You can BeAt ITBFS!!
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iLiotibial Band friction syndrome- Caused by repetitive friction rub between iliotibial band and lateral femoral condyle.

iLiotibial Band friction syndrome- Caused by repetitive friction rub between iliotibial band and lateral femoral condyle.

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    You can BeAt ITBFS!! You can BeAt ITBFS!! Presentation Transcript

    • Iliotibial Band Friction Syndrome
    • What is ITB Friction Syndrome?
      • ITBFS is an inflammatory, non- traumatic, repetitive strain injury to the knee affecting predominantly long distance runners and cyclists.
    • Anatomy
      • The ITB is the condensation of fascia formed by the tensor fascia lata and the gluteus medius and minimus muscles.
      • ITB is a wide, flat structure that originates at the iliac crest and inserts at the Gerdy tubercle on the lateral aspect of the proximal tibia.
      • The band serves as a ligament between lateral femoral condyle and lateral tibia to stabilize the knee.
    •  
      • The ITB is not attached to
      • bone as it courses between
      • the Gerdy Tubercle and the
      • Lateral Femoral epicondyle .
      • Iliotibial band moves
      • posterior to lateral
      • epicondyle with knee flexion.
      • Iliotibial band moves
      • anterior to lateral femoral
      • Epicondyle with
      • knee extension
    • Etiology
      • During flexion and extension of the Knee, the iliotibial band rubs over the Lateral Femoral condyle
      • Resulting an irritated
      • and inflamed bursa.
      • Excessive lower leg
      • adduction and medial
      • rotation of tibia exerts
      • more stress over distal
      • attachment of iliotibial
      • band.
    • Predisposing Factors
      • Most common in runners or cyclists
      • Chronic overuse injury
      • Sudden increase in mileage, training errors
      • Changes in surfaces (i.e. soft to hard, flat to uneven etc.)
      • Overpronation and underpronation
      • Leg Length discrepancies
      • Circular and arched track running
      • Weak quadriceps, and abductors, particularly weak gluteus medius
      • Genu Varum
      • Genu Valgus
      • Thicker IT band
      • Lateral Femoral condyle protrusion
    • Risk Factors for ITBFS
      • Extrinsic risk factors may include :
      • Worn out running shoes:
      • The more worn out the shoe, the more ground reactive forces are transferred to the knee.
    •  
      • Training programs that increase mileage or incorporate hills inappropriately (10% rule should be followed).
      • Running at improper pace. – placing too much strain on untrained legs may lead to fatigue or injury
      • Running on cambered surface or slippery surface.
      • Intrinsic risk factors may include :
      • Bow legs/Genu varum
      • Rarefoot and forefoot varum – increases the stress over lateral ankle and knee
      • Pes cavus/high arch. – this foot has limited ability in absorbing ground reactive forces, placing more stress on the knee joint
      • A prominent lateral femoral epicondyle and tight ITB and TFL. – results in irriration of the bursa between the condyle and ITB due to constant friction rub.
      • 5. Weak gluteus medius, gluteus maximus and TFL
      • On the side of gluteus medius weakness pelvic hiking occurs which results in trendelenberg gait and also results in stretching of ITB causes lateral knee pain.
      • 6 . Tightness in the quadriceps, ITB and lateral retinaculum
      • This leads to lateral tracking of patella more during
      • initial knee extension thus limiting the medial glide
      • of patella, leading to increased stress on the lateral
      • stabilizing structures of the knee joint.
    • Aggravating Factors
      • Any movement that causes excessive
      • friction of the IT band over the lateral femoral condyle
      • Running down hills
      • Lengthening stride
      • Sitting for long period of time with Knee in flexed position
    • Clinical Presentation
      • Point tenderness on the lateral femoral epicondyle approximately 1-2 cm above the lateral joint line.
      • Pain elicited with active flexion-extension of the knee within the first 30°
      • Pain may radiate from knee proximally or distally.
      • Abnormal Gait – patient may walk with affected knee extended.
      • Injury progression not unlike that of tendonitis
        • 1º Pain only after exercise
        • 2º Pain during and after exercise
        • 3º Pain affecting Activity of daily Living.
    • On Examination
      • Inspection
      • Localized edema, if any
      • Palpation
      • Tenderness over
      • Lateral femoral
      • condyle and distal attachment of ITB at
      • lateral tibial tubercle
      • Snapping, crepitus over Lateral femoral condyle
    • On Examination (contd.)
      • RANGE OF MOTION AND STRENGTH
      • Full ROM with pain at last 20-30 º of extension
        • If there is a decrease in ROM, most likely from
        • patient apprehension (pain)
        • Strength : Weak hip abductors (gluteus medius)
        • Weak hip adductors and flexors
    • Special Tests
      • Ober’s Test
        • Patient lies on side, unaffected side down
        • Flex unaffected hip and knee to 90 degrees
        • Abduct and extend affected leg and hip
        • Adduct affected knee
    • Ober’s Test Position
        • Positive sign: leg remains abducted.
        • Indication: IT band tightness
      • Negative Test : Thigh drop to adducted position
    • Nobles Test
      • Patient supine, Knee flexed to 90 º
      • Apply firm digital pressure to lateral femoral condyle while passively extending Knee
      • Positive sign: Pain (typically around 20-30º flexion)
      • Indication:
        • Iliotibial band
        • Friction
        • Syndrome
    • Renee creak test
      • Similar to Nobles Test:
        • Patient stands on affect limb on step stool
        • Place finger over lateral Femoral condyle
        • Patient bends Knee into 30-40 º flex
        • Positive sign: Pain
        • Indication: ITBFS
    • Thomas test
      • Patient in supine. Ask patient to bring
      • unaffected knee to chest.
      • Lower the affected limb
      • Positive sign: If affected limb abducts as leg flexed to chest
      • Indication: Tight IT band
    • Differential Diagnoses
      • Hamstring Strain Osteoarthritis of hip and knee joint Lateral Collateral Ligament Injury Overuse Injury Meniscal Injury Patellofemoral Syndrome Myofascial Pain
      • Trochanteric bursitis
    • Management-Acute Phase
      • Activity Modifications
      • If edema
        • NSAIDS
        • Ice massage,
        • Phonophoresis,
        • Iontophoresis,
        • Ultrasound
    • Nonsteroidal anti-inflammatory drugs
      • Have analgesic, anti-inflammatory, and antipyretic activities.
      • Their mechanism of action is not known, but they may inhibit prostaglandin synthesis. Other mechanisms may exist as well such as neutrophil aggregation, and various cell membrane functions.
    • Corticosteroid injection
      • Local corticosteroid injection has been shown to be beneficial in managing acute inflammation for those who do not respond to analgesia and rest
      • Position : Place the patient in a lateral recumbent position with the affected knee flexed to approximately 30 º.
      • Direct the injection into the deep space at the point of maximal tenderness just lateral to the lateral femoral condyle.
    • Subacute Phase
      • Stretching
        • Hip Abductor - Iliotibial Band
        • Hip Adductors
        • Hip Flexors
      • Myofascial Release : Using foam roller
    • Recovery Phase
      • Progressive strengthening exercises
        • Single leg squats
        • Hip abduction (GLUTEUS MEDIUS), adduction, flexion.
      • Easy sprints (during faster running, ITB is flexed beyond the angles that cause friction/irriation)
      • Shorten running stride
      • Gradual increase in distance and frequency
    • Alternative Treatments
      • IT band strap
      • Arch tapping
      • Orthotics
      • Motion-control shoes
      • If treatment unsuccessful,
      • surgery is an option