Department of rehabilitation services physical therapy standard of care. Iliotibial band syndrome it band syndrome medicinenet. Jan 14, 2020 iliotibial band syndrome itbs also known as iliotibial band friction syndrome is a common1 and often maddeningly stubborn repetitive strain injury that causes pain mainly on the side of the knee, especially when descending stairs and hills. Two hundred and twenty one cases were seen in a two year period. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. This rubbing causes pain with each step that you take. We examine the areas anatomical and biomechanical properties. Iliotibial band syndrome itbs, inflammation of the band of fibrous tissue known as the iliotibial band or tract, which extends from the ilium of the hip to the tibia shinbone. Overview of iliotibial band syndrome itbs pdf hprc. Iliotibial band itb syndrome itbs is a common cause of distal lateral thigh pain in athletes.
Flexibility, strength, and running mechanics are commonly assessed in patients with itbs. Iliotibial band syndrome is one of the top 10 injuries seen in distance runners. Iliotibial band syndrome is caused by excessive friction of the iliotibial band and the underlying bursa due to repetitive kneebending activities. This band of fibers has many different names, often referred to as the it band, iliotibial band, and iliotibial tract. Iliotibial band syndrome rehabilitation exercises you may do stretching exercises 1 through 5 and strengthening exercises 6 through 10 right away, 1.
Iliotibial band syndrome radiology reference article. When the leg is in a straight known as extended position, the band fibers are anterior to, or in front of, the condyle a bony projection on the outer surface of the femur, or thigh bone. Iliotibial band syndrome itbs or it band syndrome is an overuse injury of the connective tissues that are located on the lateral or outer part of thigh and knee. This overuse injury occurs with repetitive flexion and extension of the knee. Iliotibial band syndrome occurs when the itb becomes swollen and irritated from rubbing against the bone on the outside of your hip or knee. Itbs, also known as runners knee, happens when your iliotibial band itb becomes injured and causes pain. Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion. Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best. However, these variables have not been evaluated concurrently in this population. Inflammation of this bursa is called trochanteric bursitis. Runners predisposed to this injury are typically in a phase of overtraining and often have underlying weakness of the hip abductor muscle. Physical therapy for iliotibial band friction syndrome. If youve got a nagging pain on the outer part of your knee, especially if youre a runner, it could be a symptom of iliotibial band it band syndrome.
Iliotibial band syndrome is the most common cause of lateral knee pain in runners. Iliotibial band friction syndrome itbfs involves pain in the region of the lateral femoral condyle or slightly inferior to it, that occurs after repetitive. There is much to be learned about the etiology, pathology, and optimal treatment of the condition. It is a very common injury for runners to receive, and the pain is usually located around the knees. However, despite being one of the most common injuries in runners, it is still often misunderstood and poorly treated. There are two major bursae in the hip that typically become irritated and inflamed. Iliotibial band syndrome is pain and swelling of the iliotibial band also called the it band. The functional anatomy of the iliotibial band during flexion and extension of the knee. Iliotibial band syndrome definition of iliotibial band.
Evidence based treatment for iliotibial band friction syndrome. Lean your hips towards the chair or wall until you feel a stretch on the side of your hip. It helps keep your knee and hip stable and in their normal position. Reach the arm on the side of the back leg over your head while you do this. Iliotibial band itb syndrome is an overuse injury that results from constant friction of the itb over the lateral femoral epicondyle often seen in runners. Apr 03, 2018 iliotibial band syndrome also known as. Many published studies seem to approach the problem from differing and hardtoreconcile viewpoints. Iliotibial band syndrome itb syndrome itb syndrome. Cross your uninjured leg over your injured leg and bend down to touch your toes. The iliotibial band friction syndrome itbfs is a syndrome caused by inflammation deep to the iliotibial band itb, which is a band of tough fascia going from the hip to the knee along the outer.
Iliotibial band friction syndrome is a common cause of knee pain in long distance runners. It extends from the outside of your pelvis hip bone to the outside of your tibia shin bone. Proximally, the iliotibial band provides an insertion for the tensor fascia lata and gluteus maximus muscles. Iliotibial band syndrome is a relatively common condition characterised by rubbing of the iliotibial band against a bony prominence at the outer aspect of the knee femoral epicondyle. Research, up until recently, has described iliotibial band syndrome as friction that develops by the band rubbing over the lateral femoral condyle of the knee bone. I think it is fairly easy to diagnoselocalized pain on the outside of the knee tends to be from iliotibial band syndrome. Cross one leg in front of the other leg and lean in the opposite direction from the front leg. Strauss, md iliotibial band syndrome is a common overuse injury typically. Iliotibial band syndrome itbs is one of the most common overuse injuries among runners. Itbs develops as a result of inflammation of the bursa surrounding the itb and usually affects athletes who are involved in sports that require continuous running or repetitive knee flexion and extension.
Iliotibial band syndrome etiology bmj best practice. What do i need to know about iliotibial band syndrome itbs. Iliotibial band syndrome it band syndrome topic guide. It is usually a friction type of injury that occurs where the iliotibial band passes across the lateral femoral condyle, a small bony projection at the base of the femur, or leg, bone. Sep 18, 2018 iliotibial band itb syndrome itbs is the most common cause of lateral knee pain among athletes. Iliotibial band syndrome itbs is one of the most common injuries seen in runners. Iliotibial band syndrome it band stretchs, exercises. Tenderness over the lateral epicondyle associated with pain at 30 degrees of flexion on compressing the iliotibial band against the lateral. If the foam roller is initially too painful, utilize a thera band roller massager to perform the mobilization. Your doctor or physical therapist will tell you when you can start these exercises and which ones will work best for you. A case report gregory decker, md, devyani hunt, md abstract overuse injuries of the hip are frequent among runners and often present a diagnostic dilemma requiring imaging modalities beyond radiographs, delayed diagnosis, and. Iliotibial band syndrome itbs is one of the more common injuries among runners. It is essential to remember that the iliotibial band is nothing more than a longitudinal fibrous reinforcement of the fascia lata and has no control over its own positioning or tone. Itbfs is a condition that occurs when abnormal rubbing or friction occurs at the side of the knee where the iliotibial band it band crosses.
Iliotibial band syndrome can cause significant morbidity and lead to cessation of exercise. It was first seen in us marine corps recruits during their training in 1975 and has been diagnosed frequently in long distance runners, cyclists, skiers and participants of hockey, basketball, and soccer since then. Anatomical studies of the itb of 20 embalmed cadavers. A home exercise program that includes a flexibility and strength conditioning routine and modified training recommendations can aid in the treatment and prevention of further injury.
In brief inflammation of the iliotibial brief band at the lateral femoral epicondylecalled iliotibial band syndrome can be treated effectively with a twophase conservative regimen. It is frequently related to hip weakness and instability standing on one leg. Iliotibial band syndrome itb syndrome, it band syndrome or itbs affects hundreds of thousands of runners each year. Your it band and the bursa can both start to swell, which leads to the pain of it band syndrome. Iliotibial band syndrome it band syndrome emedicinehealth. Patellofemoral syndrome tips and exercises kaiser permanente. The injury mostly plagues runners, but its not their problem exclusively. Iliotibial band syndrome brigham and womens hospital. It band syndrome, itb syndrome, or itbs is one of the most common overuse injuries among runners. Weak hip abductor muscles play a large role in the development of itb syndrome.
The dilemma of knee osteoarthritis and iliotibial band syndrome author. There is a fluidfilled sac, called a bursa, between the bone and the tendon on the outside part of your leg. This thick, dense, connective tissue or fascia, extends from the outside of your hip to down just past your knee joint. Iliotibial band syndrome itbs is the result of inflammation and irritation of the distal portion of the iliotibial tendon as it rubs against the lateral femoral condyle, or less commonly, the greater tuberosity. It causes pain and tenderness in those areas, especially just above the knee joint. Iliotibial band syndrome strengthening exercises it band pdf. A tight iliotibial band is the main cause of it band syndrome. Everything you need to know about it band syndrome including symptoms, prevention, solutions and exercises to relieve the pain. 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. What is the pathophysiology of iliotibial band syndrome. Hold onto a wall or chair on the side you want to stretch.
The treatment of iliotibial band friction syndrome. The pain is caused by friction of the iliotibial band over the lateral epicondyle of the femur. When working normally, the it band will glide across the outside of the knee over a fluidfilled sac called a bursa. The band may overdevelop, tighten, and rub across the hipbone or the outer part of the knee. Treatment often focuses on stretching the itb and treating local inflammation at the lateral femoral condyle lfc. The iliotibial band is a band of fibrous tissue that runs down the outside of the thigh. Snapping hip pain as the iliotibial band snaps back and forth over the point of the hip greater trochanter. Iliotibial band syndrome itbs is the result of inflammation and irritation of the distal portion of the iliotibial tendon see illustration as it rubs against the bursa.
The it band is attached to the knee to assist in stabilizing and moving the joint. Illiotibial band syndrome protocol princeton university. It is usually seen in runners and typically causes pain at the outer aspect of the knee where the iliotibial band itb crosses the knee joint. It provides stability to the knee and hip and helps prevent dislocation of those joints. Male runners may exhibit kinematic faults such as increased hip internal r. It causes lateral knee pain on the outer side of the knee, which can radiate up the thigh. Risk factors in women include increased hip adduction, knee. Affected patients report lateral knee pain associated with repetitive motion activities. Practical, conservative management of iiiotibial band syndrome. Fairclough, john, koji hayashi, hechmi toumi, kathleen lyons, graeme bydder, nicola phillips, thomas m. It band tightness may also lead to patellofemoral syndrome, which is known as runners knee. A doctor may prescribe physical therapy if the initial treatment described above is unsuccessful.
Iliotibial band friction syndrome itbfs is the second most common cause of knee pain in runners, and accounts for up to 12% of all running injuries. Iliotibial band syndrome itbs is an overuse injury of the lateral knee that occurs primarily in runners and was first described in 1973. Jul 20, 2010 iliotibial band friction syndrome is a common occurrence among physically active individuals, causing pain in the lateral knee. This fact sheet is designed to provide you with information on iliotibial band friction syndrome.
Effects of multimodal physiotherapy, including hip abductor strengthening, in patients with iliotibial band friction syndrome. Iliotibial band friction syndrome pubmed central pmc. It connects the side of your hip to the side of your knee. Feb 28, 2020 iliotibial band syndrome describes the pain caused by inflammation of the band as it crosses the lateral femoral epicondyle. Slowly roll the massager back and forth along the entire length of the it band and lateral thigh. The iliotibial band is a fascial structure composed of dense connective tissue that assists stance stability and is capable of resisting large varus torques at the knee 7,11,12. Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The band is crucial to stabilizing the knee during running, as it moves from. Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. One bursa covers the bony point of the hip bone called the greater trochanter.
Classically, iliotibial band syndrome is diagnosed by history and physical examination. This is an overuse injury, although direct trauma to the outer knee may cause the bursa to get inflamed. Often the deceleration of running down hills may lead to the excessive friction. I am a former massage therapist in vancouver, canada. Pain that generally disappears as the band is stretched out and becomes more flexible. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. Phase 1, for treating the initial symptoms, involves antiinflammatory drugs, icing, stretching, and using a knee immobilizer and crutches. Exercises your kaiser permanente care instructions here are some examples of typical rehabilitation exercises for your condition. Biomechanical implications and exercise interventions article pdf available in physical medicine and rehabilitation clinics of north america 271. In brief inflammation of the iliotibial brief band at the lateral femoral epicondylecalled iliotibial band syndromecan be treated effectively with a twophase conservative regimen. Whether you have been diagnosed with or suspect iliotibial band syndrome, your first step should be to rest the affected leg.
Share to facebook share to twitter share to print share to email share to more. If you have iliotibial band friction syndrome itbfs, you may benefit from the skilled treatments of a physical therapist to help relieve your pain and improve your mobility. It is not intended to replace the need for a consultation with your doctor. If the foam roller is initially too painful, utilize a theraband roller massager to perform the mobilization. Physical medicine and rehabilitation for iliotibial band. The it band attaches to the intramuscular septum of the femur in a variety of places this is a natural variant of it band anatomy via. Iliotibial band syndrome is a common cause of running knee pain, frequently affecting long distance runners and can be notoriously difficult to treat. Iliotibial band syndrome exercises what you need to know. Iliotibial band friction syndrome itbfs is an inflammatory, nontraumatic, overuse injury of the knee affecting predominantly longdistance runners. Iliotibial band syndrome strengthening exercises it band. A fluidfilled sac called a bursa normally helps the it band glide smoothly over your knee as you bend and straighten your leg. Assessment of strength, flexibility, and running mechanics. The sac provides lubrication between the tendon and the bone.
It band mobilization with theraband roller massager. Pain develops where the iliotibial band itb courses over the lateral femoral epicondyle lfe, just proximal to the lateral joint line. Rest, ice and the use of antiinflammatory medications may alleviate symptoms. Iliotibial band syndrome itbs, also referred to as iliotibial band friction syndrome itbfs, is an overuse injury that occurs when the distal portion of the it band rubs repeatedly over the lateral condyle of the femur at approximately 30 degrees of knee flexion. Orthopaedics if you have questions, please contact our team by email to physical. Do not roll it over the greater trochanter of the hip the boney part near your pelvis. Itbs is a wellknown cause of lateral knee pain in endurance sports and particularly in longdistance runners. Iliotibial band syndrome deep tissue massage manual. Iliotibial band syndrome itbs is an overuse injury caused by repetitive friction of the iliotibial band and the underlying bursa or lateral recess across the lateral femoral epicondyle. This is a band of tissue that runs down the outside of your thigh. The dilemma of knee osteoarthritis and iliotibial band. This information does not replace the advice of a docto.
Iliotibial band syndrome itbsiliotibial band friction syndrome itbfs is considered to be one of the most common overuse injuries in the lower extremity, affecting anywhere from 7. Iliotibial band syndrome itbs is the result of inflammation. Typically, iliotibial band syndrome itbs results from overuse injury, seen most commonly in distance runners and. Knee pain has been reported to limit mobility and impair quality of life in 25% of adults. Iliotibial band strengthening exercises syndrome courtesy of. 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. Itb syndrome treatment for runners return to running. Apr 15, 2005 iliotibial band syndrome is a common knee injury.
Here are some examples of typical rehabilitation exercises for your condition. But if your it band is too tight, bending your knee creates friction. Knee, iliotibial band syndrome, synovial, cyst introduction iliotibial band syndrome is a common cause of lateral knee pain, especially in active athletes. It cannot contract as a muscle would, and we cannot stretch the it band. It band stretch stand with the leg you want to stretch crossed behind the other. Do not roll it over the greater trochanter of the hip the boney part near your. It is postulated to arise from repetitive friction of the iliotibial band over the lateral femoral condyle during flexion and extension of. Iliotibial band syndrome, or it band syndrome, is a painful condition that results from excessive tightness or inflammation in the it band. In the majority of cases, acute exacerbation of lateral knee pains is associated with medial joint collapse and varus deformity in the absence of any joint effusion. Iliotibial band syndrome accounts for 12% of runningrelated overuse injuries 4.
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