Iliotibial band syndrome: Difference between revisions
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{{about|injury of the iliotibial band||Runner's knee}} |
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'''Iliotibial Band Syndrome''', aka ITBS or ITBFS (for Iliotibial Band Friction Syndrome), is a common [[injury]] generally associated with [[running]]. Though it can also be caused by [[biking]], [[hiking]] or [[weight-lifting]] (squats). |
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{{Infobox medical condition (new) |
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| name = Iliotibial band syndrome |
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| synonyms = Iliotibial band friction syndrome (ITBFS)<ref name="pmid17208506">{{cite journal |last1=Ellis |first1=R |last2=Hing |first2=W |last3=Reid |first3=D |title=Iliotibial band friction syndrome—A systematic review |journal=Manual Therapy |volume=12 |issue=3 |pages=200–8 |date=August 2007 |pmid=17208506 |doi=10.1016/j.math.2006.08.004}}</ref> |
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| image = File:Iliotibial band syndrome-en.svg |
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| field = [[Sports medicine]], [[orthopedics]] |
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'''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]] and the [[lateral epicondyle of the femur]].<ref name=":02">{{Cite web|url=https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1047965115000650?scrollTo=#hl0000423|title=ClinicalKey|last1=Baker|first1=Rober L.|last2=Fredericson|first2=Michael|date=2016|website=www.clinicalkey.com|access-date=2019-11-17}}</ref> Pain is felt most commonly on the lateral aspect of the knee and is most intensive at 30 degrees of knee flexion.<ref name=":02"/> Risk factors in women include increased hip adduction and knee internal rotation.<ref name=":02"/><ref name=":33">{{Cite journal|last=Neal|first=Bradley|date=2016|title=Iliotibial Band Syndrome: A Narrative Review|journal=Co-Kinetic Journal|volume=67|pages=16–20|via=EBSCO host}}</ref> Risk factors seen in men are increased hip internal rotation and knee adduction.<ref name=":02"/> ITB syndrome is most associated with long-distance running, cycling, weight-lifting, and with military training.<ref name="s699">{{cite web | last=Stirling | first=Jerold M | title=Iliotibial Band Syndrome: Practice Essentials, Etiology, Epidemiology | website=Medscape Reference | date=2023-10-13 | url=https://emedicine.medscape.com/article/91129-overview#a6 | access-date=2024-08-06}}</ref><ref>{{Citation|last1=Hadeed|first1=Andrew|title=Iliotibial Band Friction Syndrome|date=2019|url=http://www.ncbi.nlm.nih.gov/books/NBK542185/|work=StatPearls|publisher=StatPearls Publishing|pmid=31194342|access-date=2019-11-17|last2=Tapscott|first2=David C.}}</ref> |
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=== Definition === |
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Iliotibial Band Syndrome is one of the leading causes of lateral [[knee]] pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, 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, moving from behind the femur to the front of it during the [[gait]] cycle. The continual rubbing of the band over the bone, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed or the band itself may become irritated. |
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== Signs and symptoms == |
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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 tract|iliotibial band]]. At initial symptom onset pain typically occurs following activity, but as the condition progresses pain is frequently felt during activities and may be present at rest.<ref name=":0" /> Pain may also be present above and below the knee, where the ITB attaches to the [[tibia]].<ref>{{Cite web|title=Iliotibial band syndrome - aftercare: MedlinePlus Medical Encyclopedia|url=https://medlineplus.gov/ency/patientinstructions/000683.htm|access-date=2022-02-22|website=medlineplus.gov|language=en}}</ref> Pain is frequently worsened by running up or downhill or by stride lengthening.<ref>{{Cite journal |last=Khaund |first=Razib |last2=Flynn |first2=Sharon H. |date=2005-04-15 |title=Iliotibial band syndrome: a common source of knee pain |url=https://pubmed.ncbi.nlm.nih.gov/15864895 |journal=American Family Physician |volume=71 |issue=8 |pages=1545–1550 |issn=0002-838X |pmid=15864895}}</ref> |
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The symptoms range from a stinging sensation just above the knee [[joint]] on the outside of the knee or along the entire length of the iliotibial band to swelling to a thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately, but will worsen during activity when the foot strikes the ground if you overstride or run downhill, and may persist afterward. A single workout of excessive distance or a rapid increase in weekly mileage can aggravate the condition, especially if other predispositions exist. |
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{{clear}} |
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== Risk factors == |
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ITBS is associated with various risk factors including training habits, anatomical abnormalities, or muscular imbalances:<ref>{{Cite web |title=Iliotibial Band Syndrome Specialist Clinic {{!}} Singapore Sports and Orthopaedic Clinic - Neurosurgeon |url=https://www.boneclinic.com.sg/orthopaedic-conditions/hip-pain/iliotibial-band-syndrome-itbs/ |access-date=2022-06-24 |language=en-US}}</ref> |
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{{Col-begin}} |
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ITBS can also occur at the hip joint, where the IT band connects to the hip. It is less likely to occur at the hip as a sports injury. It can commonly occur during pregnancy, as the connective tissues loosen to allow for delivery at the same time the women gains weight, adding more pressure. The hip version also commonly affects the elderly. This version is much less-commonly studied and few treatments are generally known. |
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{{Col-break}} |
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'''Training habits''' |
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* Spending long periods of time/regularly sitting in lotus posture in yoga, especially beginners forcing the feet onto the top of the thighs |
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* Consistently running on a horizontally banked surface (such as the shoulder of a road or an [[indoor track]]) on which the downhill leg is bent slightly inward, causing extreme stretching of the band against the femur |
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* Inadequate warmup or cool-down |
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* Excessive uphill and downhill running |
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* Positioning the feet "[[Pigeon toe|toed-in]]" to an excessive angle when cycling. (Knee should be positioned between 30 and 35 degree to help avoid ITBS)<ref>{{cite journal |last1=Farrell |first1=Kevin C. |last2=Reisinger |first2=Kim D. |last3=Tillman |first3=Mark D. |title=Force and repetition in cycling: possible implications for iliotibial band friction syndrome |journal=The Knee |date=March 2003 |volume=10 |issue=1 |pages=103–109 |doi=10.1016/S0968-0160(02)00090-X |pmid=12649036 }}</ref> |
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* Running up and down stairs |
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* Hiking long distances |
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* Rowing |
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* [[Breaststroke]] |
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* Treading water |
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{{Col-break}} |
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'''Abnormalities in leg/feet anatomy''' |
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* [[pes cavus|High]] or [[flat feet|low arches]] |
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* [[Supination]] of the foot |
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* Excessive lower-leg rotation due to over-pronation |
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* Excessive foot-strike force |
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* [[Unequal leg length|Uneven leg lengths]] |
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* [[Genu varum|Bowlegs]] or tightness about the iliotibial band. |
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'''Muscle imbalance''' |
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=== Causes of Injury === |
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* Weak hip abductor muscles |
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Iliotibial Band Syndrome is the result of both poor training habits, equipment and [[anatomy|anatomical]] abnormalities. |
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* Weak/nonfiring [[multifidus muscle]] |
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* Uneven left-right stretching of the band, which could be caused by habits such as sitting cross-legged |
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{{col-end}} |
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==Anatomical mechanism== |
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* Running on a banked surface, such as the shoulder of a road or an indoor track, causes the downhill leg to bend slightly inward and causes extreme stretching of the band against the femur. |
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Iliotibial band syndrome is one of the leading causes of lateral [[knee pain]] in runners. The [[iliotibial tract|iliotibial band]] is a thick band of [[fascia]] composing the tendon of the [[tensor fasciae latae muscle]]. It is located on the lateral aspect of the knee, extending from the outside of the [[human pelvis|pelvis]], over the [[hip (anatomy)|hip]] and knee, and inserting just below the knee. The band serves to stabilize the knee. It has been proposed that during activity such as running and cycling the iliotibial band slides back and forth over the [[Lateral epicondyle of the femur|lateral femoral epicondyle]], which causes friction and inflammation of the band.<ref name=":0" /> It has also been suggested that symptoms are caused by impingement of the iliotibial band in the knee during 30 degree [[flexion]], which is a position common in running and cycling.<ref>{{Cite journal|last1=Fairclough|first1=John|last2=Hayashi|first2=Koji|last3=Toumi|first3=Hechmi|last4=Lyons|first4=Kathleen|author5-link=Graeme Bydder|last5=Bydder|first5=Graeme|last6=Phillips|first6=Nicola|last7=Best|first7=Thomas M|last8=Benjamin|first8=Mike|date=March 2006|title=The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome|journal=Journal of Anatomy|volume=208|issue=3|pages=309–316|doi=10.1111/j.1469-7580.2006.00531.x|issn=0021-8782|pmc=2100245|pmid=16533314}}</ref> Additional proposed mechanisms causing the symptoms of ITBS include compression of the fat and soft tissues beneath the iliotibial band, and chronic iliotibial band [[bursitis]].<ref name=":0" /> |
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* Inadequate warm-up or cool-down. |
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* Running excessive distances or increasing mileage too quickly can aggravate or cause injury. |
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* Anatomical abnormalities such as bowlegs or tightness about the iliotibial band. |
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** One common indicator of bowleggedness for runners is that the outside of your sneaker's heel will have excessive wear, compared to the inside. |
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==Diagnosis== |
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=== Short Term Treatment === |
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Diagnosis of iliotibial band syndrome is primarily based on history and physical exam findings, including tenderness at the lateral femoral epicondyle, where the iliotibial band passes over the bone.<ref>{{Cite journal | url=https://www.aafp.org/afp/2005/0415/p1545.html | title=Iliotibial Band Syndrome: A Common Source of Knee Pain| journal=American Family Physician| volume=71| issue=8| pages=1545–1550| date=2005-04-15| last1=Flynn| first1=Sharon H.| last2=Khaund| first2=Razib| pmid=15864895}}</ref> |
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To treat functional problems resulting from poor training: |
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* Decrease mileage. |
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** For chronic problems, stop running altogether for 3-4 weeks. |
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* Limit climbing stairs or any activity that puts pressure on the knee while it bends (e.g. squats). |
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* Ice knee after activity. |
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* Alternate running direction on a pitched surface. |
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* Lateral sole wedge (orthotics) to lessen pressure on the knee. |
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* Stretching to tolerance. |
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=== Differential diagnosis === |
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=== Staying in Shape while Not Running === |
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Other conditions that may present with knee pain similar to ITBS that must be differentiated include a [[lateral meniscus]] tear, degenerative joint disease, [[tendinopathy]] of the [[Biceps femoris muscle|biceps femoris]], [[stress fracture]], [[patellofemoral pain syndrome]], and injury to the [[Fibular collateral ligament|lateral collateral ligament]].<ref name=":0" /> |
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If you don't want to lose all your conditioning, try some of the following: |
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* Deep-water pool running |
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* Swimming with any kick '''except''' the "frog kick", whose whip-like action could aggrevate your IT. |
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* Speed walking with straight legs on flat surfaces. |
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* Cross-country skiing, especially on machine (keep legs fairly straight). |
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* Pleiades |
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* Yoga |
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=== Exam maneuvers === |
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=== Sports Activities to Avoid while you're Symptomatic === |
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There are several physical exam maneuvers used to test iliotibial band function and provoke symptoms diagnostic of ITBS. The Noble test is used to assess for iliotibial band disfuction, in which the examiner [[Anatomical terms of motion|extends]] the patient's knee from the 90 degree position with pain over the lateral femoral epicondyle occurring at 30 degrees of [[Anatomical terms of motion|flexion]]. Additional tests include the Ober test to detect iliotibial band [[contracture]], where the patient lies on their side and the examiner attempts to [[Anatomical terms of motion|abduct]], extend, and then [[Anatomical terms of motion|adduct]] the leg. A positive test occurs with inability to adduct the leg due to iliotibial band shortening. The Thomas test is used to detect excessive tightness of the iliotibial band. In this test the patient holds the unaffected leg to their chest while the examiner straightens and lowers the other leg to a horizonal position, inability to fully straighten and lower the leg indicates excessive band tightness.<ref>{{Cite journal |last=Hariri |first=Sanaz |last2=Savidge |first2=Edgar T. |last3=Reinold |first3=Michael M. |last4=Zachazewski |first4=James |last5=Gill |first5=Thomas J. |date=July 2009 |title=Treatment of Recalcitrant Iliotibial Band Friction Syndrome with Open Iliotibial Band Bursectomy: Indications, Technique, and Clinical Outcomes |url=http://journals.sagepub.com/doi/10.1177/0363546509332039 |journal=The American Journal of Sports Medicine |language=en |volume=37 |issue=7 |pages=1417–1424 |doi=10.1177/0363546509332039 |issn=0363-5465}}</ref><ref>{{Cite journal |last=Fredericson |first=Michael |last2=Weir |first2=Adam |date=May 2006 |title=Practical Management of Iliotibial Band Friction Syndrome in Runners |url=http://dx.doi.org/10.1097/00042752-200605000-00013 |journal=Clinical Journal of Sport Medicine |volume=16 |issue=3 |pages=261–268 |doi=10.1097/00042752-200605000-00013 |issn=1050-642X}}</ref><ref>{{Cite journal |last=West |first=R |last2=Irrgang |first2=J |date=2009 |title=Overuse injuries of the lower extremity |journal=Orthopaedic Knowledge Update: Sports Medicine 4}}</ref> |
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* StairMasters |
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[[File:Wrap around artifact MRI right knee on proton density fat saturation sequence.jpg|thumb|The iliotibial band may be assessed by MRI in severe cases.]] |
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* Dead-lifts |
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* Step Aerobics |
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* Court sports, such as tennis, racket ball, squash, basketball |
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=== Imaging === |
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Imaging studies are generally not needed for diagnosis of ITBS, as characteristic symptoms and physical exam findings are sufficient for diagnosis. However, in severe or persistent cases [[Magnetic resonance imaging|MRI]] may be used to confirm the diagnosis as well as rule out other causes of lateral knee pain. [[Ultrasound|Ultrasonography]] may also be used to evaluate disease progression by measuring iliotibial band thickness.<ref name=":0" /> |
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To treat structural abnormalities such as a natural tightness in the band: |
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== Treatment == |
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* Stretching, especially before working out, to make the band more flexible and less susceptible to injury. |
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* To check for anatomical abnormalities, have a physical therapist familiar with ITBS videotape your running form on a treadmill and look at your body mechanics. |
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* In extreme cases, surgery to relieve tightness in the band. However, surgery is not always effective. |
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=== Conservative treatments === |
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Both structural and functional problems need to be considered when treating Iliotibial Band Syndrome. |
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While ITBS pain can be acute, the iliotibial band can be treated conservatively with rest, ice, compression and elevation ([[RICE (medicine)|RICE]]) to reduce pain and [[inflammation]], followed by stretching.<ref name="barber92">{{cite journal|last1=Barber|first1=F. Alan|last2=Sutker|first2=Allan N.|date=August 1992|title=Iliotibial Band Syndrome|journal=Sports Medicine|volume=14|issue=2|pages=144–148|doi=10.2165/00007256-199214020-00005|pmid=1509227}}</ref> Utilization of [[corticosteroid]] injections and the use of [[Oral administration|oral]] [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] (NSAIDs) or [[Topical medication|topical]] NSAIDs 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.<ref name=":22">{{Cite journal|last1=Beals|first1=Corey|last2=Flanigan|first2=David|date=2013|title=A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population|journal=Journal of Sports Medicine|volume=2013|pages=367169|doi=10.1155/2013/367169|issn=2356-7651|pmc=4590904|pmid=26464876|doi-access=free}}</ref> Similar results can be found with the use of anti-inflammatory medication, analgesic/anti-inflammatory medication, specifically.<ref name=":22"/> [[Physical therapy]] is an effective treatment modality, with the goal of stretching the [[Iliotibial tract|iliotibial band]], [[Tensor fasciae latae muscle|tensor fasciae latae]], and [[gluteus medius]].<ref name=":0" /> Other non-invasive treatments include modalities such as flexibility and strength training, neuromuscular/gait training, [[manual therapy]], training volume reduction, [[myofascial release]], or changes in running shoe.<ref name=":02"/><ref name=":22"/><ref name=":33"/><ref>{{Cite journal|last1=Weckström|first1=Kristoffer|last2=Söderström|first2=Johan|date=2016|title=Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome|journal=Journal of Back and Musculoskeletal Rehabilitation|volume=29|issue=1|pages=161–170|doi=10.3233/BMR-150612|pmid=26406193}}</ref> 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.<ref name=":02" /> 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.<ref name=":02" /> 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.<ref name=":33"/> |
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=== Surgical treatments === |
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Surgery treatments are utilized if several conservative approaches fail to produce results.<ref name=":22"/> 6 months of conservative treatments are generally used before surgical intervention.<ref name=":33"/> Surgery typically involves removal of a small piece of the iliotibial band to release excessive tension. Other procedures that have been utilized include [[Resection (surgery)|resection]] of the iliotibial band [[Synovial bursa|bursa]] and z-lengthening. In the z-lengthening procedure, two horizontal incisions are made in the band and connected by a vertical incision, forming a z. The resulting sections are reattached together in a lengthened position, increasing the length of the band.<ref name=":0" /> |
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=== Prognosis === |
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* You should not start running ''as soon as'' the pain stops. |
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ITBS symptoms typically improve with treatment. An estimated 50-90% of patients have symptom resolution with 4-8 weeks of conservative treatment, while surgical patients also generally have good outcomes.<ref name=":1">{{Citation |last=Hadeed |first=Andrew |title=Iliotibial Band Friction Syndrome |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK542185/ |work=StatPearls |access-date=2023-11-06 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31194342 |last2=Tapscott |first2=David C.}}</ref> Complications of ITBS include recurrence and exacerbation by return to activity following treatment, as well as possible progression to [[patellofemoral pain syndrome]].<ref name=":1" /> |
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** If you have chronic ITBS, you may have to wait 2 weeks after the symptoms are gone. |
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* Restart running '''with minimal mileage''', building slowly. |
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** As you build your mileage, '''stop''' as soon as you feel pain. |
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*** Even better, try to stop running ''before'' the pain starts. |
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* Continue stretches, as well as strengthing of your quads and glutes. |
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== Epidemiology == |
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=== Additional Treatment Options === |
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* Deep-tissue massage or [[Rolfing]] may help break up [[scar]] tissue that forms. |
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* Non-steroidal anti-inflammatory drugs (aka NSAIDs), in high doses for a period of weeks, can help reduce the inflammation. |
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* Strengthening exercises for the [[quadriceps femoris]] and [[gluteus medius]] muscles can help support the leg, thus lessening the load on the ITB. |
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* [[Cortisone]] shots have been used to help reduce the [[inflammation]], though some risks are involved with this treatment. |
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=== Occupation === |
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ITBS commonly affects athletes and has been reported in runners, cyclists, rowers, skiers, and triathletes, as well as basketball, soccer, and field hockey players.<ref name=":0" /> |
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As with any injury or ailment, you should see your doctor or physical therapist for diagnosis and treatment, rather than relying solely on advice you get from the Internet. |
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Significant association between the diagnosis of ITBS and occupational background of the patients has been thoroughly determined. Occupations that require extensive use of the iliotibial band are more susceptible to developing ITBS due to a continuum of their iliotibial band repeatedly abrading against the [[Lateral epicondyle of the femur|lateral epicondyle]] prominence, thereby inducing an inflammatory response. Professional or amateur runners are at high clinical risk of ITBS, and there is a greater risk in those running 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.<ref>{{Cite journal|last1=Richards|first1=David P.|last2=Alan Barber|first2=F.|last3=Troop|first3=Randal L.|date=March 2003|title=Iliotibial band Z-lengthening|journal=Arthroscopy: The Journal of Arthroscopic & Related Surgery|volume=19|issue=3|pages=326–329|doi=10.1053/jars.2003.50081|pmid=12627161|issn=0749-8063}}</ref> |
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---- |
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Information provided by the American Running and Fitness Association, and other sources. |
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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.<ref>{{Cite journal|last1=Hafer|first1=Jocelyn F.|last2=Brown|first2=Allison M.|last3=Boyer|first3=Katherine A.|date=August 2017|title=Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome|journal=Clinical Biomechanics|volume=47|pages=73–78|doi=10.1016/j.clinbiomech.2017.06.006|pmid=28618309|s2cid=4007166|issn=0268-0033}}</ref> 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.<ref name="u060">{{cite web | last=Martinez | first=John M | title=Physical Medicine and Rehabilitation for Iliotibial Band Syndrome: Practice Essentials, Pathophysiology, Epidemiology | website=Medscape Reference | date=2022-04-04 | url=https://emedicine.medscape.com/article/307850-overview | access-date=2024-08-06}}</ref> |
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<b>References and Links </b> |
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[http://www.rice.edu/~jenky/sports/itband.v2.html Sports Medicine Tent: ITB] |
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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.<ref>{{Cite journal|last1=Jensen|first1=Andrew E|last2=Laird|first2=Melissa|last3=Jameson|first3=Jason T|last4=Kelly|first4=Karen R|date=2019-03-01|title=Prevalence of Musculoskeletal Injuries Sustained During Marine Corps Recruit Training|journal=Military Medicine|volume=184|issue=Supplement_1|pages=511–520|doi=10.1093/milmed/usy387|pmid=30901397|issn=0026-4075|doi-access=free}}</ref> |
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Studies suggest that there is not a difference in ITBS incidence rate between patients of different race, gender, or age. However, there has been a claim that females are more prone to ITBS due to their anatomical differences in the [[pelvis]] and [[lower extremity|lower extremities]]. Males with a larger lateral epicondyle prominence may also be more susceptible to ITBS.<ref>{{Cite journal|last1=Everhart|first1=Joshua S.|last2=Kirven|first2=James C.|last3=Higgins|first3=John|last4=Hair|first4=Andrew|last5=Chaudhari|first5=Ajit A.M.W.|last6=Flanigan|first6=David C.|date=August 2019|title=The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case–control study|journal=The Knee|volume=26|issue=6|language=en|pages=1198–1203|doi=10.1016/j.knee.2019.07.015|pmid=31439366|s2cid=201616794}}</ref> Higher incidence rate of ITBS has been reported between the ages of 15 and 50, which generally includes most active athletes.<ref name="u060"/> |
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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.<ref>{{Cite journal|last1=Farrell|first1=Kevin C.|last2=Reisinger|first2=Kim D.|last3=Tillman|first3=Mark D.|date=March 2003|title=Force and repetition in cycling: possible implications for iliotibial band friction syndrome|journal=The Knee|volume=10|issue=1|pages=103–109|doi=10.1016/s0968-0160(02)00090-x|pmid=12649036|issn=0968-0160}}</ref> A study provided data that shows more than half (50%) of professional cyclists complain of knee pain.<ref>{{Cite journal|last1=Holmes|first1=James C.|last2=Pruitt|first2=Andrew L.|last3=Whalen|first3=Nina J.|date=May 1993|title=Iliotibial band syndrome in cyclists|journal=The American Journal of Sports Medicine|volume=21|issue=3|pages=419–424|doi=10.1177/036354659302100316|pmid=8166785|s2cid=21010647|issn=0363-5465}}</ref> Additional studies have shown that ITBS makes up 15–24% of all overuse injuries in cyclists.<ref name=":0">{{Cite journal |last=Strauss |first=Eric J. |last2=Kim |first2=Suezie |last3=Calcei |first3=Jacob G. |last4=Park |first4=Daniel |date=December 2011 |title=Iliotibial Band Syndrome: Evaluation and Management: |url=http://journals.lww.com/00124635-201112000-00003 |journal=American Academy of Orthopaedic Surgeon |language=en |volume=19 |issue=12 |pages=728–736 |doi=10.5435/00124635-201112000-00003 |issn=1067-151X}}</ref> |
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== History == |
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ITBS was originally described by Lieutenant Commander James W. Renne in 1975 after observing frequent lateral knee pain in recruits participating in intensive military training. He initially named the syndrome ''iliotibial band friction syndrome''.<ref>{{Cite journal |last=Renne |first=James |date=December 1975 |title=The Iliotibial Band Friction Syndrome |url=https://pubmed.ncbi.nlm.nih.gov/1201997/ |journal=The Journal of Bone & Joint Surgery}}</ref> |
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== See also == |
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<!-- Please keep entries in alphabetical order & add a short description [[WP:SEEALSO]] --> |
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*[[Chondromalacia patellae]] |
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*[[Patellofemoral pain syndrome]] |
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*[[Plica syndrome]] |
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<!-- please keep entries in alphabetical order --> |
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== References == |
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{{Reflist|colwidth=30em}} |
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==Further reading== |
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{{cite journal |last1=van der Worp |first1=Maarten P. |last2=van der Horst |first2=Nick |last3=de Wijer |first3=Anton |last4=Backx |first4=Frank J. G. |last5=Nijhuis-van der Sanden |first5=Maria W. G. |title=Iliotibial Band Syndrome in Runners |journal=Sports Medicine |date=23 December 2012 |volume=42 |issue=11 |pages=969–992 |doi=10.1007/BF03262306 |s2cid=73959693 }} |
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== External links == |
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{{commons category}} |
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{{Medical resources |
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| DiseasesDB = 32612 |
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| ICD10 = {{ICD10|M|76|3|m|70}} |
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| ICD9 = {{ICD9|728.89}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = pmr |
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| eMedicineTopic = 61 |
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| eMedicine_mult = {{eMedicine2|sport|53}} |
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{{Soft tissue disorders}} |
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[[Category:Overuse injuries]] |
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[[Category:Soft tissue disorders]] |
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[[Category:Syndromes]] |
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Latest revision as of 16:17, 20 December 2024
| Iliotibial band syndrome | |
|---|---|
| Other names | Iliotibial band friction syndrome (ITBFS)[1] |
 | |
| Specialty | Sports medicine, orthopedics |
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 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 and 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]
Signs and symptoms
[edit]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. At initial symptom onset pain typically occurs following activity, but as the condition progresses pain is frequently felt during activities and may be present at rest.[6] Pain may also be present above and below the knee, where the ITB attaches to the tibia.[7] Pain is frequently worsened by running up or downhill or by stride lengthening.[8]
Risk factors
[edit]ITBS is associated with various risk factors including training habits, anatomical abnormalities, or muscular imbalances:[9]
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Training habits
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Abnormalities in leg/feet anatomy
Muscle imbalance
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Anatomical mechanism
[edit]Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a thick band of fascia composing the tendon of the tensor fasciae latae muscle. It is located 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 serves to stabilize the knee. It has been proposed that during activity such as running and cycling the iliotibial band slides back and forth over the lateral femoral epicondyle, which causes friction and inflammation of the band.[6] It has also been suggested that symptoms are caused by impingement of the iliotibial band in the knee during 30 degree flexion, which is a position common in running and cycling.[11] Additional proposed mechanisms causing the symptoms of ITBS include compression of the fat and soft tissues beneath the iliotibial band, and chronic iliotibial band bursitis.[6]
Diagnosis
[edit]Diagnosis of iliotibial band syndrome is primarily based on history and physical exam findings, including tenderness at the lateral femoral epicondyle, where the iliotibial band passes over the bone.[12]
Differential diagnosis
[edit]Other conditions that may present with knee pain similar to ITBS that must be differentiated include a lateral meniscus tear, degenerative joint disease, tendinopathy of the biceps femoris, stress fracture, patellofemoral pain syndrome, and injury to the lateral collateral ligament.[6]
Exam maneuvers
[edit]There are several physical exam maneuvers used to test iliotibial band function and provoke symptoms diagnostic of ITBS. The Noble test is used to assess for iliotibial band disfuction, in which the examiner extends the patient's knee from the 90 degree position with pain over the lateral femoral epicondyle occurring at 30 degrees of flexion. Additional tests include the Ober test to detect iliotibial band contracture, where the patient lies on their side and the examiner attempts to abduct, extend, and then adduct the leg. A positive test occurs with inability to adduct the leg due to iliotibial band shortening. The Thomas test is used to detect excessive tightness of the iliotibial band. In this test the patient holds the unaffected leg to their chest while the examiner straightens and lowers the other leg to a horizonal position, inability to fully straighten and lower the leg indicates excessive band tightness.[13][14][15]
Imaging
[edit]Imaging studies are generally not needed for diagnosis of ITBS, as characteristic symptoms and physical exam findings are sufficient for diagnosis. However, in severe or persistent cases MRI may be used to confirm the diagnosis as well as rule out other causes of lateral knee pain. Ultrasonography may also be used to evaluate disease progression by measuring iliotibial band thickness.[6]
Treatment
[edit]Conservative treatments
[edit]While ITBS pain can be acute, the iliotibial band can be treated conservatively with rest, ice, compression and elevation (RICE) to reduce pain and inflammation, followed by stretching.[16] Utilization of corticosteroid injections and the use of oral nonsteroidal anti-inflammatory drugs (NSAIDs) or topical NSAIDs 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.[17] Similar results can be found with the use of anti-inflammatory medication, analgesic/anti-inflammatory medication, specifically.[17] Physical therapy is an effective treatment modality, with the goal of stretching the iliotibial band, tensor fasciae latae, and gluteus medius.[6] Other non-invasive treatments include modalities such as flexibility and strength training, neuromuscular/gait training, manual therapy, training volume reduction, myofascial release, or changes in running shoe.[2][17][3][18] 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
[edit]Surgery treatments are utilized if several conservative approaches fail to produce results.[17] 6 months of conservative treatments are generally used before surgical intervention.[3] Surgery typically involves removal of a small piece of the iliotibial band to release excessive tension. Other procedures that have been utilized include resection of the iliotibial band bursa and z-lengthening. In the z-lengthening procedure, two horizontal incisions are made in the band and connected by a vertical incision, forming a z. The resulting sections are reattached together in a lengthened position, increasing the length of the band.[6]
Prognosis
[edit]ITBS symptoms typically improve with treatment. An estimated 50-90% of patients have symptom resolution with 4-8 weeks of conservative treatment, while surgical patients also generally have good outcomes.[19] Complications of ITBS include recurrence and exacerbation by return to activity following treatment, as well as possible progression to patellofemoral pain syndrome.[19]
Epidemiology
[edit]Occupation
[edit]ITBS commonly affects athletes and has been reported in runners, cyclists, rowers, skiers, and triathletes, as well as basketball, soccer, and field hockey players.[6]
Significant association between the diagnosis of ITBS and occupational background of the patients has been thoroughly determined. Occupations that require extensive use of the iliotibial band are more susceptible to developing ITBS due to a continuum of their iliotibial band repeatedly abrading against the lateral epicondyle prominence, thereby inducing an inflammatory response. Professional or amateur runners are at high clinical risk of ITBS, and there is a greater risk in those running 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.[20]
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.[21] 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.[22]
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.[23]
Studies suggest that there is not a difference in ITBS incidence rate between patients of different race, gender, or age. However, there has been a claim that females are more prone to ITBS due to their anatomical differences in the pelvis and lower extremities. Males with a larger lateral epicondyle prominence may also be more susceptible to ITBS.[24] Higher incidence rate of ITBS has been reported between the ages of 15 and 50, which generally includes most active athletes.[22]
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.[25] A study provided data that shows more than half (50%) of professional cyclists complain of knee pain.[26] Additional studies have shown that ITBS makes up 15–24% of all overuse injuries in cyclists.[6]
History
[edit]ITBS was originally described by Lieutenant Commander James W. Renne in 1975 after observing frequent lateral knee pain in recruits participating in intensive military training. He initially named the syndrome iliotibial band friction syndrome.[27]
See also
[edit]References
[edit]- ^ 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.
- ^ a b c d e f g Baker, Rober L.; Fredericson, Michael (2016). "ClinicalKey". www.clinicalkey.com. Retrieved 2019-11-17.
- ^ a b c d Neal, Bradley (2016). "Iliotibial Band Syndrome: A Narrative Review". Co-Kinetic Journal. 67: 16–20 – via EBSCO host.
- ^ Stirling, Jerold M (2023-10-13). "Iliotibial Band Syndrome: Practice Essentials, Etiology, Epidemiology". Medscape Reference. Retrieved 2024-08-06.
- ^ Hadeed, Andrew; Tapscott, David C. (2019), "Iliotibial Band Friction Syndrome", StatPearls, StatPearls Publishing, PMID 31194342, retrieved 2019-11-17
- ^ a b c d e f g h i Strauss, Eric J.; Kim, Suezie; Calcei, Jacob G.; Park, Daniel (December 2011). "Iliotibial Band Syndrome: Evaluation and Management:". American Academy of Orthopaedic Surgeon. 19 (12): 728–736. doi:10.5435/00124635-201112000-00003. ISSN 1067-151X.
- ^ "Iliotibial band syndrome - aftercare: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2022-02-22.
- ^ Khaund, Razib; Flynn, Sharon H. (2005-04-15). "Iliotibial band syndrome: a common source of knee pain". American Family Physician. 71 (8): 1545–1550. ISSN 0002-838X. PMID 15864895.
- ^ "Iliotibial Band Syndrome Specialist Clinic | Singapore Sports and Orthopaedic Clinic - Neurosurgeon". Retrieved 2022-06-24.
- ^ 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.
- ^ Fairclough, John; Hayashi, Koji; Toumi, Hechmi; Lyons, Kathleen; Bydder, Graeme; Phillips, Nicola; Best, Thomas M; Benjamin, Mike (March 2006). "The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome". Journal of Anatomy. 208 (3): 309–316. doi:10.1111/j.1469-7580.2006.00531.x. ISSN 0021-8782. PMC 2100245. PMID 16533314.
- ^ Flynn, Sharon H.; Khaund, Razib (2005-04-15). "Iliotibial Band Syndrome: A Common Source of Knee Pain". American Family Physician. 71 (8): 1545–1550. PMID 15864895.
- ^ Hariri, Sanaz; Savidge, Edgar T.; Reinold, Michael M.; Zachazewski, James; Gill, Thomas J. (July 2009). "Treatment of Recalcitrant Iliotibial Band Friction Syndrome with Open Iliotibial Band Bursectomy: Indications, Technique, and Clinical Outcomes". The American Journal of Sports Medicine. 37 (7): 1417–1424. doi:10.1177/0363546509332039. ISSN 0363-5465.
- ^ Fredericson, Michael; Weir, Adam (May 2006). "Practical Management of Iliotibial Band Friction Syndrome in Runners". Clinical Journal of Sport Medicine. 16 (3): 261–268. doi:10.1097/00042752-200605000-00013. ISSN 1050-642X.
- ^ West, R; Irrgang, J (2009). "Overuse injuries of the lower extremity". Orthopaedic Knowledge Update: Sports Medicine 4.
- ^ 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.
- ^ a b c d 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.
- ^ 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.
- ^ a b Hadeed, Andrew; Tapscott, David C. (2023), "Iliotibial Band Friction Syndrome", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 31194342, retrieved 2023-11-06
- ^ 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.
- ^ 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. S2CID 4007166.
- ^ a b Martinez, John M (2022-04-04). "Physical Medicine and Rehabilitation for Iliotibial Band Syndrome: Practice Essentials, Pathophysiology, Epidemiology". Medscape Reference. Retrieved 2024-08-06.
- ^ 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.
- ^ 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. S2CID 201616794.
- ^ 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.
- ^ 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. S2CID 21010647.
- ^ Renne, James (December 1975). "The Iliotibial Band Friction Syndrome". The Journal of Bone & Joint Surgery.
Further reading
[edit]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. S2CID 73959693.
External links
[edit]