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Iliotibial Band Friction Syndrome Physiotherapy

Iliotibial band syndrome (ITBS) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats)

Signs and symptoms

ITBS symptoms range from a stinging sensation just above the knee and outside of the knee (lateral side of the knee) joint, to swelling or thickening of the tissue in the area where the band moves over the femur.

The stinging sensation just above the knee joint is felt on the outside of the knee or along the entire length of the iliotibial band. Pain may not occur immediately during activity, but may intensify over time.

Pain is most commonly felt when the foot strikes the ground, and pain might persist after activity. Pain may also be present above and below the knee, where the ITB attaches to the tibia.

Causes

ITBS can result from one or more of the following: training habits, anatomical abnormalities, or muscular imbalances:

Training habits

• Spending long periods of time/regularly sitting in lotus posture in yoga. Esp beginners forcing the feet onto the top of the thighs
• Consistently running on a horizontally banked surface (such as the shoulder of a road or an indoor track) on which the downhill leg is bent slightly inward, causing extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Excessive up-hill and down-hill running
• Positioning the feet "toed-in" to an excessive angle when cycling. (Knee should be positioned between 30-35 degree to help avoid ITBS)
• Running up and down stairs
• Hiking long distances
• Rowing
• Breaststroke
• Treading water

Anatomical mechanism

Iliotibial band syndrome is one of the leading causes of lateral knee pain in runners.

The iliotibial band is a thick band of fascia on the lateral aspect of the knee, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, as it moves from behind the femur to the front of the femur during activity.

The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

Diagnosis

Diagnosis of iliotibial band syndrome is based on history and physical exam findings, including tenderness at the lateral femoral epicondyle, where the iliotibial band passes over the bone.

Treatment

While ITBS pain can be acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Physical therapy, and many of its modalities, can offer relief if symptoms arise.

Stretches used to help:

• Standing Stretch- 1.) Cross the uninjured leg over the injured one while standing. 2.) Lean towards the opposite side of the injured leg.
• Iliotibial band rope stretch - 1.) Put injured leg in the bottom of the rope, slowly raising it to the ceiling. 2.) Cross leg over the uninjured leg. 3.) Hold this position for 15 seconds, then release. 
• Hip Flexor Stretch - (Need a raised surface) 1.) Standing a small distance away from the front of a chair, take your right foot and place it on top of the seat. Your right leg should be bent at a 90 degree angle, with your left leg stretched straight behind you. 2.) After holding it for a couple of seconds, go back to a standing position. 3.) Repeat with opposite leg.
• Child's pose - 1.) Sit on your knees, with your knees spread outward. 2.) Bring your upper body between your knees with your arms stretched out as far as you can go. 3.) Hold it for 20 seconds then sit back up.

Strengthening exercises:

• Side-lying hip abductor exercise- 1. Lie on your side with the injured leg on top. 2. Both legs should be straight, then slowly raise injured leg up. 3.) Slowly bring your leg back down. 4.) Repeat steps 1-3 ten or more times.
• Clam Shells- 1.) Lie on your side, with your knees bent inward. 2.) Move your top leg up slowly. 3.) Lower your leg back down. 4.) Repeat 10+ times then switch legs.
• Single leg bridge- 1.) Lie on your back. 2.) Place your feet flat on the ground, where your legs is bent at a 90 degree angle. 3.) Straighten your right leg, and raise it off the ground. 4.) Raise your bottom off the ground and hold the position for 15+ seconds with your right leg still raised off the ground. 5.) Lower your bottom to the ground and repeat with left leg.
• Pelvic Drop Exercise- 1. Stand on a stool with the foot of the uninjured side on the stool, and the injured side hanging off the stool with the toes of your foot pointed upwards. 2.) Slowly lower your body down bending at the knees, until the heel of your foot touches the ground. 3.) Slowly straighten your leg to go back up. 4.) After repeating 10+ times, switch to where your injured leg is on the stool and repeat steps one through three.

Lunge Matrix (five different lunges)

• Front Cross Over Lunge- 1.) Keep your left foot planted firmly on the ground. 2.) Bring your right foot forward and position it in front of your left foot. 3.) Your right leg should be bent at a 90 degree angle. 4.) Repeat with opposite leg.
• Rotational Lunge- 1.) Standing with both feet planted side by side on the ground. Step forward with your right leg, with the knee bent at a 90 degree angle. 2.) Twist your upper body towards the right side (left elbow lined up with your right knee). 3.) Hold for a couple of seconds than twist back, and go back to the standing position. 4.) Repeat with opposite leg.
• Backward Lunge- 1.) Keep one foot on the ground. 2.) Bring your right foot behind you, bending it at a 90 degree angle. The front leg should be straight. 3.) Hold for a few seconds then repeat with opposite leg.
• Rotational Backward Lunge- 1.) Standing with both feet planted side by side on the ground. Step backward with your right leg, with the knee bent at a 90 degree angle. Left leg should stay straight. 2.) Twist your upper body towards the right side (left elbow lined up with your right knee). 3.) Hold for a couple of seconds than twist back, and go back to the standing position. 4.) Repeat with opposite leg.
• Lateral Lunge- 1.) Stand with both feet planted side by side. 2.) Take your right foot and step outward towards the right, bending your knee. 3.) Hold for a couple of seconds then bring your right foot back to the left, then repeat with the opposite leg.