Iliotibial Band Syndrome
The iliotibial band is a thick band of tissue running from the upper and outer part of the hip to the outer part of the upper shin bone. The tissue is formed from the structures connecting the tensor fascia lata muscle and the gluteus maximus muscle.
The normal function of the iliotibial band is the stabilization of the knee joint during the bending and straightening of the knee. The constant overuse of the iliotibial band in activities such as long-distance running and cycling causes the band to rub against the bony prominence of the lower end of the thigh bone. The friction results in inflammation of the iliotibial band.
Besides chronic overuse, a sudden increase in activity may also result in an iliotibial band syndrome. The weakness of the muscles on the outer side of the thigh is a common cause of iliotibial band syndrome as the weakness results in an increased stretching force on the band.
Other causes which have been implicated include running on uneven surfaces especially which slope to one side. Some patients may have a tight iliotibial band by birth resulting in excessive stretching and inflammation.
The symptoms of iliotibial band syndrome are especially worse on walking/running, especially when the heel strikes the ground. The pain is usually described as a sharp pain that may or may not radiate down the leg or up the thigh. Some patients may also report a snapping sensation of the knee while bending or straightening the knee.
There may be an associated swelling on the outer part of the knee. Occasionally there may be redness or warmth on the outer aspect of the knee. The symptoms may be worse on navigating the stairs.
The diagnosis of iliotibial band syndrome by the physician involves a detailed history and thorough examination of the knee joint. The physician may perform certain physical tests to identify the tightness of the iliotibial band. The physician may also perform more physical tests including examination of the lower spine to rule out other causes of pain.
Physical examination may involve tests such as ober test and noble compression test. The Ober test involves the patients lying on the side of the normal knee.
The examiner physician bends the knee at 90 degrees and places the thigh in line with the body but lifts the thigh up sideways. The patient is then requested to try to move the thigh inward towards the ground. Inability to move the thigh past a level may indicate iliotibial tightness.
Another test known as noble compression test involves testing the patient while he/she lies with their back on the examining table. The physician bends their knee at 90 degrees and tries to straighten it while applying pressure over the outer side of the knee. A positive test involves pain at 30-40 degrees of knee flexion.
The examining physician may also request imaging studies such as an MRI or ultrasound to aid in the diagnosis and rule out other causes. Other causes of pain on the outer side of the knee may include degenerative joint disease, patellofemoral stress syndrome, damage to the structures forming the knee joint such as ligaments and meniscus.
The treatment of iliotibial band syndrome is mostly nonsurgical. Activity modification is the first step of managing iliotibial band syndrome. The activity modification may involve complete cessation of the offending activity or modification in the form of decrease in intensity, frequent rest, changes to other forms of activity, etc.
Other conservative forms of treatment such as icing, heat therapy, physical therapy and ultrasound therapy etc may be used to decrease the pain and inflammation. Non-steroidal anti-inflammatory medications such as aleve and ibuprofen may be used to reduce pain.
Physical therapy is done to improve flexibility and strength of the muscles. The improvement of the strength of the hip abductor muscles is linked with improved stability of the hip that may lead to improved function of the iliotibial band.
In rare circumstances, surgical management may be required for the treatment of iliotibial band syndrome. The surgery may involve cutting a small part of the band near the knee to increase the length of the band. Speak with your orthopedic surgeon regarding the best management for your symptoms.