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You can BeAt ITBFS!!


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

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You can BeAt ITBFS!!

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