REHABILITATION

ILIOTIBIAL BAND FRICTION SYNDROME

REHABILITATION By Christopher Norris, MSc MCSP

INTRODUCTION Iliotibial band syndrome (ITBS) is a com- mon cause of both lateral knee pain and lateral hip pain in sport. In running the incidence can be as high as 12% (1), and the condition is also seen in cyclists (2). ITBS over the knee occurs when the tight ITB repeatedly rubs over the lateral femoral epicondyle, and the bursa cover- ing it (Figs.1a+b), causing friction and tissue irritation. The condition here is often described as ‘runners knee’. The ITB has been shown to thicken from an aver- age of 2.5mm to 5.5mm at the knee, and to develop fluid beneath itself (3). Over the hip, ITBS occurs when the band rubs across the greater trochanter. In this case the condition represents external ‘snap- ping’ hip (coxa saltans) and may give rise to irritation or trochanteric bursitis. Internal snapping hip is a separate condi- tion affecting the iliopsoas tendon.

Although common in athletes, both con- ditions may also occur in the general pop- ulation. ITBS at the hip is a common cause of hip pain in middle age, with pain presenting at night when lying on the unaffected side. This position (adduction and medial rotation of the affected upper hip) places a stretch over the ITB and lengthens the posterior portion of the

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gluteus medius muscle. Pain is also often noticed with functional squatting actions (hip flexion) such as sitting down into a low chair.

ITBS is often paralleled by an altered mus- cle balance in the lower limb (4,5). The most common imbalance presenting as lengthening of the gluteus medius muscle

Gluteus medius

Tensor fascia lata

Gluteus maximus

Greater trochanter

and tightening of the iliotibial band and tensor fascia lata muscle.

STRUCTURE The deep fascia of the lower limb is collec- tively called the fascia lata. It attaches to the outer lip of the iliac crest between the anterior superior iliac spine (ASIS) and the posterior superior iliac spine (PSIS). In

Iliotibial band

Lateral femoral epicondyle

Figure 1a: Anatomy of the iliotibial band

Figure 1b: Friction points on the ITB www.sportex.net

©1999 Primal Pictures Ltd

©1999 Primal Pictures Ltd