Iliotibial band friction syndrome

Iliotibial Band Friction Syndrome

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. In greater detail I will be discussing the causes of this injury
specifically the biomechanics, anatomy and symptoms involved, also ways of
preventing this injury by identifying common training errors and the appropriate
training modifications needed, and finally a variety of ways for treatment and
rehabilitation to help improve the injury.
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.

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.
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