ITB firction syndrome

iliotibial band SYNDROME - 腸脛靱帯（ちょうけいじんたい）シンドローム

 

I have come across a patient with suspected ITB syndrome and I have looked into a recent concept of ITB syndrome ^^ please post up any opinions or comments regarding this topic~~ 

 ランナーによく見られる疾患の中の一つに、腸脛靱帯（ちょうけいじんたい）シンドローム。　最近の診断そして治療法について、簡単に復習した内容をみていきましょう。

 ITB friction syndrome is a misleading name for this condition as recent studies have found that it is the bursa that is compressed in between ITB and lateral epicondyle that gives rise to the pain. concept of ITB being inflamed or damaged due to friction is therefore not a strong idea.

Hallmarks of ITBS were 

• ·         pain on weight bearing at 30° of knee flexion and

• ·         the exacerbation of pain after having run more than 2 miles or having hiked more than 10 miles. In summary, the subjective examination in cases of ITBS has the defining characteristics of lateral knee pain with repetitive knee activity usually in a weight-bearing position and associated overtraining issues.

• ·         diagnosis of ITBS by the history and tenderness localized at the lateral epicondyle of the femur or less commonly at the Gerdy tubercle. Concurrently, the patients did not have symptoms at the lateral joint line or popliteal tendon, and did not have signs of intraarticular disorders.

• ·         Positive Noble compression test (compression over lateral femoral epicondyle whilst flexing the knee from flexion 90 to extension (esp. pain provoked through 30degrees of knee flexion)

o    The investigators described this as the deceleration phase, which suggests that impingement occurs during eccentric loading of the iliotibial band during the weight-acceptance phase of running

• ·         Ober’s test postive on affected side

• ·         Modified Thomas test

• ·         A step down test or trendelenberg test

• ·         Prone glut max muscle test

·         clinical management of ITBS may involve training method to control frontal plane dynamics at the knee, in addition to assessing and treating transverse plane issues

·          (1) tensor fascia lata may substitute for the posterior fibers of the gluteus medius, and

·          (2) hamstring may substitute for the gluteus maximus

o   some research findings:

•  significant hip abductor strength deficits

• on average, patients in the ITBS cases were tighter in the iliotibial band than control runners when the Ober test was used

• an increased maximum knee internal rotation velocity in patients in the ITBS cases near exhaustion, which suggests fatigue-related factors

•  abnormal segmental coordination patterns

•  ITB is a postural muscle and the clinical finding is increased hip flexion in stance, along with a tendency for increased hip internal rotation

•  In contrast, the gluteus maximus and gluteus medius are phasic muscles with the tendency to become lengthened and weak

•  Subsequently, the taut and relatively stronger tensor fascia lata may dominate the weaker gluteus medius posterior and gluteus maximus, and may result in a postural pattern, including a Trendelenburg sign

Extrinsic factors

•  Training factors, including rapid increases in mileage and hill training, can lead to iliotibial band injury.

• increased impingement zone impact time during both downhill and slow running leads to ITBS and sprinting may result in relatively less impact time because of greater knee flexion beyond the impingement zone.

• less experienced runners with rapid changes in mileage were at risk for ITBS, but hypothesized that intrinsic factors, including strength deficits, were necessary for extrinsic factors to cause symptoms (これは結構重要なポイントですね。ただのオバートレーニングではないと）

 治療法は基本的のバイオメカニックス的は姿勢や動作を改善することのようです。もちろん、外的要因も考慮しなくてはいけないでしょう。

treatment includes:

• acute phase management 
• RICE 
• +/- iontophoresis, 
• NSAIDs
• corticosteroid if abovementioned treatments fail
• stretching of ITB
• strengthening according to physical examination findings (esp. glut med, max, VMO, and ankle stabilisers)
• soft tissue therapy to prevent adhesion
• recovery is between 4-6 weeks to return to sport