1. ITB Syndrome

2. Normal Anatomy Origin Insertion Gluteus Maximus Gluteus Medius
Tensor Fascia Latae
Ilium
Insertion
Lateral Femoral Condyle
Tibial Infracondylar Tubercle

3. Normal Anatomy Continuation of TFL tendon
Thickened aspect of lateral fascia
Non-contractile structure

4. Pathology
Friction of ITB against femoral epicondyle with repeated flexion and extension
Compression of distal ITB against lateral femoral condyle
Irritation of lateral structures
Fat
Connective tissue
ITB Bursa

5. Mechanism of Injury ITB Compression “Impingement Zone”
30 degrees
Eccentric TFL
Eccentric Glute Max
Stance phase
Repetitive movement
Long distance running
Cycling
Hill walking

6. Mechanism of Injury Posterior fibre irritation
Irritation of Lateral Synovial recess
Periosteum inflammation
Insufficient recovery

7. Classification Compression Tissue Irritation
Lateral structures
ITB itself
Lateral condyle
Tissue Irritation
Synovial recess
Bursa
Cyst
?Inflammation presence in condition
?Anterior-Posterior movement or “snapping”
Lavine, 2010

8. Associated Pathologies
PFPS
Lateral ligament injury
Bursitis

9. Subjective Lateral knee pains Increase throughout activity
Some pain on bending activities
Increases with repetition
Can have swelling
?Tightness sensation

10. Objective - Knee Observation ROM Local swelling Increased Q –angle
Valgus
Anterior pelvic tilt
ROM
Full ROM
Pain at 30 degrees flexion

11. Objective - Knee Squat/Single Leg Squat Palpation Pain at 30 degrees
Weight shift
Valgus
Palpation
Distal ITB tenderness
Lateral condyle tenderness
ITB tension

12. Objective - Hip Decreased abductor strength Contralateral Pelvic Drop
Dynamic Knee Valgus
Fredericson et al, 2000

13. Objective - Foot Excessive calcaneal eversion Lack of supination
Tibial Internal Rotation
Ferber et al, 2010

14. Special Tests Ober’s & Modified Ober’s Test Noble Compression Test
Side lying
Fix pelvis
Take hip into extension
Release hip
Positive if does not pass midline
Noble Compression Test
Patient supine
Flex knee to 90 degrees
Add compression
Extend knee
Symptoms approx 30 degrees

15. Further Investigation
MRI

16. Management Reduce pain Reduce insertional compression
Correct imbalances
Improve kinetic chain function

17. Conservative - Management
94% improvement conservative treatment
NSAIDs
0-7 days with treatment
Cryotherapy
Pain relief
McNichol et al, 1981
Schwellnus et al, 1991

18. Conservative - Management
Tissue Release
Foam rolling
TFL
Adductors
Soft tissue techniques
Massage
Not DTF
Not Stretching
Schwellnus et al, 1992
Chaudry et al, 2008

19. Conservative - Management
Muscle Activation
Clam shells
Hip abductions
Strengthening
Band Walks
Hip thrusts
Tibialis posterior
Cambridge et al, 2012

20. Conservative - Management
Biomechanics
Movement patterns
Single leg squat
FMS
Gait assessment/re-education
Stride width
Cadence
Footwear
Orthotics
Ramp angles

21. Conservative - Management
Adjuncts
Acupuncture
Electrotherapy
Supports
Taping

22. Conservative Management
Reduce pain, swelling
Prepare tissues
Restore Normal ROM
Activate muscles
Correct Movement Patterns

23. Surgical - Management Lateral Release Injection
Transect posterior half
Bursa removal
Release of lateral retinaculum
Injection
Corticosteroid
30% improvement
Drogset et al, 1999
Gunter & Schwellnus, 2004

24. References
Cambridge ED, Sidorkewicz N, Ikeda DM, McGill SM. (2012). Progressive hip rehabilitation: the effects of resistance band placement on gluteal activation during two common exercises. Clin Biomech. 27(7);
Chaudry H, Schleip R, Zhiming J, Bukiet B, Maney M, Findley T. (2008). Three-Dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 108;
Drogset JO, Rossvoll I. Grontvedt T. (1999). Surgical treatment of iliotibial band friction syndrome. A retrospective study of 45 patients. Scand J Med Sci Sports. 9;
Ellis R, Hing W, Reid D. (2007). Iliotibial band friction syndrome – A systematic review. Manual Therapy. 12;
Ferber R, Noehren B, Hamill J, Davis I. (2010). Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. Journal of Orthopaedic & Sports Physical Therapy. 40(2); 52-60
Fredericson M, Cookingham CL, Chaudhari AM, Dowdell BC, Oestreicher N, Sahrmann SA. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine. 10(3);

25. References
Gunter P, Schwellnus M. (2004). Local corticosteroid injection in iliotibial band friction syndrome in runners: a randomised controlled trial. British Journal of Sports Medicine. 38; 269–72
Lavine R. (2010). Iliotibial band friction syndrome. Curr Rev Musculoskelet Med. 3; 18-22
McNicol K, Taunton J, Clement D. (1981). Iliotibial tract friction syndrome in athletes. Canadian Journal of Applied Sport Science. 6(2);76–80
Schwellnus M, Theunissen L, Noakes T, Reinach S. (1991). Anti-inflammatory and combined anti-inflammatory/analgesic medication in the early management of iliotibial band friction syndrome. South African Medical Journal. 79; 602–6
Schwellnus M, Mackintosh L, Mee J. (1992). Deep transverse frictions in the treatment of iliotibial band friction syndrome in athletes: a clinical trial. Physiotherapy. 78(8); 564–8