What is Iliotibial Band Syndrome?
The iliotibial band is broad band made of muscle fibers that starts at the iliac crest in the pelvis and will run through the side or the exterior part of the leg until it connects into the shinbone known as tibia. The iliac crest is the boundary of the most apparent bone found in the pelvis. The gluteal muscle or the buttocks and the muscles of the hip joint connect to it and the IT band works to organize muscle activity and steady the knee while running.
The iliotibial band syndrome is characterized by the pain brought about by the swelling of the band as it passes through the lateral condyle found in the femur. As the knee bends, the fibers shift transversely along the condyle and are placed at the back of it. A bursa also known as a sac in this part lets the iliotibial band to move smoothly above the last part of the femur.
Once the band became inflamed, friction can happen while walking or running leading to knee pain brought about by the swelling on the side part of the knee joint.
If untreated, more swelling and scarring may happen inside the bursa, leading to a constant pain with reduced work.
Symptoms & Signs
Pain in the knee is the chief symptom brought about by swelling as the iliotibial band glides transversely along the femoral condyle on the exterior, or side part of the knee. The pain is most painful while walking or running and may extend from the knee to the leg and towards the hip. Pain can also be sensed while the knees are bent, particularly climbing up or down the stairs.
Physical assessment may show overall pain and swelling above the area of the iliotibial band found at the knee joint. Particular tender points may be noticed above the side part of the femoral condyle where the bursa is found. The assessment may reveal few vulnerability or disproportion of the quadriceps muscles and the hamstring muscles found in the rear of the thigh that bends the knee.
The iliotibial band might as well be rigid. Its elasticity can be verified by the doctor as the client performed different stretches. The Thomas and Ober tests are the two maneuvers that may aid in examining if the tensor fascia latae, the muscles of the buttocks and the iliotibial band is flexible.
The diagnosis of any kind of injury should involve questions regarding the patient’s overall health status, past injuries and present injuries. The purpose of these questions is to know which part might be the reason for the pain and what kind of management is suitable.
The physical therapist will perform a physical examination to assess what parts are the causes of the pain and what may have helped for having the injury.
Palpation of the iliotibial band is necessary. The physical therapist will sense from top to bottom the length of the iliotibial band, examining its overall tension and assessing if there any tight spots. The physical therapist will also look for tender points surrounding the exterior knee.
This test is indicated to test the tightness of the iliotibial band. The client will be placed in a lateral position, and the leg will be examined above. The physical therapist will steady the pelvis with the use of his or her hand, while they pull out the hip with their other hand. It will permit the hip to go down in the direction of the table known as abduction. The result will be positive if the leg shifts down below 10 degrees horizontally.
A) Iliotibial Band Syndrome Stretches
There are two types of stretches, self-stretching and stretching using an outside applied force:
The first that we will discuss is the self-stretching:
- First the initial position should be upright and standing. Then, cross the affected leg in the back of the unaffected leg while standing. Stretch the affected leg while it is at the back of the unaffected leg. Lean over the unaffected leg until the stretch will be felt on the affected hip.
- First the initial position should be lying down on your back (supine position) and position your arms on your sides. Then, raise your affected leg above the unaffected leg. Position your opposite hand behind the extended thigh. Maintain your arm on the affected side stretched out towards the side and put both shoulders in flat position. If likely, try to extend the knee of your extended leg to put emphasis on the extension.
- First the initial position is to sit at ease placing your legs in front. Then, place the foot of the affected knee flat on the floor outside the extended leg. Touch your extended leg with your opposite arm therefore your elbow will be on the exterior of your extended thigh. Gradually twist your head and see above your extended side shoulder while turning you upper half in the direction of the same side. Maintain your hips flat on the ground always.
- First the initial position should be lying down on your back (supine position) with your legs extended straight. Then, flex your knee of the affected leg and while keeping it using your both hands, bring it in the direction of your chest and toward the opposite shoulder.
b) Stretching using an outside applied force:
First the initial position should be lateral position with the extended leg placed above. Then, the client will be placed lying on the unaffected side and the hip and knee of the leg below will be bent toward the chest and keep firmly in this kind of place. The hip of the upper leg is bent and abducted than stretched with the knee bent. The physical therapist will stand at the back of the client putting one hand on the client’s hip to keep it steady and the other hand on the extended knee while putting a downward pressure.
Reverse Ober’s stretch
First the initial position should be on the side lying position of the affected side in the bottom. Then, the client is placed side-lying and the hip and knee of the upper leg are bent. The hip of the lower leg to be extended and the knee is somewhat bent. The physical therapist will stand at the back of the client putting one hand on the client’s pelvis to make it steady and the other hand is put below the affected knee. The physical therapist brings it upward on the lower extended leg and more hip stretching may be needed for the tension of the iliotibial band.
B) Iliotibial band Syndrome Rehabilitation
These are just examples of the rehabilitation for this condition. This is for educational purposes only. Seeking medical advice and help is still necessary prior to performing any kind of rehabilitation.
The purposes of rehabilitation are the following:
- Decreasing the pain and the swelling
- Extending the Tenser Fascia Latae and the iliotibial band
- Strengthening the tendon around the muscles
- Slow recovery to full fitness
- Prevent reappearance
In decreasing pain and swelling it may continue from two days to two weeks based on how severe the injury is and how good the treatment is.
- Provide rest from any type of work that can cause pain and swelling. Begin with minimum of five days of total rest from activity.
- After that, attempt to perform other tasks like swimming or cycling if doing these activities cause no pain.
- If they cause pain attempt to work with only the upper half of your body. It is necessary to keep a training schedule.
- Application of ice will help to decrease the swelling. At first it can be used for fifteen minutes every hour. You should try to use ice with minimum of three times per day.
- Anti-inflammatory drugs like Ibuprofen may assist in the first few days.
In extending the iliotibial bane the following should be done:
- Extension should be performed all the way through the management of this injury and is the most important factor to early and complete rehabilitation.
- Extend slowly in the early phases if pain and swelling is present. Keep the extension for a minimum of ten seconds and repeat for five times. You goal should be to extend with minimum of three times per day.
- Afterward the process of rehabilitation once the pain has left away, extending can be intensified. Keep extensions up to 45 seconds and do it for five times. Do this extension at least three times per day.
- Use sports massage techniques. This is necessary for faster recovery and to prevent the recurrence of injury when you start running again.
In strengthening the following should be done:
- Strengthening can be done if the pain has gone away and you already established a stretching routine.
- The entire leg requires to be strengthened especially the Tenser Fascia Latae and buttocks muscles.
- Begin with two sets of ten reps, but it should be painless.
- Once it became effortless, slowly increase the numbers you are performing until you can finish the full three sets of 15. Take note that you should never add above five reps on the day before.
In slow recovery to fitness the following should be done:
- This usually begins during two weeks of initiating treatment of injury; however, it will be based on the seriousness of the injury.
- Create running time from a minimum point compared before you have the injury. A decreased of 50% of the original miles or time is alright.
- Use ice in the knee for fifteen minutes following activity.
- Intensify the time for running compared to the miles for the initial runs. The miles should not be intensified by above 10% in a week.
- If you sense pain or swelling reappears ten rests for a minute to ease the swelling and begin again.
- It is necessary to keep a maximum level of extension. If the iliotibial band is contracted, then the injury will probably re-appear. Merely decreasing the swelling will not heal the injury for a long-time.
- Use sports massage often, especially to the iliotibial band. This will prevent tight areas.
Iliotibial Band Syndrome Prevention
In prevention the following should be done:
- A lot of extensions regularly
- Applying deep massage to the iliotibial band
- Intensifying training slowly