Ilio-Tibial Band Syndrome (Runner's Knee)

[Evastar]

The Physiology of Ilio-tibial Band Syndrome

The joint affected by ilio-tibial band syndrome is the knee. The knee is a very important joint in the body, being involved both in weight bearing and movement, often both simultaneously. It is a hinge joint. The knee joint is formed by the lateral and medial epicondyles of the femur, the lateral and medial condyles of the tibia and the patella, which is a sesamoid bone i.e. a bone that forms in a tendon.

The head of the fibula articulates with the lateral condyle of the tibia, forming an almost immoveable synovial joint and is an attachement point for biceps femoris and the lateral collateral ligament.

The knee is a synovial joint and has cartilage between the tibial plateau and the epicondyles of the femur calal ed the medial and lateral meniscus.

The ligaments involved in the knee joint are the patellar ligament, the lateral and medial collateral ligaments and the anterior and posterior cruciate ligaments.

Ligaments connecct bone to bone, tendons connect muscle to bone. Both ligaments and tendons are a type of white fibrous connective tissue, and as such have poor blood supply and poor regenerative capabilities.

Muscles

The muscles that cross the knee are:

The quadriceps, which are on the anterior thigh i.e. rectus femoris, vastus lateralis, vastus medialis and vastus intermedius, all of which insert into the patellar tendon. This group of muscles extend the knee.

The hamstrings which are the antagonists to the quadriceps and lie on the posterior thigh; biceps femoris, semitendinosus and semimembranosis. The biceps femoris inserts into the head of the fibula and the lateral condyle of the tibia and semitendinosus and semimembranosis insert into the medial condyle of the tibia. This group of muscles flex the knee, and semitendinosus medially rotates the knee.

Sartorius inserts into the medial tibial condyle and flexes the knee.

Gastrocnemius is a muscle of the posterior calf and originates from the medial and lateral condyles of the femur.

The gluteus muscles are muscles of the hip rather than the knee, but can directly contribute to ITB syndrome. Gluteus maximus originates on the posterior gluteal line of the ilium, the sacrum and coccyx and inserts into the fascia lata and the gluteal tuberosity of the femur. It's functions are extension of the hip, lateral rotation of the hip and abduction of the hip.

Gluteus medius originates at the crest of the ilium and inserts into the greater trochanter. It's functions are abduction of the hip, lateral and medial rotation of the hip.

Gluteus minimus is deep to gluteus medius and abducts and medially rotates the hip.

Tensor fasia lata is a muscle that originates on the outer iliac crest (one fo the triple attachment) and inserts into the ilio-tibial band. It's function is medial rotation of the leg, and abduction of the leg.

The ilio-tibial band (ITB) is a dense fibrous band of tissue that originates from the anterior superior iliac spine region and extends down the lateral portion of the thigh to the knee. It has insertions on the lateral tibial condyle and the distal portion of the femur. When the knee is flexed more than 30 degrees, the ITB is posterior to the lateral femoral condyle.

 

[Evastar]

Causes

The injury is usually due to overuse. Irritation is caused as the ilio-tibial band crosses over the lateral femoral condyle. Continued use results in the ITB becoming inflamed resulting in knee pain. MRI scans in people with ITB syndrome have shown thickening in the ITB over the lateral femoral condyle and a fluid collection under the ITB at this area. The sports this injury is most prevalent in are long distance running and long distance cycling.


Symptoms

Pain on the outer side of the knee.
Pain is worse running downhill.
Pain starts while running causing the athlete to stop.
Tenderness over the lateral eipcondyle.

Treatment

Treatment of ITB syndrome is usually conservative. Initially rest, ice and anti-inflammatory medications. The athlete should refrain from whatever activity caused the inflammation and also from going up and down stairs. If there is still visible swelling and pain after 3 days of rest, a local corticosteriod injection should be considered.

The athlete should reduce the running distance, run on soft ground, avoid downhill running and apply ice. They should also do specific stretching of the ITB.


The physical therapist should perform massage and stretching exercises on the client's leg. The client should commence exercises to increase the flexibility of the ITB and of the gluteus muscles, especially gluteus medius. Also the hamstrings, quadriceps, gastrocnemius and soleus. Clients can go swimming during treatment to maintain cardiovascular fitness.

In most clients physical therapy will result in strength development and maintenance. In some clients that show no sign of improvement, they can go for surgery. The most common surgical approach is to release the posterior 2 cm of the ITB where it passes over the lateral eipcondyle of the femur.

To stretch the ITB yourself at home get a mini leather football, place it under the outer thigh while lying on the floor on your side, and roll the football under the thigh.