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| Ref: https://www.knee-pain-explained.com/lateral-knee-pain.html |
Some of my patients who are with knee pain include lateral pain, fore - knee cap pain, and medial pain. Lateral thigh evaluation is one of my routine standard physical assessments. I have found some patients with iliotibial band syndrome or iliotibial friction band syndrome (ITBS).
My patients with ITBS are distance runners, cyclists, and triathlon, the most. Recently, I found it in an ice hockey player. They have trigger points, high - tension, and tightness on the IT band that stretch IT band uses for prevention and treatment of ITBS.
6 Optionals of IT band stretching
Exercise #1: Stand stretch TFL & IT band
Exercise #2: Chop stretch TFL & IT band
Exercise #3: Half cross sitting stretch TFL & IT band
Exercise #4: Half kneeing stretch TFL & IT band
Exercise #5: Side lying stretch TFL & IT band (easy)
Exercise #6: Side lying stretch TFL & IT band (advance)
Anatomically, the IT band is a thick tendinous big band that locates on the lateral thigh. It is a continuation of the tendinous portion of the tensor fascia lata (TFL) muscle with some contributions from the lateral gluteal muscles. The IT band has many distal attachments that span out to the lateral border of the patella (by way of epicondylopatellar ligament and patellar retinaculum), patellar tendon, lateral patellar retinaculum before its insertion on Gerdy’s tubercle of the tibia, the biceps femoris, and vastus lateralis.
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| IT band anatomy picture that has origin near hip joint and many insertions end around knee joint; ITB: IT band (Ref: https://www.researchgate.net/figure/The-iliotibial-band-and-site-of-injury-at-lateral-epicondyle-of-the-femur_fig1_51211560) |
The site of injury is near the insertion at the lateral epicondyle. Majority of the injury mechanism is repetitive friction and compression of the IT band against the lateral epicondyle. IT band sliding over the lateral femoral epicondyle, moving anterior to the epicondyle as the knee extends and posterior as the knee flexes, and remaining tense in both positions. Repetitive irritation can lead to chronic inflammation, especially beneath the posterior fibers of the ITB, which are thought to be tighter against the lateral femoral epicondyle than the anterior fibers. The critical friction angle of the knee occurs at or at slightly less than 30 degrees of knee flexion which is called ‘‘impingement zone’’ that associates during walking, running, and cycling.
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| Triathlon consists of swimming - biking - running Ref: https://www.drjimtaylor.com/ |
The intrinsic factors consist of leg - length discrepancies that the longer one is more risky, and biomechanics that are very strongly related to muscle performance include strength, endurance, flexibility, and segmental coordination. Strength of the gluteus medius and gluteus maximus muscles is important to control hip adduction and knee varus and valgus because strength deficits in the hip abductors are believed to play a role in the development of ITBS.
Extrinsic factors are related to training methods as well as running shoes or cycle fit. Several training factors have been related to ITBS, including excessive running in the same direction on a track, downhill running, a lack of running experience, abrupt increase in running distance or frequency, and running long distances.
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| Downhill running (Ref: https://www.runpacers.org/pasadena/downhill-race-training/) |
According to a subjective examination in my physiotherapy clinic, I have heard patients' stories, for example, change speed running immediately, increase distance immediately, not enough recovery, etc. For objective examination some patients never know the cause of pain, for example, weakness of hip abductor muscles, improper running shoes, etc.
One case came to see me with fore - knee pain who just bought popular and expensive running shoes. She is mid foot strike pattern and her shoes have a narrow outsole at mid and heel section. I informed her of two options; include, change the strike pattern to forefoot strike pattern, or change to new shoes which are wide mid and heel section outsole.
Clinical present with complaints of a sharp or burning pain roughly 2 cm superior to the lateral joint line. The pain may radiate proximally or distally. There usually is tenderness on palpation of the ITB 2 to 3 cm above to the lateral joint line. There may be local edema or crepitation. The pain always makes it difficult to go up - down stairs, bend knee, and sports performance drop.
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| Ober's test use for IT band tightness assessment (Ref: http://corebalancetherapy.com/wp-content/uploads/2013/09/Iliotibial-Band-Syndrome-review-PMR-2011.pdf) |
Michael and Adam (2006) classified ITBS recovery into 4 phases including acure, subacute, recovery - strengthening phase, and Return - to - running phase. Stretching exercises are suggested to start after acute inflammation subsides that mean they should start in the subacute phase.
The way to stretch is simple: stretch to the point where “tightness without pain” or “noticeable tension without pain” will hold at the point for 30 seconds of 3 - 5 repetitions in one muscle as demonstrated in the video. Stretching exercise is one of the important management parts of ITBS. However, gluteus medius and gluteus maximus strength is very crucial management part for prevention and treatment, as well.
Reference:
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