Introduction to Iliotibial Band Syndrome
Iliotibial Band Syndrome (ITBS) is a widely prevalent condition amongst sportsmen and professional athletes. It is caused by an inflammation of the distal iliotibial band that causes pain in the lateral aspect of the knee joint. The incidence of ITBS varies from 5 to 14% and is more prevalent in men than in women. Apart from recreational and professional runners, ITBS affects cyclists, football players, basketballers, rowers and hockey players alike. The primary risk factors for ITBS are those that cause biomechanical alterations in the anatomy of the lower limbs. These include weak hip abductors, a tight iliotibial band, an obtuse angle of flexion at the knee joint, and eversion of the rearfoot.
Pathophysiology of ITBS
The distal iliotibial band is a longitudinal thickening of the underlying fascia lata which splits into superficial and deep layers. The iliotibial band surrounds a muscle known as the tensor fascia lata and affixes to the iliac crest (part of the hip bone). The friction between the iliotibial band and the lateral femoral epicondyle which it passes over, is responsible for the resultant inflammation that causes pain in the lateral aspect of the knee joint. ITBS is preceded by activities that involve repetitive flexion at the knee joint such as running or cycling. The iliotibial band is chronically displaced forwards and backwards over the lateral femoral epicondyle. This repetitive movement results in friction which then leads to mechanical irritation and inflammation. Finally, this manifests as knee pain localized to the lateral aspect.
Diagnosis of ITBS
The diagnosis of ITBS hinges upon a good patient history and targeted physical examination. A complete examination of the knee is required to exclude other conditions affecting the lateral knee such as a lateral meniscal tear, a stress fracture or patellofemoral syndrome. Radiographs of the knee are useful in this regard. In cases of refractory ITBS, MRI is useful in diagnosis as well as in ruling out concomitant problems which may be responsible for the persistent symptoms, such as articular cartilage injuries, meniscal injuries and cysts. A more cost-effective imaging modality such as ultrasound may be a better alternative to MRI in measuring the thickness of the iliotibial band.
Management of ITBS
The management approach to ITBS can be classified into conservative and surgical therapeutic options. The former category consists of protracted bed-rest and cessation of the offending activity, stretching exercises as prescribed in a physiotherapeutic regimen, pain-relief with non-steroidal anti-inflammatory drugs (NSAIDS) such as Ibuprofen or Arcoxia, and a tailored modification of athletic activities. Surgical options for ITBS include the excision of the distal portion of the iliotibial band as well as a bursectomy. However, these options are typically reserved for ITBS which has failed to resolve after all conventional approaches have been considered and/or implemented. One alternative offered by our clinic, is that of corticosteroid injections. These are guided by ultrasound and provide pain-relief for months at a time
References
- Aderem, J. and Louw, Q. A. (2015) ‘Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review’, BMC musculoskeletal disorders, 16, pp. 356-356.
- Beals, C. and Flanigan, D. (2013) ‘A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population’, Journal of sports medicine (Hindawi Publishing Corporation), 2013, pp. 367169-367169.
Fredericson, M. and Wolf, C. (2005) ‘Iliotibial band syndrome in runners: innovations in treatment’, Sports Med, 35(5), pp. 451-9. - Hong, J. H. and Kim, J. S. (2013) ‘Diagnosis of iliotibial band friction syndrome and ultrasound guided steroid injection’, The Korean journal of pain, 26(4), pp. 387-391.
- van der Worp, M. P., van der Horst, N., de Wijer, A., Backx, F. J. and Nijhuis-van der Sanden, M. W. (2012) ‘Iliotibial band syndrome in runners: a systematic review’, Sports Med, 42(11), pp. 969-92.