Iliotibial Band Syndrome

About Iliotibial Band Syndrome

The Iliotibial Band (ITB) Syndrome (ITBS) is a common lateral knee pain condition, especially among athletes involved in running, hiking, cycling, and more. The ITB is a band of fibrous tissue that begins from the outside of the pelvis, runs over the hip & knee, and ends just below the knee. During knee movement, it provides support to the joint and it moves from the rear of the femur to its front.

The continuous activity of the knee, including flexions and extensions, results in the ITB to rub over the Lateral Femoral Epicondyle, causing inflammation. An ITBS is this injury of the bursa enveloping the ITB, due to rubbing, tightening, or overdevelopment of the band.

Causes

Overuse of the knee-joint causes inflammation resulting in an ITBS. The common causes for this syndrome include:

1. Running on flat surfaces, especially cemented ones
2. Insufficient warm-up exercises before starting a workout and inadequate cool-down exercises after completion of the workout
3. Incorrect positioning of the feet while cycling
4. Excessive hiking, rowing, and similar activities
5. Deformity in the feet or leg
6. Weak muscles

Signs and Symptoms

Pain in the knee and hip are the two main symptoms of an ITBS. Pain in the knee includes that on the outside of the joint, pain while folding the knee, flexing the joint, and more. The patient may experience tenderness, snapping or popping sensation over the site of the syndrome.

Consultation

A General Physician or an Orthopedic Surgeon is the subject matter expert.

Tests and Investigations

Medical practitioners diagnose this condition through a physical examination of the knee, including the ITB, lateral femoral condyle, quadriceps muscles, & the hamstring muscles. The patient needs to undergo a few stretching exercises to enable the physician to make the right diagnosis. Two of the common exercise tests involved in this scenario, include the Thomas Test and the Ober Test.

The physician may also take note of the medical history of the patient, to understand the cause of the syndrome. X-Rays and MRI scans (Magnetic Resonance Imaging) help in diagnosing other underlying problems that may have led to the ITBS.

Treatment Modalities Available

To treat this condition, it is significant to reduce friction of the ITB and the Femoral Condyle. Initially, it is crucial to lessen the inflammation and get rid of the pain. Taking rest stops further aggravation of the condition. Regular massage and indulging in stretching & strengthening exercises are some of the few treatment modalities available. However, the last resort to treat an ITBS is surgery.

Non-Surgical Treatment:

The common non-surgical treatments for curing an ITBS include:

1. Adequate rest
2. Application of ice packs
3. Friction massage
4. Ultrasound
5. Over-the-counter anti-inflammatory medications, such as, Ibuprofen, Naproxen, and more
6. Injecting Cortisone into the bursa if oral medication fails
7. Physical therapy under a physiotherapist's guidance
8. Iontophoresis (process of applying mild electric current to drive the anti-inflammatory medicine into the affected area)

Surgical Treatment:

Surgery for treating ITBS is rare. If all the non-surgical treatments fail, the surgeon may suggest a surgery involving removal of the bursa and loosening the ITB to aide in moving the joint. Veterans advise Diagnostic Arthroscopy with any surgical procedure for ITBS.

Physical Activity Requirements during the Course of the Treatment

It is important to take rest to avoid deterioration of the condition. Physiotherapy under a professional's guidance helps to strengthen the muscles, enabling the patient to get back to his normal routine.

Prevention to Avoid Occurrence and Recurrence

Taking the following precautions may help avoid occurrence or recurrence of an ITBS:

1. In case of the slightest pain, the person must take rest or decrease his level of activity
2. Indulge in warm-up and cooling-down exercises
3. Wear good quality shoes
4. Avoid running on uneven or concrete surfaces
5. Consult a podiatrist for orthotics if needed

Support from Family

ITBS is painful and the patient may get restless due to this. However, constant support from the family helps the patient to recover faster and with ease.