ILIO TIBIAL BAND SYNDROME

ILIO TIBIAL BAND SYNDROME DR GAVIN SHANG SPORTS PHYSICIAN MBBCH (WITS) MPHIL SPORTS MED (UCT/SSISA) INTRODUCTION •  ITB syndrome: overuse injury of distal ITB tendon •  Friction (anterior to posterior) vs. compression (medial to lateral) over and against lateral femoral condyle respectively •  Most common cause of lateral knee pain •  ITB friction / compression: fat pad vs. bursal irritation / inQlammation ANATOMY •  Flat and widened portion of distal fascia •  Proximally formed by TFL and Gluteus Maximus •  Extends from iliac crest to Gerdy’s tubercle (lat tibial condyle) •  ITB anterior to lateral femoral condyle knee extension •  ITB posterior to lateral femoral condyle knee Qlexed >30° •  ITB: stabilizing ligament between lateral femoral condyle and lateral tibia ETIOLOGY •  Traditional view: ITB not attached to bone between proximal and distal insertions (movement anterior to posterior) •  View challenged: Fairclough et al 2006 -­‐  ITB attached to distal femur by oblique Qibrous bands (movement more medial to lateral) -­‐  ITB compresses highly innervated fat pad/ bursa against epicondyle during knee Qlexion (associated tibial internal rotation during Qlexion-­‐extension) -­‐  Better understanding of functional anatomy and biomechanics -­‐  Improves management strategies RUNNING -­‐ 10-­‐15% of running related injuries -­‐ affects 5-­‐10% of runners -­‐ greatest at 30° of knee Qlexion -­‐ downhills (knee less Qlexed at foot-­‐strike) -­‐ insidious onset with resolution -­‐ worsens and painful enough to force cessation of activity -­‐ overuse (frequency and intensity) -­‐ varus knee alignment -­‐ lateral pelvic tilt -­‐ inappropriate footwear -­‐ steeply cambered surface -­‐ limb length discrepencies CYCLING -­‐ ITB pulled anteriorly on down stroke -­‐ ITB pulled posteriorly on up stroke -­‐ saddle height -­‐ varus allignment -­‐ cleat inversion -­‐ tibial internal rotation DIFFERENTIAL DIAGNOSES •  Patello-­‐femoral anterior knee pain •  Lateral collateral ligament injury •  Postero-­‐lateral corner / popliteal tendon injury •  Common peroneal nerve entrapment •  Lateral meniscal tear •  Degenerative lateral compartment OA •  Stress fracture •  Referred pain DIAGNOSIS •  Mainly clinical: -­‐ Noble’s test (30°) -­‐ Ober test (ITB Qlexion) •  Imaging: -­‐ only for exclusion of differentials (X-­‐rays, MSK ultrasound, MRI) •  Make the diagnosis •  Treat the condition •  Address the cause TREATMENT •  NSAIDs and analgesics •  Corticosteroid inQiltration(s) •  Orthotics (limit tibial internal rotation) •  Stop aggravating activity •  Cross train •  Check bike set up •  Avoid cambered surfaces and downhills TREATMENT •  Physiotherapy •  Stretches and pelvic stabilizing rehabilitation (gluteal strengthening) •  Continued maintenance •  Surgery