Iliotibial band syndrome

Iliotibial band syndrome is the most common cause of lateral knee pain in runners.

Runners predisposed to this injury are typically in a phase of over-training and often have underlying weakness of the hip abductor muscle. Male runners may exhibit kinematic faults such as increased hip internal rotation and knee varus, and weakness in the external rotator muscles of the hip. Female runners may exhibit increased hip adduction and knee internal rotation, and abnormal iliotibial band strain and strain rate.

In the acute phase, treatment includes activity modification, ice, and non-steroidal anti-inflammatory drugs. Offer a combined local anaesthetic and corticosteroid injection if severe pain or swelling.

During the sub-acute phase, emphasis is on stretching of the iliotibial band and soft-tissue therapy for any myofascial restrictions.

The recovery phase focuses on a series of exercises to improve hip abductor strength and integrated movement patterns. The final return to running phase is begun with an every-other-day programme, starting with easy sprints and avoidance of hill training with a gradual increase in frequency and intensity.

Consider surgery if refractory to conservative treatment.

Iliotibial band syndrome (ITBS) results from repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, and remaining tense in both positions. However, some functional anatomists and musculoskeletal radiologists consider ITBS a possible compression syndrome. The soft tissue involved may include the iliotibial band attachment into the lateral epicondyle of the femur, underlying adipose and bursal tissue, and distal ligamentous insertions into Gerdy's tubercle of the tibia.[1]Tuite MJ. Imaging of triathlon injuries. Radiol Clin North Am. 2010 Nov;48(6):1125-35. http://www.ncbi.nlm.nih.gov/pubmed/21094402?tool=bestpractice.com [2]Muhle C, Ahn JM, Yeh L, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. 1999 Jul;212(1):103-10. http://www.ncbi.nlm.nih.gov/pubmed/10405728?tool=bestpractice.com [3]Fairclough J, Hayashi K, Toumi H, et al. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-8. http://www.ncbi.nlm.nih.gov/pubmed/16996312?tool=bestpractice.com [4]Ekman EF, Pope T, Martin DF, et al. Magnetic resonance imaging of iliotibial band syndrome. Am J Sports Med. 1994 Nov-Dec;22(6):851-4. http://www.ncbi.nlm.nih.gov/pubmed/7856812?tool=bestpractice.com [5]Orchard JW, Fricker PA, Abud AT, et al. Biome­chanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May-Jun;24(3):375-9. http://www.ncbi.nlm.nih.gov/pubmed/8734891?tool=bestpractice.com [6]Baker RL, Fredericson M. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am. 2016 Feb;27(1):53-77. http://www.ncbi.nlm.nih.gov/pubmed/26616177?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Iliotibial band syndrome. Red mark indicates site of injury: insertion of the iliotibial band into and just proximal to the lateral femoral epicondyle. (BF: biceps femoris; GMAX: gluteus maximus; GT: greater trochanter; ITB: iliotibial band; TFL: tensor fasciae latae; VL: vastus lateralis)Baker RL et al. Iliotibial band syndrome in runners: biomechanical implications and exercise interventions. Phys Med Rehabil Clin N Am. 2016 Feb;27(1):53-77; used with permission [Citation ends].