Iliotibial band (ITBS or IT band syndrome) is an overuse of the connective tissue that is located in the back or outer part of the thigh and knee. It causes pain and tenderness in those areas, especially just above the knee joint. Iliotibial band syndrome is the most common cause of back knee pain in runners and cyclists.
The iliotibial band is a thick band of fascia (tissue) that begins at the pelvic floor in the pelvis, passes below the outer or outer part of the thigh, and crosses the knee to attach to the upper part of the tibia or shinbone. It is formed from the tensor fascia late with two gluteal muscles (gluteus medius and gluteus minimus) at the buttocks and then passes to the knee. The iliotibial band (IT) helps to calm the outer part of the knee through its motion.
Iliotibial band fracture includes pain in the region of the future female condyle or slightly inferior to it, which occurs after a knee replacement, usually in a runner, cyclist, or other athlete. Diagnosis is usually made based on case history and physical examination, although in some cases it may be shown to rule out another disease in the region. An important finding on body examination is the gentleness of the lower knee area below the epicondyle and better than the soft joint. Ober’s attempt to expand the iliotibial band is also a measure of interest.
ITBS also occurs when excessive irritation causes pain outside or part of the knee. The iliotibial band, often referred to as the (IT band,) is a type of soft tissue that runs along the thigh from the pelvis to the knee. As it nears the knee, its shape increases as it crosses the prominent area of the femoral femur called the femoral condyle before attaching to the tibia. Near the pelvis, it connects to the two hip muscles, the tensor fascia latae and the gluteus maximus.
Itching and swelling are caused by friction between the IT band and the underlying structures as a person undergoes frequent stretching and knee flexion. Typically, ITB pain is caused by excessive use during activities such as running and cycling. It is considered a non-traumatic traumatic injury, often seen in runners, and is often accompanied by underlying muscle weakness of the trophy muscles.
The current theory is that this condition can be caused by suppression of internal adipose tissue. The study has described the ‘insertion area’ that occurs, or slightly below, 30 ° of knee flexion during a foot strike and the point of an early running motion. During this period of incorporation into the running cycle, eccentric degeneration of the tensor fascia latae and gluteus maximus muscles causes the foot to shrink, resulting in compression in the iliotibial band.
Symptoms of iliotibial band (ITB) syndrome
- Pain in the knee joint is a common symptom of iliotibial band disease and is due to inflammation of the area where the band crosses and returns to the female epicondyle.
- In the past, there may have been feelings of stinging or stinging like needles that are often overlooked. This can progress slowly to the point of pain every time the heel hits the ground and can eventually be paralyzed by pain when walking or while climbing up or down.
- Some patients may feel a tingling or tingling sensation in the knee, and there may be swelling either at the point where the band crosses the female epicondyle or below the knee where it holds the tibia.
- Sometimes, the pain can spread along the IT band to the outside of the thigh to the hips.
- Pain or aching pain outside the knee.
- The feeling of an IT band “hitting” on the knee while bending and straightening.
- Swelling near the outside of your knee.
- Frequent constipation and pain outside the hips.
- Persistent pain following activity, especially walking, climbing, or descending stairs, or moving from sitting to standing.
The pain is usually most intense when the knee is in a slightly bent position, either right before or right after the foot hits the ground. This is where the IT band rubs the most over the thigh bone.
How Can a Physical Therapist Help You?
Your physiotherapist will use treatment strategies based on:
Variety of motion: Often, abnormal joint movements of the hip, knee, and leg can cause ITBS because of the way the band holds the waist muscles. Your physiotherapist will evaluate the movement of your affected leg compared to the normal expected motion hip motion on your unattended leg.
Muscle strength; Lack of cell and core may contribute to ITBS. The cell refers to the muscles of the abdomen, lower back, and pelvis. Basic strength is important, as a strong center will allow for greater stability through the body as the arms and legs go through a wide range of motion. For athletes who do endurance sports, it is important to have a solid foundation for calming the trunk and pelvis during repetitive motion. Your physiotherapist will be able to determine which muscles are weak and provide specific exercises to target these areas.
Manual therapy; Many physiotherapists have been trained in manual therapy, which means they use their hands to move and move muscles and joints to improve mobility and strength. These techniques can target areas that are difficult to treat on your own.
Career training; Even when a person has normal movement and strength, it is important to teach the body how to perform controlled and coordinated movements so there is no longer too much stress on previously injured structures. Your physiotherapist will come up with an exercise program specifically for the activity you want or sport. This means creating exercises that will mimic your activities and challenge your body to learn the right way to move.
Your physiotherapist will also work with you to develop a treatment plan and personalized training specifically for your personal goals. They will provide tips to help you prevent your injury from recurring.
How Is It Diagnosed?
Your physiotherapist will ask you questions about your medical history and activity regimen. A physical examination will be done so that your physiotherapist can collect movement (range of motion), strength, and flexibility measurements on the hips, knee, and ankle.
When dealing with ITBS, it is also common for a physiotherapist to use specific tests and complete movement analysis. This will give your physiotherapist information about the route you are taking and how it may contribute to your injury. Your physiotherapist can evaluate your walking / running, body position, foot structure, and balance. They may ask you to repeat the activity that causes your pain to see for yourself how your body moves when you feel pain. If you are an athlete, your physiotherapist may also ask you about your chosen sport, shoes, training methods, and regular exercise routine.
In most cases, diagnosis of iliotibial band disease can be made with the patient’s symptomatic history. The patient describes a continuous future knee pain that is exacerbated when the heel hits the ground. Physical examination is important because the area of pain can often be relieved by the tenderness and swelling felt over the female epicondyle, where the bursa or sac is located.
A health care professional can also look for differences in leg length, muscle balance, and strain on the legs and spine. There is tenderness of the outer thigh just above the knee joint, while the joints of the knee and hips themselves are common for examination. Typically, a thorough examination of the lower back and lower limbs, as well as the hips, knees, and ankles, is performed to detect other possible causes of future knee pain.
Treatments for Iliotibial band friction syndrome
The treatment of ITBS usually does not work, and physical therapy should be considered as the first and best treatment. Iliotibial band syndrome is an overactive wound that causes inflammation. Treatment of IT band includes the following;
1. Conservative treatment
There are many different approaches to conservative treatment of IT band disease. Many treatment modalities are targeted at the number of runners, and some guidelines for returning to the “running” game have been recommended. shows four studies that demonstrated conservative treatment methods.
In another randomized controlled trial, 18 runners with dementia were randomly assigned to two groups: group 1 received a corticosteroid injection and group 2 received a placebo injection. The subjects were ordered not to run for 14 days following the injection and to apply ice to the area for 30 minutes every 12 hours. Running pain was significantly reduced in the group that received the corticosteroid injection.
From clinical experience, rest is the best treatment for acute visas. This treatment becomes less beneficial as it becomes a chronic condition when bursal and periosteal changes are introduced. There is little evidence to support the specific approach to ITBS treatment; However, when looking at the desired goal of returning to the game, a combination of breaks (2-6 weeks), stretching, pain control, and rehabilitation of running habits provide a high level of return for the game.
2. Surgical Treatment
Surgery is often reserved for refractory cases that have failed other conservative management methods. However, in the number of athletes, a return to the sport is a common occurrence, and a long absence from sport due to experiments on a variety of conservative treatment methods is often not ideal.
There are differing opinions on when surgical treatment should be performed. Martens et al. recommends that conservative treatment be maintained for an average of 9 months before considering surgical intervention. Some have made their decision for surgical intervention with the observation that at 30 degrees, the posterior ITB fibers are stronger against the posterior femoral epicondyle than the outer fibers, in which case surgical removal of the posterior fibers is required to correct the problem.
In one study, 36 athletes with chronic ITBS were treated with a standard arthroscopic technique, prescribed for the reduction of future synovial rest. Patients had been diagnosed with ITBS for an average of 18 months (1-7 years). Thirty-three patients were found to be monitored at least 6 months after surgery. Prior to surgery, all patients had been conservatively treated for at least 6 months with rest, training error correction, shoe adjustment, physical therapy and internal penetration with steroids. Thirty-two patients had better or better outcomes based on performance results in follow-up. All patients returned to sports after 3 months.
3. Physical exercises
The exercises for stretching the iliotibial band are not considered as evidence-based treatment. The best start-up exercises will depend on the factors that lead to the availability of rational evaluation and goals. If the future gluteal muscle is found to be weak or malfunctioning, this will lead to compensatory muscle repair which can lead to excessive reduction of the iliotibial band. If the gluteal groups are too short, the external rotation of the leg can occur and create an abnormal strain on the iliotibial band.
Exercises to strengthen the abductor’s muscles and soothe the hips can be helpful if shown in the clinic. Since ITBS can often be attributed to hip flexor weakness, hip strengthening and stabilization will be beneficial in the treatment of ITBS. Several examples of important exercises. Increased hips to strengthen the gluteus medius to help relax the hips. Stand on the side of the stage with a lot of body weight on the untouched side.
Lower the hip joint involved and return it to either side. Another example is the exercise of hip abduction lying on the side and back behind the wall with the leg held for approximately 30 ° of hip abduction and slightly rotated to the external hip by neutral hip extension. This exercise can be made weaker by placing a 1 meter long band between the ankles.
4. Physical therapy may be needed
If this first-line treatment does not work, physical therapy may be needed to reduce swelling in the IT band. Other treatments focus on flexibility and stretching. Rubbing friction can occur over the IT band on the female epicondyle can help break down inflammation and scars.
Ultrasound treatment methods can be used, as well as phonopheresis “ultrasound recommends anti-inflammatory drugs through the skin on inflamed tissues” and “electric iontophoresis” is used instead of ultrasound “to help reduce irritation in the soft tissues surrounding the knee.
A physiotherapist can also help assess the cause of the problem and look at muscle strength and balance and flexibility with gait analysis “watching a person walk, run, or rotate”. Shoe laces can be beneficial if there is a problem of loss, pelvic reliability, or variation in leg length as a possible cause of IT band disease.
5. Use of foam rollers
Home remedies may include stretching, massage, and the use of foam rollers at the site of pain and inflammation. The use of a foam roller on hard muscles can also be beneficial. The patient can also exercise using a foam roller at home to create deep friction, myofascial exchange “massage” and stretch muscles.
A possible exercise is to lie on the side with a foam roller placed evenly on the lower leg, just below the bone. The upper leg should be placed forward horizontally. Using the hands for support, move from the top of the outer thigh down to just above the knee, straightening the front leg during movement.