Iliotibial Band Syndrome

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Overuse injury thought to be due to friction between iliotibial band and lateral femoral epicondyle  tendonitis and/or bursitis. Common in runners (up to 12% of all running injuries).

Risk factors:
more common in less experienced runners
Excessive foot pronation  excessive internal rotation of tibia
More common in those with genu varum
Inappropriate training activities
leg length difference
running on cambered road
Lateral pelvic thrust during running
Tight iliotibial band

Clinical features:
Insidious onset of ache/pain or burning sensation over lateral aspect of knee – pain typically begins after a set distance of running after a pain free start to run. Should be able to palpate tenderness over lateral epicondyle, just above joint line (but not at joint line).
Ober’s test – for iliotibial band tightness – patient lying on side, hip neutral, knee flexed to 90 degrees. Hip is extended and then adducted. If iliotibial band is tight, get knee extension with the adduction
Rennes’ test – have patient squat with knee at 45º – pressure on lateral epicondyle  pain

Differential diagnosis:
Patellofemoral pain syndrome; popliteus tendonitis; lateral meniscus tear; superior tibiofibular joint strain; referred pain from lumbar spine.

Treatment:
RICE; activity modification; NSAID’s; reduction of pain and inflammation; correction of biomechanics; correction of training errors; evaluation of running shoes; stretching of iliotibial band; physical therapy; electrotherapeutic modalities; cortisone injection; surgical release and/or excision of bursa

 
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