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ITB syndrome     

 

ITB syndrome is a very common injury in cyclists and runners as well as increasing numbers of weightlifters, skiers and footballers.

 

It is commonly regarded as a syndrome in which the ITB rubs against the femoral epicondyle at the knee causing inflammation and pain.

itb

 

Anatomy 

 

Attachments:

 

The ITB has been shown to be essentially a continuation/thickening of the Fascia Lata (fascia in outer thigh) which encloses the Tensor Fascia Lata (TFL) muscle.

 

The TFL muscle provides movement control/assistance to the hip and knee during certain movements.

 

As the ITB is a continuation of the TFL, contractions of the TFL will directly affect the ITB and therefore stiffness of the TFL means stiffness of the ITB.

 

Symptoms of ITB syndrome:

 

  • Tenderness over the outer part of the knee (lateral femoral epicondyle)
  • Often a sharp or burning pain is felt especially when touched.
  • Pain particularly when knee is bent to around 30degrees.
  • Pain with running (mostly on heel strike)
  • Can worsen with time of running.

 

Research from Fairclough et al, 2006,  showed that the pain seen in people with ITB syndrome was not, as initially thought, due to the rubbing of the ITB over the bone. The pain was actually due to a compression of the ITB over highly innervated fat tissue sat between the bone and the ITB.

 

One of the most important things to take note of is that the ITB is NOT able to move and contract on its own and therefore cannot simply tighten on its own. So, assessment and treatment of ITB syndrome needs to focus on factors surrounding the ITB and not the ITB itself.  These include:

 

  • TFL tightness
  • Hip Flexor weakness- as TFL also helps move the hip into flexion, if your hip flexors are weak you may rely on TFL to do the work which will cause it to shorten over time.
  • Gluteal muscle weakness- can contribute to genu valgum (knocking knees) during movement (see the diagram below).
  • Biomechanics (movement during activity)- any movement faults resulting from factors such as abnormal foot positioning, muscular tension, muscular weakness etc. have the potential to lead to ITB syndrome.
  • Core stability- Reduced core stability along with gluteal weakness can have a detrimental effect on hip stability.

 

knee valgus

Foam Rollering?

 

I’m sure many of you have heard of foam rollering for ITB syndrome. If you are intending to foam roller the ITB, based on the research it may not be of much use unless you focus on the TFL muscle of the hip, however, you need to be cautious due to compressive forces acting around gluteal muscle tendons. The best advice I can give is to consult a relevant therapist prior to rollering for ITB syndrome to make sure that it will be helping and not hindering as it will depend on the individual in question.

 

Treatment of ITB syndrome

 

As we have mentioned, the causes of ITB syndrome are not necessarily simple and require a full and detailed assessment before any real advice can be given for rehab. Factors such as muscle tension, muscle strength, joint restrictions etc will be looked at in depth as part of the assessment. It may also include a detailed look at your Biomechanics and gait (Video Gait Analysisto establish any abnormalities. Pressure plate technology and slow motion analysis is occasionally used to assess biomechanics in more detail.

 

Treatments such as soft tissue release, joint mobilisation, ultrasound and home rehab programmes can be relevant; however, these will be very much based on what is found during the assessment itself.

 

If you need any more advice regarding knee pain or ITB syndrome feel free to give me (Luke) a call on 01223832808. We are a clinic based in Sawston, Cambridgeshire. CB22 3BG.

 

 

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