Iliotibial band friction syndrome, a very recurrently occurring yet not very keenly looked upon condition amongst runners, which shall be taken care of emergently

1. CONSERVATIVE MANAGEMENT OF
ILIOTIBIAL BAND FRICTION SYNDROME
AMONGST RUNNERS
Presented by: Supervised by:
Sonali Joshi Dr. Vandana Esht
MPT (Sports injury) Associate Professor
MMIPR MM(DU) MMIPR MM(DU)
Mullana-Ambala Mullana-Ambala
Haryana Haryana

2. WHAT IS ILIOTIBIAL BAND? (ITB)
 Iliotibial tract has its origination from proximal
iliac crest and insertion on gerdy’s tubercle of
tibia whilst its passage over lateral femoral
epicondyle
 It has its proximal continuation from Gluteus
Maximus (GM) muscle posteriorly Tensor fascia
lata (TFL) anteriorly, forming a Y-shaped
structure altogether

3. BIOMECHANICS
 The ITB has its role in stabilization of knee in
both partial flexion and extension, consequently
taking part during running and walking constantly
 The ITB moves continously from anterior to
posterior as it extends and flexes in connection
with lateral femoral epicondyle during running
cycle

4.  To allow hip to remain in extension with
reinforcement from its two leading muscles
ITB lies posteriorly to greater trochanter of
femur
 Allowing knee to remain in extension, ITB is
posed anteriorly to lateral epicondyle of femur

5. ILIOTIBIAL BAND FRICTION SYNDROME (ITBFS)
 Common overuse injury of knee ( accounts for
approx. 22.2% of lower limb injuries amongst
runners)
 It is inflammation of ITB distally, as it slides over
lateral femoral epicondyle whilst repetitive
extension and flexion activities of knee causing
lateral femoral epicondyle and ITB to rub against
each other
 This undue friction leads to potential sharp or
burning pain and irritation on lateral aspect of
knee, ofttimes radiating to lateral calf or thigh

6.  Friction (impingement) takes place near
footstrike which is much large during foot
contact phase
 Also runners generally have an average angle
of knee flexion of about 21 degree during foot
strike, with maximum friction happening
slightly below or at knee flexion of 30 degrees
(impingement zone)

7. RISK FACTORS AND TRAINING ERRORS
 Common cause of overuse injuries is the training
errors or faulty techniques
 Structural mal-alignments lead to altered pattern of
movement in hip, knee and ankle joint which can
contribute to ITBFS
Extrinsic risk factors :
 Worn out and overused shoes
 Training practices which increase mileage
unsuitably or climbing hills inappropriately
 Improper pace.
 Skipping the warm-up

8. INTRINSIC RISK FACTORS:
 Bow leg or Genu varum
 forefoot and Rarefoot varus
 Pes planus and pes cavus
 TFL and ITB tightness
 Gluteus maximus, medius and TFL weakness
 Weakness or tightness in quadriceps muscle

9. SPECIAL DIAGNOSTIC TESTS
Follwing are the test for evaluation of contracted or
tight ITB:
OBER’S TEST:
Patient position: Side-lying
Procedure: With having hip in neutral rotation and
knee in flexion of the involved side, the hip is
extended then frequently adducted
Interpretation: Knee pain in lateral side with leg
remaining in abducted position is suggestive of
ITB tightness

10. Modified Ober’s test:
Patient position: Side-lying
Procedure: With having hip in neutral rotation and
knee kept in extension of involved side , the hip
is extended then frequently adducted
Interpretation: Knee pain in lateral side with leg
remaining in abducted position is suggestive of
ITB tightness

11. Noble Compression test:
Patient position: Supine lying
Procedure: Gripping the leg just above ankle while
simultaneously bending the knee backward and
forward whilst applying firm pressure at lateral
femoral epicondyle with thumb of other hand
Interpretation: ‘Squeaky-like’ snapping or localized
pain increasing with pressure around epicondyle
(generally at 30 degrees of flexion) indicates of
ITBFS

12. PHYSIOTHERAPY MANAGEMENT
Primary goal is to relieve inflammation
Grading of injury on the basis of pain:
Grade 1: No pain felt while normal activities of
daily living (ADL), although generalised feeling of
pain for 1-2 hours after specific training for sport
ends
Grade 2: No impact on performance. Minimal pain
felt at end of a training session

13. Grade 3: Pain interposing duration and speed
of training sitting present earlier at the start of
training
Grade 4: Pain puts restrictions training,
observably during ADL’s too
Grade 5: Pain interposes with training and
ADL’s. Perhaps surgery is required, therapy is
incumbent

14. Symptomatic relief may be achieved with
analgesics and other electrotherapeutic
modalities
 Cryotherapy (10 minutes through ice-bag
method, 3 times a day)
 Ultasound (1Mhz for 3-5 minutes)
 LASER ( frequency- 1000hz for 2 minutes over
each trigger point with 5J/cm2 of energy density)
 T.E.N.S (50-150hz, 15 minutes)

15.  Kinesiology tape for fascia correction:
Position: Resting position of thigh
Procedure: Measuring tape according to width of
muscle, then placing tail of tape on skin towards
the direction of correction transversally in muscle
fibre course, capturing pain in between tape tails,
stretching rhythmically the tape towards the
correction and affix them. Append the end with
no tension (Fig: 1.1)

16. K Taping: An illustrated guide, Chapter 5: Corrective applications, Page no: 98
Fig: 1.1: Fascia correction of
ITB

17.  Sustained myofascial tension to ITB is proved to
be effective
 Medial patellar mobilisation
 Muscle Energy Technique (MET) for gluteal
muscles and TFL
 Soft tissue adhesions can be broken up by using
a foam roller

18.  Stretching of ITB with its proximal muscles of
origination (TFL, gluteal muscles)
 Strengthening to stabilize the pelvis, targeting
hip abductors with core muscles
 Lateral stabilizers (Piriformis, gluteal
muscles) of hip should be strenghthened

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