KNEE

Pain in the knee? Might be ITB...

 

Laura Seger, SPTA

Laura is a Level III Physical Therapy Assistant student intern from the Community College of Rhode Island. She successfully completed her clinical affiliation at Ortho RI West Bay in May 2018.

During the spring and summer months, most folks will have more opportunities for outdoor fun! But a sudden increase in activity can be problematic if you’ve been hibernating all winter. One common injury for runners, cyclists, athletes and those who are stepping up their activity level is iliotibial band syndrome (ITBS). The iliotibial band (ITB) is a structure of connective tissue that runs down the lateral thigh from hip to knee. It is a piece of anatomy unique to humans, and helps stabilize us when walking upright. The IT band can sometimes become inflamed and cause pain at the lateral knee or hip. So what’s the best way to stay active and protect yourself?

ITBS is very treatable and rarely requires surgery. Because it is an overuse injury, it is important to rest and take a temporary break from high impact activities if you feel pain. This allows the IT band to recover and heal, and prevents damage to the tissue. Applying an ice pack may also help reduce pain and inflammation. If pain continues to persist, returns with return of activity, or worsens when walking downhill or down stairs, consult your doctor for a diagnosis.

Many doctors will refer patients diagnosed with ITBS to a physical therapist. A physical therapist will prescribe an exercise regimen with focus on stretching the IT band and hip musculature, and strengthening the hip, gluteal muscles, and core. Physical therapy may also incorporate modalities and massage to help promote healing.

Here are the best ways to minimize risk of developing iliotibial band syndrome.

● If you are increasing your activity level, increase it gradually. Running longer distances has been associated with increased incidence of ITBS, so make sure to slowly ramp up to your tolerance.
● Wear proper footwear. Supportive footwear reduces impact on joints, bones, and connective tissues which can help prevent injury.
● Stretch. Stretching the IT band helps decrease tightness in the tissue which will help protect it.
● Strengthen. Strengthening the muscles of the hip (especially the glutes and pelvic stabilizers) can help prevent ITBS. Add a hip abductor exercise to you regimen.
● Foam rolling. Foam rolling is a good technique for myofascial release at home.
● Train for form. Proper running form is important for preventing injury. Make sure you’re not over striding- you should land softly on the ball of your foot with a slight bend in the knee. Also lean forward slightly (about 10°) and keep your core engaged when running, this will prevent excessive IT band tautness.
● Rest when you need it. It’s okay to take a couple days off if you’re fatigued or experiencing pain. Allow your body time for rest and recovery.
● If you think something is wrong, consult your doctor. If you are experiencing pain that’s not resolving with rest, see a medical professional. ITBS is easier to treat earlier because chronic inflammation creates damage to tissues. An earlier intervention may mean shorter treatment time.

References
Noehren B, Schmitz A, Hempel R, Westlake C, Black W. Assessment of Strength, Flexibility, and Running Mechanics in Men With Iliotibial Band Syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(3):217-222. doi:10.2519/jospt.2014.4991.
Fullem BW. Overuse Lower Extremity Injuries in Sports. Clinics in Podiatric Medicine and Surgery. 2015;32(2):239-251. doi:10.1016/j.cpm.2014.11.006.
Baker RL, Fredericson M. Iliotibial Band Syndrome in Runners. Physical Medicine and Rehabilitation Clinics of North America. 2016;27(1):53-77. doi:10.1016/j.pmr.2015.08.001.
Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiology. 2017;46(5):605-622. doi:10.1007/s00256-017-2604-y.

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