From the Guidelines
Iliotibial band syndrome (ITBS) is a common overuse injury affecting the lateral knee, primarily seen in runners and cyclists, and its management should prioritize a multidisciplinary approach to reduce the risk of recurrence and improve outcomes in terms of morbidity, mortality, and quality of life. The condition occurs when the iliotibial band, a thick band of tissue running from the hip to the knee, becomes irritated and inflamed due to repetitive friction against the lateral femoral epicondyle 1. Key highlights of ITBS include its characteristic lateral knee pain that typically worsens during activity, especially when running downhill or cycling for prolonged periods. Diagnosis is usually clinical, based on history and physical examination, with pain reproduced by the Noble test (pain with knee flexion at 30 degrees while applying pressure to the lateral femoral epicondyle) 1.
Treatment and Prevention
Treatment of ITBS is primarily conservative, including:
- Relative rest
- Ice
- Anti-inflammatory medications like ibuprofen (400-600mg three times daily with food for 1-2 weeks)
- Physical therapy focusing on hip abductor strengthening, flexibility exercises, and correcting biomechanical issues 1 Foam rolling the IT band may provide symptomatic relief. Most cases resolve within 4-6 weeks with proper management, though persistent cases may benefit from corticosteroid injections. Prevention strategies include proper warm-up, gradual training progression, appropriate footwear, and addressing biomechanical factors such as overpronation or leg length discrepancies 1.
Return to Running
When returning to running after a tibial bone stress injury, it is essential to follow a gradual and individualized approach, considering factors such as pain, risk of location, grade of injury, and the athlete's risk profile 1. The return to running process should be shared between clinicians, coaches, and athletes, and should involve addressing the athlete's risk profile and managing risk by balancing the athlete's interests and reinjury prevention. A multidisciplinary approach is essential to reduce the risk of recurrence, and should include addressing biomechanical abnormalities and muscle imbalances potentially contributing to the initial injury 1.
Biomechanical Factors
Biomechanical factors, such as excessive hip adduction and rearfoot eversion angles, can contribute to the development of ITBS and tibial bone stress injuries 1. Addressing these factors through running gait analysis and retraining, as well as hip and proximal strengthening, can be beneficial in preventing and managing these injuries. Plyometric training, such as jumping or hopping, can also be highly osteogenic and energy efficient, and may be beneficial for improving lower extremity bone mass during advanced stages of the return-to-running process 1.
Conclusion is not allowed, so the response will be ended here.
From the Research
Highlights of Iliotibial Band Syndrome
- Iliotibial band syndrome (ITBS) is a common injury in runners and other long distance athletes, characterized by lateral knee pain caused by inflammation of the distal portion of the iliotibial band 2, 3.
- The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon, and repetitive flexion and extension of the knee can cause the distal iliotibial band to become irritated and inflamed 3.
- Symptoms of ITBS include diffuse lateral knee pain, and the diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities 3, 4.
- Treatment options for ITBS include:
- Conservative management: rest, stretching, pain management, and modification of running habits, which can produce a 44% complete cure rate, with return to sport at 8 weeks and a 91.7% cure rate with return to sport at 6 months after injury 2.
- Surgical therapy: excision or release of the pathologic distal portion of the iliotibial band or bursectomy, which can show a 100% return to sport rate at both 7 weeks and 3 months after injury 2.
- Corticosteroid injections: can be considered if visible swelling or pain with ambulation persists for more than three days after initiating treatment 3.
- Ultrasound guided local corticosteroid injection: can be effective in alleviating symptoms in patients who do not respond to conservative treatment 5.
- Despite various treatment options, there is still controversy about the pathogenesis of ITBS, and no uniform diagnostic criteria or specific indications for various therapies have been established 6.