iliotibial band syndrome

The iliotibial band in human beings serves the purpose of providing stability to the knee by working in conjunction with flexion at the level of the knee joint. When an excessive friction occurs between the iliotibial band and either the knee or hip bones, it results in an injury to the thigh which is described in medical terms either as iliotibial band syndrome or iliotibial band friction syndrome.

The injury manifests itself with a shooting pain which is experienced in the side of the knee or the hip traveling downwards which also results in the heel or foot pain. The pain accentuates while engaged in such active types of sports as cycling, running, trekking or weight-lifting.

This syndrome is a commonly found condition in women during pregnancy the reason for which is traced to the loosening of the tendons and shifts that occur in the distribution of weight in their bodies during various stages in pregnancy, both due to weight gain and hormonal changes. In a vast number of cases, this syndrome affects both the knees resulting in foot pain but its occurrence cannot be ruled out in the hip joint as well.

How does iliotibial band syndrome occur? Medically, this is related to the foot structure of the individuals, and such structure is traced to an imperfection in the length between the two legs, known as a limb length discrepancy. Muscle imbalances would also make a person prone to this injury. Iliotibial band syndrome could also be man made in that it can be attributed to faulty ways of running.

For example, a runner who runs primarily on "pitched" roads or runs circular tracks on a regular basis will tend to create an artificial limb length discrepancy as well as a muscle imbalance as one leg will tend to work harder than the other. Both of these factors can result in iliotibial band syndrome. Intoeing of the feet in an excessive angle while cycling may also create this condition.

Sometimes, nothing more than moving the heels inward while biking can relieve the symptoms. The syndrome is much more common in athletes who are involved in such sports as tennis, soccer, volleyball, etc., in whom the pain typically occurs in the lateral knee.

It is of utmost importance for any person who is diagnosed with this syndrome to immediately reduce or eliminate participating in their particular sport. While this would reduce the pain to some extent, a visit to an sports medicine specialist would also be indicated. Treatment would generally include oral anti-inflammatory medicine as well as possibly a cortisone injection in the area of most pain.

At this point the source of the problem needs to be identified. The syndrome may be a result of foot biomechanics in which case an orthotic would be indicated. The purpose of the orthotic is two fold. One is to balance the foot so it hits the ground at the proper angle and two, to help absorb the shock that is created when the foot hits the ground. Excessive shock which is not absorbed by the foot may travel up the leg and aggravate the iliotibial band.

Although I recommend both prescription and medical grade orthotics to my patients for various conditions, I have found that people suffering from iliotibial band syndrome generally require a prescription orthotic in order to get the maximum amount of biomechanical correction and the maximum amount of shock absorption.

Once orthotics have been prescribed it is also important to observe the athletic technique of the patient. Many times poor technique can lead to irritation of the illiotibial band. Particularly as we get older and the body becomes less adaptive to the stresses placed on it, proper technique along with proper preparation such as stretching and icing before and after the activity becomes much more important. Iliotibial band stretching should be done on a regular basis in order to keep the ligament from over tightening.

When being treated for iliotibial band syndrome it is important for your doctor to rule out other causes such as lateral meniscus tear, ligament sprain or possibly a stress fracture.

REFERENCES

Hospital for Special Surgery

The British Medical Journal

Cedars-Sinai