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Running Injuries (10)
Iliotibial band friction syndrome (ITBFS)

Iliotibial band friction syndrome (ITBFS) also known as “runners knee” is a very common athletic injury that effects the knee. Runners knee is especially prone to long distance runners or athletes who participate in activities that require highly repetitive running.

Causes Anatomy/Biomechanics: The iliotibial band is a thick band of tissue that extends from the thigh(femur) down over the knee and attaches to the tibia. When the knee bends (flexion) and straightens (extension), the iliotibial band slides over the lateral femoral epicondyle, the bony part of outer knee. Iliotibial band friction syndrome refers specifically to the lateral knee pain related to irritation and inflammation to the point at which the band crosses the lateral femoral epicondyle. This type of irritation occurs when the knee is flexed at approximately an angle greater than 30 degrees, because the iliotibial band shifts posteriorly behind the lateral femoral epicondyle. During extension, the band shifts back anteriorly in front of the lateral femoral epicondyle and it is this motion that causes friction between the iliotibial band and the lateral femoral epicondyle which leads to irritation and inflammation within the iliotibial band.

Symptoms: Iliotibial band friction syndrome is a condition not unique to runners, it and its symptoms are now frequently seen in cyclists, weight lifters, skiers and soccer players. The most obvious sign that you have ITBFS is the pain felt usually during exercise. Runners will describe the pain on the outside part of the knee or lower thigh. The degree of discomfort runs from dull aching sensation to a sharp stabbing pain. The pain is not localized so most suffers cannot put their finger on one particular spot. Suffers will generally use the flat of their hand to describe the location of the pain. One easy self test to know if you might have ITBFS, is the point of tenderness test. A patient with ITBFS will exhibit extreme point of tenderness at about 2 cm over the outside part of the knee when flexed at thirty degrees. Another common symptom is a “creaking” noise during activity, this noise mostly occurs during weight bearing exercise like weight lifting. This is because during weight bearing activities the additional pressure and compression forces the contraction of the knee joint. This leads to elevated friction over the lateral epicondyle and increased pain. One important factor about ITBFS is that it is a problem not inside the knee joint, but around it, which makes more easily distinguishable and treatable.

Prevention Common Training Errors/Training Modifications: Iliotibial band friction syndrome is an overuse injury caused by extensive repetitive friction of the iliotibial band. The most frequent oversight runners and athletes make is over doing it or over training. This can be controversial because if you wish to compete at highly competitive levels what is over training? This should be decided by the athletes themselves who should know when to make the rational decision of knowing when to stop. Another predisposing factor for the development of ITBFS is training error and abnormal biomechanics. Many runners make the mistake of only running on one side of the road. Most roads are higher in the centre and slope off on either sides. The foot on the outside part of the road is lower than the other. This causes the pelvis to tilt to one side and tightens the iliotibial band occurs, naturally increasing friction. Runners must always remember to try when possible to run on flat terrain, this will greatly reduce the chances of acquiring ITBFS. As running on flat terrain reduces friction, highly shock absorbing footwear is also needed. In runners with normal feet, the force of running is dissipated by the foot. However, if you have a minor abnormality in your foot anatomy, like high or low arches, the shock from the force of the foot strike is primarily passed directly to the knee. A good pair of shock absorbing shoes will decrease the pressure, inturn allowing the muscles and tendons surrounding the knee, chiefly the iliotibial band to be more relaxed reducing friction. Shoe mileage should also be considered for serious runners or athletes. After about 500 miles or 800 kilometres most shoes loose 60% of their initial shock absorption capacity. As some one jogging leisurely or training competitively, both should participate accordingly, knowing when not to over do it, and knowing to implement good training habits like appropriate footwear and stretching before and after performance. If these aspects of sport along with others are followed avoiding ITBFS should be easily accomplished.

Rehabilitation Treatment: In establishing an appropriate treatment program, the severity of the present inflammation must first be determined. Once the injury is properly assessed and the diagnosis taken into consideration, the athlete may be placed into one of the three phases of iliotibial band care. The first phase of care is the Immediate Phase. This is the phase in which the pain and inflammation must be controlled along with any poor training habits, which some I already discussed are corrected. Achievement of these goals require a reduction of activity and the proper administration of oral anti-inflammatories. If the trainer sees fit, many alternate treatments may be implemented. Such as ice, heat, ultrasound, and electrical stimulation. It should also be noted that stretching exercises which are extremely important to combat any excessive iliotibial band tightness are conducted in this phase. The second phase, or the Short Term Phase becomes a consideration only if the painful symptoms have not yet resolved within approximately 10 days of the previous treatment. All the previous treatment should be continued with the possible addition of a physician administering steroid injections, in two week intervals. Further restriction of activity may be necessary. If deconditioning of the athlete becomes a concern during this phase, he/she can participate in other activities like swimming or cycling, as long as the activity remains pain free. The third and final phase, the Long Term Phase is seen as an optimistical stage. This phase begins only after the pain and inflammation symptoms have resolved. This phase is typically in close association with the athletes return to sport. During this stage, it is very important to prevent any reoccurrence of the resolved symptoms. So a gradual return to play with extensive specific stretching exercises both before and after workout is essential. If at this point pain and inflammation has not significantly reduced, a return to play is not a good option yet. Your trainer or physician should recommend further rest or surgery as a last resort.

Using a PattStrap: The principle behind the PattStrap knee strap is to compress the tendons surrounding the knee. This can redistribute tension, thus decreasing the localized stress any particular tendon must assume while contracting. The PattStrap knee strap helps keep the patella and patella tendon properly aligned. It also is effective in reducing the friction caused by the ITB passing over the outside of the knee, hence reducing the pain and Inflammation of your ITB Band.

Whether PattStrap knee strap is effective for you or not depends on several factors.
First, of course, you must have a correct diagnosis of your problem. If you actually have an avulsion fracture (when the tendon tears away a piece of the bone) of the patella, a strap won’t do much good.
Second, you must wear the Patt Strap properly; instructions are included with with the strap, on the PattStrap ordering page, and in a video online on this site, but it’s also good idea to have a doctor or athletic trainer demonstrate.
Third, you must take other steps to address the root cause of your injury, such as by reducing your mileage and/or intensity, icing the inflamed area and taking anti-inflammatory medications. See a sports medicine professional for advice on the best treatment for your specific injury.

Surgery: Surgery is contemplated and seen only after many attempts of non operative measures failed to relieve symptoms. Surgery is usually only required for those individuals who are unwilling for many reasons, some very valid to modify their sports participation. The surgery consists of making a 2cm incision in the posterior fibres of the iliotibial band. This loosens the tendon some what but mostly allows for space for the band to pass over the lateral femoral epicondyle without much of the friction. Iliotibial band friction syndrome (ITBFS) is an overuse injury that is most common in those athletes that entertain highly repetitive running sports. It is seen in a variety of athletes from soccer players to cyclists. It is the inflammation of iliotibial band as a result of friction with the lateral femoral epicondyle. The injury is easily detectable and the proper treatment and rehabilitation should be diagnosed. The injury should be first be treated in a conservative manner by initiating the progression of rest, stretching, and the moderate use of medications only if directed by a physician. If all conservative attempts fail to achieve results then surgery might have to be necessary.

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