-0160. PMID   12649036.
  16. Holmes, James C.; Pruitt, Andrew L.; Whalen, Nina J. (May 1993). "Iliotibial band syndrome in cyclists". The American Journal of Sports Medicine. 21 (3): 419–424. doi:10.1177/036354659302100316. ISSN   0363-5465. PMID   8166785.

Further reading

van der Worp, Maarten P.; van der Horst, Nick; de Wijer, Anton; Backx, Frank J. G.; Nijhuis-van der Sanden, Maria W. G. (23 December 2012). "Iliotibial Band Syndrome in Runners". Sports Medicine. 42 (11): 969–992. doi:10.1007/BF03262306.

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