Iliotibial band syndrome

General information

Iliotibial syndrome develops due to overloading of the broad fascia of the thigh. It generally occurs in athletes, cyclists, runners, and people who like frequent and long walks. With the syndrome, there is pain along the outer surface of the knee joint. The disease is amenable to conservative treatment. The iliotibial syndrome can cause discomfort and can also bother athletes, who may have worse results in competitions due to the development of this problem. 

A “runner’s knee” injury, which causes intense painful sensations on the outside of the joint, is common among athletes. The pain occurs with frequent repetitive flexion-extension of the leg due to overloading of the broad fascia of the thigh. Additional signs of iliotibial tract syndrome can be burning, swelling of the affected area, and clicking during movement. Treatment is carried out by conservative therapy.

Definition

The iliotibial tract is the fascia that runs from the outside of the knee to the iliac bone. During running or cycling, it can hit the lateral epicondyle of the tibia, which leads to intense pain sensations. The following factors contribute to the development of runner’s knee syndrome:

• long-distance running on inclined surfaces;
• wrong technique;
• weak muscles in the thighs and shins;
• knee injuries;
• congenital anatomical features (valgus deformity);
• flat feet.

The main symptom of iliotibial tract syndrome is pain that increases when extending the leg during running, especially downhill running. At the initial stage of the disease, moderate discomfort is felt, but without treatment, the pain syndrome becomes permanent. It is often accompanied by a burning sensation in the knee, clicking when flexing and extending and swelling.

Anatomy

The iliotibial tract is a long, thick band of connective tissue (more correctly called the thickening of the muscular fascia of the lower limb) that serves to connect the main extensors and flexors of the thigh (gluteal muscles and the thigh broad fascia tensor muscle) to the lower leg. More specifically, it connects at the top to the tendons of the gluteus maximus, the main hip extensor, and the tensor fascia major (a short, strap-like muscle that sits between the top of the pelvis and the femur), the stabilizer and abductor muscles of the thigh, and at the bottom to the top of the tibia, just below the knee. In this way, it helps stabilize and control not only the hip but also the knee joint. This is most relevant for runners, as it stabilizes the hip and knee while the foot touches the plane of support.

The iliotibial band runs parallel to the quadriceps and hamstring muscles. The most common location of pain localization is the outside of the knee, just above the knee joint. However, this is not the only location of pain localization: sometimes, pain can occur higher up the tract, along the thigh, or even near the greater trochanter of the femur. Regardless, in most cases, the iliotibial syndrome is accompanied by severe pain localized in the lateral part of the knee.

Causes of Iliotibial Tract Syndrome

Iliotibial Tract Syndrome is most often associated with repetitive knee joint movements such as walking, running, and bicycling. According to some reports, the problem is also thought to occur when the knee is bent outward.

Other reports have suggested that patients are thought to have a predisposition to develop Iliotibial Tract Syndrome, associated with congenital foot pronation and other congenital anomalies.

Athletes with a weakened gluteal muscle also often develop Iliotibial Tract Syndrome. This muscle is thought to control the movement of the hip, and if it does not do its job, the hip tends to turn inward, making it unfavorable in terms of loading in the external condyle region.

The most common predisposing factors for this disease are considered to be:

• The difference in leg length. 
• Running downhill for long periods.
• The structure of the foot. 
• Errors in training intensity – increasing volume or intensity too quickly.
• Muscle imbalance – especially the quadriceps, to the detriment of the hamstrings. 
• Factors related to running/walking style – e.g., clubfoot, valgus knees, etc.

Symptoms of Iliotibial Tract Syndrome

The main symptom in the development of iliotibial tract syndrome is pain. The pain is localized over the external condyle of the thigh (pain in the thigh from the outside in the knee joint area). Also, with this pathology, a slight swelling in this area can be felt. Patients sometimes note small faint sounds in this area or sensations like crepitation (crunching).

Diagnosis of Iliotibial Tract Syndrome

On examination, the main problem is usually soreness in the area of the external condyle of the femur. There are no sounds or visible swelling at the time of examination. The doctor will often order an X-ray to rule out other diseases and problems in the knee joint. If there are doubts about the diagnosis, the doctor may prescribe an MRI of the knee joint.

Treatment of iliotibial tract syndrome

Conservative treatment

In most cases, iliotibial syndrome is treated conservatively. The treatment is elementary: cold in the acute period, heat in the chronic period, phonophoresis, and anti-inflammatory external medications from physiotherapeutic procedures. The main purpose of physiotherapeutic procedures is to relieve pain and swelling in the knee joint area, namely the area of the external condyle of the femur.

Therapeutic gymnastics:

Therapeutic exercises are performed under the supervision of a therapeutic gymnastics instructor. Exercises used in iliotibial syndrome are muscle-stretching exercises in combination with a special knee brace. These exercises allow stretching and toning of the gluteal and thigh muscles.

Surgical treatment 

Surgical treatment is rarely used for this condition. The aim of surgical treatment is to remove the bursa and lengthen it using various methods of repair of the iliotibial tract.

All these treatment options are available in more than 750 hospitals worldwide (https://doctor.global/results/diseases/iliotibial-band-syndrome). For example, running injuries surgical treatment can be done in these countries for following approximate prices:

Turkey $1.3 K in 26 clinics

Germany $6.6 K in 43 clinics

United States $7.3 K in 17 clinics

China $9.8 K in 8 clinics

Israel $10.3 K -in 16 clinics.

Rehabilitation of Iliotibial Tract Syndrome

Rehabilitation aims to return to regular physical activity after the disease has been identified and treated. When the acute stage is over, physiotherapy treatments are used. Muscle-strengthening procedures such as massage are used. Therapeutic gymnastics is also performed to maintain muscle tone and correct muscle imbalances, such as weakness of the gluteus maximus and tensor muscles of the iliotibial tract. An orthopedist may recommend wearing orthopedic insoles to improve load distribution on the foot. Most often, treatment takes 4 to 6 weeks.