Iliotibial band syndrome
Classification & external resources

ICD-10	M76.3
ICD-9	728.8
DiseasesDB	32612
eMedicine	pmr/61  sport/53

Iliotibial Band Syndrome (ITBS or ITBFS, for Iliotibial Band Friction Syndrome) is a common thigh injury generally associated with running. Additionally it can also be caused by biking, hiking or weight-lifting (especially squats). Image File history File links Posterior_Hip_Muscles_3. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In humans the thigh is the area between the pelvis and buttocks and the knee. ... Injury is damage or harm caused to the structure or function of the body caused by an outside agent or force, which may be physical or chemical. ... For other uses, see Running (disambiguation). ... ... Two hikers in the Mount Hood National Forest Eagle Creek hiking Hiking is a form of walking, undertaken with the specific purpose of exploring and enjoying the scenery. ... Weightlifting is a sport where competitors attempt to lift heavy weights mounted on steel bars. ... The squat is a lower body exercise used in strength training. ...

Definition

Iliotibial Band Syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front during the gait cycle. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed, or the band itself may suffer irritation. For other uses, see Knee (disambiguation). ... The deep fascia of the thigh is named, from its great extent, the fascia lata; it constitutes an investment for the whole of this region of the limb, but varies in thickness in different parts. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... The pelvis (pl. ... In anatomy, the hip is the bony projection of the femur which is known as the greater trochanter, and the overlying muscle and fat. ... The femur or thigh bone is the longest, most voluminous, and strongest bone of the mammalian bodies. ... A gait can refer to: a particular way or manner of moving on foot: walking and running are the two basic human gaits; see also gait analysis and Gait (human). ... The lateral epicondyle of the femur, smaller and less prominent than the medial epicondyle, gives attachment to the fibular collateral ligament of the knee-joint. ... In anatomy, Flexion is movement whereby bones or other objects are brought closer together. ...

Symptoms

Iliotibial Band Syndrome symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia. For other uses, see Joint (disambiguation). ... For other uses, see Foot (disambiguation). ...

ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight -- each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known. This article is about human pregnancy in biological females. ...

Sports Activities to Avoid while Symptomatic

• Stair Stepping
• Dead lifts or Squats
• Court sports, such as tennis, basketball, or similar
• Martial arts, such as Karate (especially where being bare foot emphasises any symptoms being caused by leg/foot abnormalities)

Stairs, staircase, stairway, flight of stairs are all names for a construction designed to bridge a large vertical distance by dividing it into smaller vertical distances, called steps. ... The Deadlift is a weight training exercise where one lifts a loaded barbell (or, in the case of the trapbar deadlift, a loaded trapbar) off the ground from a stabilized bent-over position. ... The squat is a lower body exercise used in strength training. ... For other uses, see Tennis (disambiguation). ... This article is about the sport. ... Hawaiian State Grappling Championships. ... For other uses, see Karate (disambiguation). ...

Causes of Injury

Iliotibial Band Syndrome is the result of poor training habits, equipment and anatomical abnormalities. Human heart and lungs, from an older edition of Grays Anatomy. ...

Training habits:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet "toed-in" to an excessive angle
• Running up and down stairs

Abnormalities in leg/feet anatomy: Indoor Track is a sport very similar to track and field, except that it takes place indoors. ...

• High or low arches
• Overpronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
  • Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bowleggedness for runners.

Muscle Imbalance: Pes cavus is a medical term for a cavus deformity of the foot due to a fixed plantar flexion of the foot. ... Flat feet, also called pes planus or fallen arches, is a condition in which the arch of the foot collapses, with the entire sole of the foot coming into complete or near-complete contact with the ground. ... In human and zoological anatomy (sometimes called zootomy), several terms are used to describe the location of organs and other structures in the body of bilateral animals. ... Genu varum A deformity marked by medial angulation of the leg in relation to the thigh; an outward bowing of the legs. ... For other uses, see Heel (disambiguation). ...

• Weak hip abductor muscles

Treatment

As with any injury or ailment, one should see one's physician, physical therapist or athletic trainer for diagnosis and treatment. For other uses, see Doctor. ... Physical therapy can help restore lost functionality in many people. ...

For a runner with acute ITBS, reduce weekly distance training to 50% for 2 weeks, and only run on flat ground. After, in the absence of ITBS pain, slowly begin to build distance again. If ITBS pain remains or is chronic, one should stop running immediately for two weeks (minimum). If the pain and inflammation are still present, another month of rest may be needed. Once the injury begins to improve, resuming activity can be possible, doing low distance, low speed jogging on flat terrain. Also, changing one's route may help counteract re-injury, as running a common route may put increased stress on the iliotibial band of one leg. Chronic pain was originally defined as pain that has lasted 6 months or longer. ... Jogging is a form of trotting or running at a slow or leisurely pace. ...

To prevent, or cure chronic ITBS there are some essential exercises:

• Strength building of the proximal hip musculature for controlling ITB tightness; especially the straight leg raising motion and hip adduction
• Performing specific stretches; Iliotibial band stretch, stretching the gluteal muscles, and other leg based static stretching

To create a good treatment program, proper assessment of injury severity is critical. Once the injury has been properly assessed, a treatment program (usually consisting of three steps) can be planned. The length of time spent on each phase varies depending on the athlete, the reasons for the initial injury, and the severity of the injury. Fox and Haskell formula Anaerobic exercise is typically used by athletes in non-endurance sports to build power and by body builders to build muscle mass. ... In anatomy and physiology, adduction is the moving of limbs towards the midline of the body. ... There are three muscles referred to by gluteus: gluteus maximus (buttocks) gluteus minimus gluteus medius This is a disambiguation page, a list of pages that otherwise might share the same title. ... Static stretching is used to stretch muscles while the body is at rest. ...

Immediate Treatment

After noticing symptoms, the important task is controlling pain and inflammation. For these symptoms, RICE works well. Stretching is second in importance, to make sure that the iliotibial band does not become taut. Next, examining what may have caused ITBS is important. Issues range from poor training habits to structural abnormalities, but the shoes a runner uses are another consideration. For example, after 500 miles most shoes retain less than 60% of their initial shock absorption capacity, increasing the chance of ITBS injury. Lastly, anti-inflammatories or ultrasound may be helpful to relieve symptoms. An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... For other uses, see Rice (disambiguation). ... shoe for right foot A shoe is a piece of footwear for humans, less than a boot and more than a slipper. ... Anti-inflammatory refers to the property of a substance or treatment that reduces inflammation. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ...

Short Term Treatment

If the pain and inflammation do not subside, all painful activity should stop while continuing immediate treatment. A regular stretching regimen is important. A video analysis of running movements may provide insight into problematic running mechanics. To retain fitness, a number of options will work at this stage, as long as they do not promote pain. Altering these exercises will minimize overtraining: Overtraining is a common problem in weight training, but it can also be experienced by runners and other athletes. ...

• Swimming, though abstain from the breaststroke as it may aggravate symptoms
  • Optionally, wearing a life jacket, one may run in the pool (depth allowing)
• Cycling, though with care, as it may aggravate symptoms
• Speed walking, especially straight-legged to discourage pain
• Cross-country skiing
• Yoga, or similar low-impact aerobics

At this stage, Steroid injections may be helpful, though some risks are involved. Swimmer redirects here. ... Recreational Breaststroke Breaststroke is a swimming style swam on the breast. ... Police officer on a bicycle Cycling is a means of transport, a form of recreation, and a sport. ... This article does not cite any references or sources. ... Cross-Country trails are often less crowded than Alpine ski slopes. ... For other uses, see Yoga (disambiguation). ... This article or section is in need of attention from an expert on the subject. ... The name glucocorticoid derives from early observations that these hormones were involved in glucose metabolism. ...

Long Term Treatment

The last phase is only started once pain and inflammation are gone. Often, this phase involves returning to a normal state, even competitive sports. Though, at least these criteria must be satisfied:

• The injured knee has regained full range of motion without pain
• The injured knee has regained normal strength compared to the uninjured knee
• Cardiovascular endurance has normalized

Most importantly, one must ensure that old symptoms do not recur. Thus, any pain or inflammation must be treated cautiously, especially if the ITBS was serious and involved a lengthy downtime. The return process must be gradual and treated with extreme care, structurally specific stretching during this time is essential and must be done extensively, before and after activity. Returning to activity should be done while correcting, or significantly reducing, any factors that were thought to have caused ITBS. If no factors are identified and corrected, the chance of the re-injury is much higher. Look up Endurance in Wiktionary, the free dictionary. ...

Rarely, and only in extreme cases, surgery is used to correct the injury. Typically, unless one is still suffering from symptoms in 6-12 months, surgery is not performed. It involves the release-excision of the iliotibial band, performed after an arthroscopic evaluation of the knee, which rules out other causes for the symptoms. Only patients unwilling to adapt their exercise because of this injury undergo surgery; it should only be performed after all other treatments have failed. Arthroscopic surgery, also known as arthroscopy, is the process where a joint is operated on using an arthroscope, a small fibre optic camera. ...

Rehabilitation

After the Pain is Gone

• Continue stretching, as well as strengthening of the leg muscles.
• The patient should start running only after treatment.
  • Restart running with small distances, building slowly.
  • If the patient feels pain, he or she should stop.

Some Rehabilitation Options

• Deep-tissue massage or Rolfing may help break up scar tissue that forms.^{[citation needed]}
• Non-steroidal anti-inflammatory drugs (aka NSAIDs), in high doses for a period of weeks, can help reduce the inflammation.
• Strengthening exercises for the quadriceps femoris and gluteus medius muscles can help support the leg, thus lessening the load on the ITB.
• Glucosamine Sulfate and Chondroitin Sulfate may help.

Rolfing, also known as Structural Integration, is a codified series of soft tissue manipulation, which purports to organize soft tissue relationships, with the objectives of realigning the body structurally and harmonizing its fundamental movement patterns. ... This article does not cite any references or sources. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ... ... The gluteus maximus is the largest of the gluteus muscles which are located in the buttock. ... Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. ... Chondroitin is an ingredient found commonly in dietary supplements. ...

Example Physical Therapy Regimen

For successful rehabilitation, it is essential to restore the flexibility of the iliotibial band, and the strength and flexibility of the muscles which act upon it. Stretching the band is a complicated task; before the band can stretch, the hip flexors must stretch.

To prepare for ITB stretching, one may heat the lateral thigh with hydrocollator packs for a period of time, typically twenty minutes. This is followed by ultrasonic heating (1.5-2.0 watts/cm²) to the length of the ITB tract for 5-7 minutes. After one stabilizes the pelvis while another person (qualified therapist) stretches the leg to maximally tolerated adduction. This may be repeated using three 1-minute stretches. Cryotherapy of the painful and inflamed tissue for ten minutes in the stretched position is also effective. (Gose, 1989)^[1] For other uses, see Watt (disambiguation). ... cm redirects here, alternate uses: cm (disambiguation) A centimetre (symbol cm; American spelling: centimeter) is an SI unit of length. ...

See also

Runner's knee Runners Knee What is Runners Knee (Chondromalacia)? Chondromalacia is a discomfort or dull pain in the knee or just under or around the knee. ...

References

1. ^ Gose J, Schweizer P. "Iliotibial band tightness." Orthop Sports Phys Ther. April 1989; 10: 399-406.

External References and Links

• Sports Medicine Tent: ITB
• A Runner's Guide to Illiotibial Band Syndrome (ITBS)
• Illiotibial Band Syndrome (ITBS)
• Iliotibial Band Friction Syndrome (archive link, was dead)