Iliotibial band syndrome (ITBS) is the second most common knee injury, and is caused by inflammation located on the lateral aspect of the knee due to friction between the

iliotibial band The iliotibial tract or iliotibial band (ITB; also known as Maissiat's band or the IT band) is a longitudinal fibrous reinforcement of the fascia lata. The action of the muscles associated with the ITB (tensor fasciae latae and some fibers of glu ...

and the

lateral epicondyle of the femur The lateral epicondyle of the femur, smaller and less prominent than the medial epicondyle, gives attachment to the fibular collateral ligament of the knee-joint. Directly below it is a small depression from which a smooth well-marked groove curv ...

. Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. Risk factors in women include increased hip adduction and knee internal rotation. Risk factors seen in men are increased hip internal rotation and knee adduction. ITB syndrome is most associated with long-distance running, cycling, weight-lifting, and with military training.

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 A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

, 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

. 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 The tibia (; ), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia); it connects ...

Causes

ITBS can result from one or more of the following: training habits, anatomical abnormalities, or muscular imbalances: Training habits * Spending long periods of time/regularly sitting in lotus posture in yoga. Esp beginners forcing the feet onto the top of the thighs * Consistently running on a horizontally banked surface (such as the shoulder of a road or an

indoor track Track and field is a sport that includes athletic contests based on running, jumping, and throwing skills. The name is derived from where the sport takes place, a running track and a grass field for the throwing and some of the jumping event ...

) on which the downhill leg is bent slightly inward, causing extreme stretching of the band against the femur * Inadequate warm-up or cool-down * Excessive up-hill and down-hill running * Positioning the feet " toed-in" to an excessive angle when cycling. (Knee should be positioned between 30 and 35 degree to help avoid ITBS) * Running up and down stairs * Hiking long distances * Rowing * Breaststroke * Treading water Abnormalities in leg/feet anatomy * High or low arches * Supination of the foot * Excessive lower-leg rotation due to over-pronation * Excessive foot-strike force * Uneven leg lengths * Bowlegs or tightness about the iliotibial band. Muscle imbalance * Weak hip abductor muscles * Weak/non-firing

multifidus muscle The multifidus (multifidus spinae : ''pl. multifidi'' ) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis. While very th ...

* Uneven left-right stretching of the band, which could be caused by habits such as sitting cross-legged

Anatomical mechanism

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The

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 The femur (; ), or thigh bone, is the proximal bone of the hindlimb in tetrapod vertebrates. The head of the femur articulates with the acetabulum in the pelvic bone forming the hip joint, while the distal part of the femur articulates wit ...

to the front of the femur during activity. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated

flexion Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relativ ...

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.

Treatment

Conservative treatments

While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (

RICE Rice is the seed of the grass species '' Oryza sativa'' (Asian rice) or less commonly ''Oryza glaberrima'' (African rice). The name wild rice is usually used for species of the genera '' Zizania'' and '' Porteresia'', both wild and domesticat ...

) to reduce pain and

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

, followed by stretching. 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. Similar results can be found with the use of anti-inflammatory medication, analgesic/anti-inflammatory medication, specifically. Other non-invasive treatments include things such as, flexibility and strength training, neuromuscular/gait training,

manual therapy Manual therapy, or manipulative therapy, is a physical treatment primarily used by physical therapists, physiotherapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of mu ...

, training volume reduction, or changes in running shoe. 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. 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. 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.

Surgical treatments

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

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 affected by ITBS. 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. 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. 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. 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. Another study provided data that shows more than half (50%) of professional cyclists complain of knee pain.

References

External links

{{Soft tissue disorders Overuse injuries Soft tissue disorders Syndromes