Friday, October 1, 2010

Iliotibial Band Syndrome (ITBS) – Part 1

Iliotibial Band Syndrome (ITBS) is a common injury that affects runners and cyclists. Using conventional treatments, this condition often never completely resolves since they typically do not address all of the key structures involved in the injury. Symptomatically ITBS presents as:
A sharp or burning pain on the lateral aspect of the knee.
Pain radiating up the side of the hip or thigh, as well as pain below the outside of the knee.

ITBS is an overuse injury caused by the repetitive action of the iliotibial band as it moves across the lateral femoral epicondyle. The primary functions of the iliotibial band (ITB) are to:
· Provide static stability to the lateral (outer) aspect of the knee.
· Control adduction (inward motion) and deceleration of the thigh.
· During a run, the ITB performs this function about 90 times per minute, or 22,000 times during a four-hour marathon (a highly repetitive motion).

Anatomy and the Biomechanics of ITBS
The ITB is a wide, flat, ligamentous structure that originates at the iliac crest and inserts on the lateral aspect of the tibia, just below the knee. The ITB serves as a ligamentous connection between the femur (lateral femoral epicondyle) and the lateral tibia (Gerdy’s Tubercle).

The ITB is not attached to bone as it passes between the femur and the tibia. This allows the ITB to move forward and backward with knee flexion and extension. When the ITB is shortened or stressed, the repetitive motion of the knee causes friction and inflammation of the ITB.

When the knee is flexed at an angle greater than 30 degrees, the ITB moves behind the lateral femoral epicondyle. During knee extension, the ITB shifts forward in front of the lateral femoral epicondyle. With ITBS, the bursa often becomes inflamed, causing a clicking sensation as the knee flexes and extends.

Running and ITBS
ITBS syndrome in runners usually starts with excessive internal rotation of the leg (femur). To effectively resolve this condition, restrictions in both the internal and external hip rotators must be corrected.

Impingement of the ITB against the outside of knee (lateral epicondyle of the femur) occurs just after foot strike in the gait cycle. Runners typically do not experience pain from the ITBS until they are into the first one or two miles of a run. Common causes of ITBS in runners include:

Running on slanted surfaces such as a circular track. (I have experienced this numerous times doing long runs inside during the winter while training for a marathon in Calgary)
· Excessive downhill runs.
· Increasing mileage or pace too quickly (Always stick to the 10% rule).
· Weak hip flexors and extensors.
· Weak hip abductor causing excessive internal rotation of the knee.
· Weak gluteus medius causing internal rotation of the thigh.
· Excessive pronation causing internal rotation of the knee.
· Bow legs (Genu Varum).
· Leg length discrepancy (Often caused by pelvic rotation – muscle imbalances).

In part two of Resolving ITBS, we will cover understanding motion patterns and specific structures that effect knee stability.

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