Syndrome
Iliotibial band friction syndrome (ITBFS) also known as “runners
knee” is a very common athletic injury that effects the knee. Runners knee is
especially prone to long distance runners or athletes who participate in
activities that require highly repetitive running. In greater detail I will be
discussing the causes of this injury specifically the biomechanics, anatomy and
symptoms involved, also ways of preventing this injury by identifying common
training errors and the appropriate training modifications needed, and finally a
variety of ways for treatment and rehabilitation to help improve the injury.
Causes Anatomy/Biomechanics: The iliotibial band is a thick band of tissue that
extends from the thigh(femur) down over the knee and attaches to the tibia. When
the knee bends (flexion) and straightens (extension), the iliotibial band slides
over the lateral femoral epicondyle, the bony part of outer knee. Iliotibial
band friction syndrome refers specifically to the lateral knee pain related to
irritation and inflammation to the point at which the band crosses the lateral
femoral epicondyle. This type of irritation occurs when the knee is flexed at
approximately an angle greater than 30 degrees, because the iliotibial band
shifts posteriorly behind the lateral femoral epicondyle. During extension, the
band shifts back anteriorly in front of the lateral femoral epicondyle and it is
this motion that causes friction between the iliotibial band and the lateral
femoral epicondyle which leads to irritation and inflammation within the
iliotibial band. Symptoms: Iliotibial band friction syndrome is a condition not
unique to runners, it and its symptoms are now frequently seen in cyclists,
weight lifters, skiers and soccer players. The most obvious sign that you have
ITBFS is the pain felt usually during exercise. Runners will describe the pain
on the outside part of the knee or lower thigh. The degree of discomfort runs
from dull aching sensation to a sharp stabbing pain. The pain is not localized
so most suffers cannot put their finger on one particular spot. Suffers will
generally use the flat of their hand to describe the location of the pain. One
easy self test to know if you might have ITBFS, is the point of tenderness test.
A patient with ITBFS will exhibit extreme point of tenderness at about 2 cm over
the outside part of the knee when flexed at thirty degrees. Another common
symptom is a “creaking” noise during activity, this noise mostly occurs
during weight bearing exercise like weight lifting. This is because during
weight bearing activities the additional pressure and compression forces the
contraction of the knee joint. This leads to elevated friction over the lateral
epicondyle and increased pain. One important factor about ITBFS is that it is a
problem not inside the knee joint, but around it, which makes more easily
distinguishable and treatable. Prevention Common Training Errors/Training
Modifications: Iliotibial band friction syndrome is an overuse injury caused by
extensive repetitive friction of the iliotibial band. The most frequent
oversight runners and athletes make is over doing it or over training. This can
be controversial because if you wish to compete at highly competitive levels
what is over training? This should be decided by the athletes themselves who
should know when to make the rational decision of knowing when to stop. Another
predisposing factor for the development of ITBFS is training error and abnormal
biomechanics. Many runners make the mistake of only running on one side of the
road. Most roads are higher in the centre and slope off on either sides. The
foot on the outside part of the road is lower than the other. This causes the
pelvis to tilt to one side and tightens the iliotibial band occurs, naturally
increasing friction. Runners must always remember to try when possible to run on
flat terrain, this will greatly reduce the chances of acquiring ITBFS. As
running on flat terrain reduces friction, highly shock absorbing footwear is
also needed. In runners with normal feet, the force of running is dissipated by
the foot. However, if you have a minor abnormality in your foot anatomy, like
high or low arches, the shock from the force of the foot strike is primarily
passed directly to the knee. A good pair of shock absorbing shoes will decrease
the pressure, inturn allowing the muscles and tendons surrounding the knee,
chiefly the iliotibial band to be more relaxed reducing friction. Shoe mileage
should also be considered for serious runners or athletes. After about 500 miles
or 800 kilometres most shoes loose 60% of their initial shock absorption
capacity. As some one jogging leisurely or training competitively, both should
participate accordingly, knowing when not to over do it, and knowing to
implement good training habits like appropriate footwear and stretching before
and after performance. If these aspects of sport along with others are followed
avoiding ITBFS should be easily accomplished. Rehabilitation Treatment: In
establishing an appropriate treatment program, the severity of the present
inflammation must first be determined. Once the injury is properly assessed and
the diagnosis taken into consideration, the athlete may be placed into one of
the three phases of iliotibial band care. The first phase of care is the
Immediate Phase. This is the phase in which the pain and inflammation must be
controlled along with any poor training habits, which some I already discussed
are corrected. Achievement of these goals require a reduction of activity and
the proper administration of oral anti-inflammatories. If the trainer sees fit,
many alternate treatments may be implemented. Such as ice, heat, ultrasound, and
electrical stimulation. It should also be noted that stretching exercises which
are extremely important to combat any excessive iliotibial band tightness are
conducted in this phase. The second phase, or the Short Term Phase becomes a
consideration only if the painful symptoms have not yet resolved within
approximately 10 days of the previous treatment. All the previous treatment
should be continued with the possible addition of a physician administering
steroid injections, in two week intervals. Further restriction of activity may
be necessary. If deconditioning of the athlete becomes a concern during this
phase, he/she can participate in other activities like swimming or cycling, as
long as the activity remains pain free. The third and final phase, the Long Term
Phase is seen as an optimistical stage. This phase begins only after the pain
and inflammation symptoms have resolved. This phase is typically in close
association with the athletes return to sport. During this stage, it is very
important to prevent any reoccurrence of the resolved symptoms. So a gradual
return to play with extensive specific stretching exercises both before and
after workout is essential. If at this point pain and inflammation has not
significantly reduced, a return to play is not a good option yet. Your trainer
or physician should recommend further rest or surgery as a last resort. Surgery:
Surgery is contemplated and seen only after many attempts of non operative
measures failed to relieve symptoms. Surgery is usually only required for those
individuals who are unwilling for many reasons, some very valid to modify their
sports participation. The surgery consists of making a 2cm incision in the
posterior fibres of the iliotibial band. This loosens the tendon some what but
mostly allows for space for the band to pass over the lateral femoral epicondyle
without much of the friction. Iliotibial band friction syndrome (ITBFS) is an
overuse injury that is most common in those athletes that entertain highly
repetitive running sports. It is seen in a variety of athletes from soccer
players to cyclists. It is the inflammation of iliotibial band as a result of
friction with the lateral femoral epicondyle. The injury is easily detectable
and the proper treatment and rehabilitation should be diagnosed. The injury
should be first be treated in a conservative manner by initiating the
progression of rest, stretching, and the moderate use of medications only if
directed by a physician. If all conservative attempts fail to achieve results
then surgery might have to be necessary. After doing this research paper I have
learned a number of things, but most importantly I believe I have learned what
that pain on the outside of my left knee that I have been experiencing for the
last few months is.
