ILIO-TIBIAL BAND SYNDROME

BY
MOSES OGUNDARE
130704019
 INTRODUCTION
 The iliotibial band (ITB) is a thick band of fibrous tissue that runs
down the outside of the thigh, connecting the hip to the knee. This
tissue is essential in stabilizing the knee, preventing it from caving
inwards during movement(Hyland et al, 2020).

 When the band is overused or overloaded, it results in a painful

condition known as iliotibial band syndrome (ITBS).
 Iliotibial band syndrome (ITBS) is a common knee injury that
usually presents with pain and/or tenderness on palpation of the
lateral aspect of the knee, superior to the joint line and inferior to
the lateral femoral epicondyle (Hyland et al, 2020).

 It is considered a non-traumatic overuse injury, often seen in

runners, and is often concomitant with underlying weakness of hip
abductor muscles
ANATOMY OF THE ILIO-TIBIAL BAND
 The iliotibial tract is a thick band of fascia that runs on the lateral side of the thigh
from the iliac crest and inserts at the knee (Baker and Frederickson, 2016).

 It descends along the lateral aspect of the thigh, between the layers of the
superficial fascia, and inserts onto the lateral tibial plateau at a projection known as
Gerdy’s tubercle. (Fairclough et al, 2016).

 The ITB functions as a knee extensor when the knee is less than 30 degrees of
flexion but becomes a knee flexor after exceeding 30 degrees of flexion.

 The ITB has been postulated to acquire a more posterior position relative to the
lateral femoral epicondyle with increasing degrees of flexion (Strauss et al, 2011).
 ANATOMY CONT’D

 The appearance of the ITB in a well-

defined, surface anatomy model at
progressively increasing angles of knee
flexion (a–c).

 The small skin blemish (arrow) is a

convenient landmark for evaluating the
changing appearance of the ITB at
different angles of knee flexion.
EPIDEMIOLOGY OF ITBS
 According to Van der Worp et al (2012), ITBS is one of the most common
injuries in runners presenting with lateral knee pain.

 Further studies indicate ITBS is responsible for approximately 22% of all lower
extremity injuries Lavine (2012).

 According to a study by Sharpe et al (2011), ITBS is the 2nd most common cause
of knee pain. It is slightly more common in women than men and seldom occurs
in the non-active population.
ETIOLOGY

 The ITBS disease process is multifactorial, and various

mechanisms have been suggested for it;

 repeated rubbing of the iliotibial band on the lateral

femoral epicondyle during knee flexion and extension
causes iliotibial band impingement at 30° knee flexion,
which is the degree of knee flexion at foot strike (Bolia et
al, 2020).
ETIOLOGY CONT’D
 Histologic examinations of cadaveric specimens show a
highly innervated fat pad that is deep to the distal ITB.

 Compression of this fat pad is implicated to be the source

of the lateral knee pain (Fairclough et al, 2007)
 RISK FACTORS

Potential risk factors for the development of iliotibial band syndrome,

including the following:

Pre-existing iliotibial band tightness, high weekly mileage

Time spent walking or running on a track

Interval training

Muscular weakness of knee extensors, knee flexors, and hip abductors

 RISK FACTORS CONT’D

 Modifiable risk factors include running on a tilted

surface, hill running, errors in training technique, and
abrupt changes in training intensity (Baker et al, 2016).

 Anatomical factors such as internal tibial torsion, hip

abductor weakness, High Q angle, leg length discrepancy
and medial compartment arthritis leading to genu varum
can increase the tension of the ITB and can perpetuate
the pathology(Foch et al, 2023).
CLINICAL FEATURES

 The primary initial complaint is diffuse pain over the lateral

aspect of the knee.

 patients are unable to indicate one specific area of

tenderness, but tend to use the palm of the hand to indicate
pain over the entire lateral aspect of the knee.

 With time and continued activity, the initial lateral achiness

progresses into a more painful, sharp, and localized
discomfort over the lateral femoral epicondyle and/or the
lateral tibial tubercle(Hutchinson et al 2022).
DIFFERENTIAL DIAGNOSIS

 Biceps femoris tendinopathy

 Degenerative joint disease
 Lateral collateral ligament (LCL) injury
 Meniscal dysfunction or injury
 Myofascial pain
 Patellofemoral stress syndrome
 Popliteal tendinopathy
 referred pain from lumbar spine, stress fractures, and
superior tibiofibular joint sprain(Bischoff, 2005).
 PHYSICAL EXAMINATION
 Iliotibial band syndrome is a clinical diagnosis and rarely
requires further studies and imaging.

 The clinician must be vigilant about mechanical symptoms,

changes in activity level, mileage of long-distance activity,
and condition of training shoes(strauss et al 2011).
PHYSICAL EXAMINATION CONT’D

 Coronal and sagittal plane knee misalignments such as

genu varum, genu valgum, recurvatum are worth noting as
this can increase tension on the ITB.

 Palpation of the distal ITB can be painful, and the

clinician may feel crepitus with range of motion. Special
tests for ITBS include the Noble and Ober tests.
 PHYSICAL EXAMINATION CONT’D

The Ober’s test can be used to assess tightness of the iliotibial band.JJJFJFJ
 MEDICAL MANAGEMENT

 Non-steroidal anti-inflammatories can help with

diminishing the inflammation.

 Likewise, corticosteroid injections can be

therapeutic, as well as diagnostic for ITBS by
providing immediate and prolonged pain relief.
 PHYSIOTHERAPY MANAGEMENT

 Exercises to stretch the iliotibial band are no longer

considered as a strong evidence-based treatment
approach(Bolia et al, 2020).

 The best exercises to start will depend on the causative

factors obtained from the subjective and objective
assessment.
PHYSIOTHERAPY MANAGEMENT MEANS CONT’D
 Myofascial treatment can be effective in reducing the pain experience in the acute
phase, when pain and inflammation in the insertion is felt.

 The trigger points in Biceps femoris, vastus lateralis, gluteus maximus, and tensor
fascia latae muscles will be addressed by a myofascial treatment (weckstrom et al,
2016).

 Other stretching strengthening exercises post acute phase includes; foam roller
strecting regimen, hip bridging with resistant band, single leg wall squatting, side
planking and side lying hip abduction exercise
PHYSIOTHERAPY MANAGEMENT CONT’D
 As the acute inflammation diminishes,
the patient should begin a stretching
regimen that focuses on the iliotibial
band as well as the hip flexors.

 The stretch shown in Figure 4C was

consistently the most effective in
increasing the length of the iliotibial
band in a study of elite distance runners
PHYSIOTHERAPY MANAGEMENT CONT’D
 If the lateral gluteal muscles are found to be weak or functioning
improperly, this will result in compensatory muscle adaptation
which can lead to excessive contraction of the iliotibial band.

 If the gluteal groups are too short, external rotation of the leg can
occur and create abnormal stress on the iliotibial band (Krista,
2015).
PHYSIOTHERAPY MANAGEMENT CONT’D
 Once the patient can perform stretching
without pain, a strengthening program
should be initiated.

 Hip hike: A strengthening exercise

geared toward the gluteus medius is
shown
PROGNOSIS OF ITBS

 Roughly 50% to 90% of patients will improve with 4 to 8 weeks of

non-operative modalities. Likewise, all surgical modalities have
reported good to excellent results (Holmes et al, (2023).

 ITBS typically follows a fluctuating course and may relapse at any

point in the treatment progression or return to activity.
CONCLUSION
 Physiotherapy is crucial for managing pain at the acute stage,
strengthening abductors and reliving ilio tibial tension. However,
accurate diagnosis is equally important.

 Many physiotherapist uses various techniques and modalties

without identifying the root cause of the knee problem.

 So, it is imperative that as a physiotherapist, we do a thorough

assessment before embarking on treatment of ilio tibial band
syndrome.
REFERENCES
 Bolia IK, Gammons P, Scholten DJ, Weber AE, (2020). Waterman BR.
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 Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM,
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 Thank
you
for
listening.