A few weeks ago, I had to write a short paper about a common lower limb injury and provide the mechanism for injury, muscles involved, treatment, and rehabilitation for the injury.
Below is the paper with the scientific resources to back up the paper. These resources came exclusively from peer-reviewed articles. So, if you were interested in knowing more about your favorite lateral fascia, here you go! It’s science.
(Image courtesy of Anaerobic.net)
(If you copy or quote any portion of this paper, you must cite me as a source and/or the sources cited within the paper and notated below)
Illiotibial band syndrome
By Abigail Bales
Illiotibial band syndrome (ITBS) is responsible for approximately 22% of lower extremity injuries.(5) It is especially prevelant in the growing number of both professional and amateur long-distance runners due to repetitive nature of the movement of the knee, specifically the flexion of the knee.(3) It is the most common lower-limb injury in long-distance runners. The illiotibial band is a thick fascia that extends from the muscle fibers of the gluteus maximus and medius as well as the tensor of fascia latae, over the lateral femoral condyle of the knee, and attaching to the infracondylar tubercle of the tibia.(2) The causes of the injury are multi-faceted, though most recent studies focus on hip adduction, knee internal rotation, hip flexion, and overall kinematics of the individual. Training factors and terrain can also contribute to cases of ITBS. All, in part, seem to be to blame. This suggests that weak hip abductors and glutes, improper form, and speed of the movement are the root causes of the injury.(1,3)
Athletes experiencing ITBS often complain of knee pain located near and around the lateral condyle of the femur and/or hip pain localized near or around the greater trochanter of the affected leg. In mild cases of ITBS, symptoms may come and go during various activities, dissipate during exercise, and become aggravated on certain terrains or during rest.(4) In its most severe form, many athletes will find the pain so severe that they are unable to participate in running or cycling activities entirely.
Surgery is rarely necessary and is not recommended as a treatment for ITBS. Common treatments include rest, reevaluation of training and mileage, strengthening exercises, stretching, and myofascial release techniques. There are conflicting theories about the role played by the hip abductors, and subsequent strengthening of them, in ITBS. While studies point more to over all body mechanics and running form as the root cause of the syndrome, including over-adduction of the hip, hip abductor strengthening is routinely part of the rehabilitative process prescribed by physical therapists.(1)
Dr. Michael Fredericson, a professor at Stanford University who has done extensive research on ITBS, found in his 2000 study that, “Long distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners” and found that “after 6 weeks of rehabilitation, 22 of 24 athletes were pain free with all exercises and able to return to running, and at 6-months follow-up there were no reports of recurrence.”(2) This study focused on improving gluteus medius and minimus strength (hip abductors) and stretching as a treatment for ITBS in males and females from the Stanford University Cross-Country and Track teams.
The literature calls for abductor strengthening exercises, such as side-lying lateral leg raises with ankle weights, side-stepping straight leg walking with resistance bands, in addition to foam rolling, stretching, and massage as the best and most common forms of treatment for ITBS. In addition to treatment, complete rest from hip flexion activities would be prescribed, with return to small amounts of activity over time, so long as symptoms did not return.(2) Gait analysis and speed of running are also to be considered as a part of the rehabilitation and preventative process since ITBS occurs less in faster runners,(3) presumably because their form is better than that of slower runners.
1. Ferber, Reed, PhD, CAT(C), ATC, et. al. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic and Sports Physical Therapy. February 2010. Vol 40 No. 2. 52-58.
2. Fredericson, Michael, M.D., et al. Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. July 2000. Vol 3. 169-175. PMID: 10959926. http://www.ncbi.nlm.nih.gov/pubmed/10959926
3. Fredericson, Michael, M.D. Illiotibial band syndrome in runners: innovations in treatment. Sports Medicine. 2005. Vol 5. 451-459. PMID: 15896092. http://www.ncbi.nlm.nih.gov/pubmed/15896092
4. Khaund, Razib M.D. Flynn, Sharon H., M.D. Iliotibial Band Syndrome: A Common Source of Knee Pain. American Family Physician. April 2005. Vol 8.1545-1550.
5. Linenger JMCC. Is iliotibial band syndrome overlooked? Physicians and Sports Medicine. 1992. Vol 20. 98–108.