Iliotibial band syndrome

History

  • Occurs in people practicing various forms of athletics (most commonly running, but can be cycling, rowing, swimming, hiking, team games)
  • Most commonly lateral knee pain, but can sometimes affect the hip or thigh.
  • Can show up if training intensity or pattern has changed recently
  • Typically has recurrent, predictable point in activity at which it shows up.
  • Worse on cambered circuits or on downhill running.
  • Doesn’t cause locking, giving way, or swelling; those are more typical of intra-articular pathology (OA, meniscal pathology, cruciate injury).
  • Anatomical factors such as foot overpronation or leg length discrepancy can cause it; if this is the case, orthotics might help.

Examination

  • Classically, there is tenderness 2 or 3 cm above the lateral joint line.
  • Also, classically there is crepitus over the lateral femoral epicondyle at 20 – 30 degrees of knee flexion.
  • There might be subtle loss of power of abduction when patient lying laterally, due to gluteal weakness.
  • Provocation tests (Ober’s/Noble’s test) aim to reproduce pain on compression of the ITB over the lateral femoral epicondyle.
  • Remember that swelling, effusion, or joint line tenderness are not typical.

Management

Usually conservative: reduce or stop exercise sessions, particularly activities such as downhill running that exacerbate the pain, and do stretches. For details, check out information guide for patients, downloadable from the BMJ website. Replacing damaged, ill-fitting or old training shoes might also help; these can increase ITB friction.

It’s often possible to do high speed interval training without exacerbating the condition, as the knee flexion angles are different during fast running, so replacing longer, slower runs with interval sprint training might help.

Second-line treatment is physiotherapy or, sometimes, corticosteroid injection if eight weeks of stretches plus activity modification hasn’t helped. Rarely, if symptoms persist for longer than 6 – 12 months, surgery might be needed.

Prognosis

Good. 44% of sufferers can expect to be back to sport by eight weeks and 92% by six months.

(From BMJ article at above link.)

 

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Credits 2019, Musculoskeletal, Orthopaedics, Sports medicine. Bookmark the permalink.

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