A Patient's Guide to Iliotibial Band Syndrome
Introduction
Iliotibial band (ITB) syndrome is an overuse problem that is often seen in bicyclists, runners, and long-distance walkers. It causes pain on the outside of the knee just above the joint. It rarely gets so bad that it requires surgery, but it can be very bothersome. The discomfort may keep athletes and other active people from participating in the activities they enjoy.
This guide will help you understand
- how ITB syndrome develops
- how the condition causes problems
- what treatment options are available
Chiropractic Treatment
Most cases of ITB syndrome respond very well to chiropractic treatment and usually require only 4-6 weeks of care.
Chiropractic doctors will make sure the joints in the entire lower extremity are functioning and moving properly. This includes checking your feet, ankles, knee and hip. We want to identify the cause of you pain, not just treat the symptoms. Chiropractic adjustments/manipulations are performed to help restore normal biomechanics to the feet, ankles, hips and knee joint. This is where chiropractic manipulation has an advantage over other specialties. It is important to manipulate and stretch capsular joint restrictions during the treatment phase. This helps improve normal motion and promotes proper biomechanics as well as keeping the joint lubricated. Modalities such as ice, electrical muscle stimulation, ultrasound and heat may also be used to decrease pain and inflammation.
Stretching and strengthening exercises may be used in combination with a knee brace, kneecap taping, or shoe inserts to improve muscle balance and joint alignment of the hip and lower limb. We will ask you about your sport activities and may give you tips on your warm up and training schedule, footwear, and choices of terrain.
You should be able to return to normal activity within four to six weeks. You may will most likely need to be working with your chiropractor during this time. A key element of treatment is your training schedule. We can work with you to adjust the distance you run, your footwear, and the running surfaces you choose.
Foot orthotics may be recommended to improve foot and lower limb alignment. Wearing orthotics in your shoes may be allow you to resume normal walking immediately, but you should probably cut back on more vigorous activities for several weeks to allow the inflammation and pain to subside.
Strengthening and stretching exercises are chosen to correct muscle imbalances, such as weakness in the gluteus medius muscle or tightness in the iliotibial band.
Treatments such as ultrasound, friction massage, and ice may be used to calm inflammation in the ITB. Chiropractic treatment sometimes includes iontophoresis, which uses a mild electrical current to "push" anti-inflammatory medicine to the sore area.
Anatomy
What is the ITB, and what does it do?
The ITB is actually a long tendon. (Tendons connect muscles to bone.) It attaches to a short muscle at the top of the pelvis called the tensor fascia lata. It runs down the side of the thigh and connects to the outside edge of the tibia (shinbone) just below the middle of the knee joint. You can feel the tendon on the outside of your thigh when you tighten your leg muscles. The ITB crosses over the side of the knee joint, giving added stability to the knee.
The lower end of the ITB passes over the outer edge of the lateral femoral condyle--the area where the lower part of the femur (thighbone) bulges out above the knee joint. When the knee is bent and straightened, the tendon glides across the edge of the femoral condyle.
A bursa is a fluid-filled sac that cushions body tissues from friction. These sacs are present where muscles or tendons glide against one another. A bursa rests between the femoral condyle and the ITB.
Normally, this bursa lets the tendon glide smoothly back and forth over the edge of the femoral condyle as the knee bends and straightens.
Causes
How does ITB syndrome develop?
The ITB glides back and forth over the lateral femoral condyle as the knee bends and straightens. Normally, this isn't a problem. But the bursa between the lateral femoral condyle and the ITB can become irritated and inflamed if the ITB starts to snap over the condyle with repeated knee motions such as those from walking, running, or biking.
People often end up with ITB syndrome from overdoing their activity. They try to push themselves too far too fast and end up running, walking, or biking more than their body can handle. The repeated strain causes the bursa on the side of the knee to become inflamed.
Some experts believe that the problem happens when the knee bows outward. This can happen in runners if their shoes are worn on the outside edge, or if they run on slanted terrain. Others feel that certain foot abnormalities, such as foot pronation, cause ITB syndrome. (Pronation of the foot occurs when the arch flattens.)
Recently, health experts have found that runners with a weakened or fatigued gluteus medius muscle in the hip are more likely to end up with ITB syndrome. This muscle controls outward movements of the hip. If the gluteus medius isn't doing its job, the thigh tends to turn inward. This makes the knee angle into a knock-kneed position. The ITB becomes tightened against the bursa on the side of the knee. This is also called a valgus deformity of the knee.
People with bowed legs may also be at risk of developing ITB syndrome. The outward angle of the bowed knee makes the lateral femoral condyle more prominent and can make the snapping worse. This condition is also called a varus deformity of the knee.
Symptoms
What does ITB syndrome feel like?
The symptoms of ITB syndrome commonly begin with pain over the outside of the knee, just above the knee joint. Tenderness in this area is usually worse after activity. As the bursitis grows worse, pain may radiate up the side of the thigh and down the side of the leg. Patients sometimes report a snapping or popping sensation on the outside of the knee.
Diagnosis
How will my doctor know it's ITB syndrome?
The diagnosis of ITB syndrome can usually be made without any complicated tests. Your doctor will take a history of the problem and ask about any other injuries that may have occurred in the past. X-rays may be taken to make sure that there are no other injuries that could be adding to the problem. Generally, no swelling is visible. The snapping sensation usually cannot be heard.
Pain on the outside of the knee can be caused from conditions other than ITB syndrome. Your doctor will perform an examination of the knee and will look at your entire leg. You may want to take the shoes that you use to run or walk with you to your appointment.
If there is doubt about the diagnosis, or you are still having problems after reasonable attempts have been made to decrease the symptoms, an MRI (magnetic resonance imaging) scan may be suggested by your doctor. An MRI scan is a special test that uses magnetic waves to create images of the soft tissues inside and around the knee. Regular X-rays only show the bones around the knee. The MRI can show if there are problems with the soft tissues such as the cartilage and ligaments.
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All materials from eORTHOPOD® are the sole property of Medical Multimedia Group, L.L.C.. and are used herein by permission. eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C..
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