Iliotibial tract syndrome

Iliotibial band friction syndrome is an overuse injury mainly affecting runners

• also described as runner's knee
  • iliotibial band friction syndrome is an overuse injury well recognized as a common cause of lateral knee pain
  • particularly common in runners and cyclists, though it also occurs in weightlifters, skiers and soccer players
• iliotibial band (ITB) or tract is a lateral thickening of the fascia lata in the thigh
  • proximally it splits into superficial and deep layers, enclosing tensor fasciae latae and anchoring this muscle to the iliac crest
    • it also receives most of the tendon of gluteus maximus
    • ITB is generally viewed as a band of dense fibrous connective tissue that passes over the lateral femoral epicondyle and attaches to Gerdy's tubercle on the anterolateral aspect of the tibia
• main symptom is lateral knee pain proximal to the joint line during exercise
  • running downhill, footstrike occurs at approximately 30 degree flexion in the knee and may aggravate the pain. At this angle the posterior part of the iliotibial band passes over the lateral epicondyle of the femur and may aggravate the pain
    • pain is due to friction between the iliotibial band and the lateral epicondyle of the femur
  • proposed predisposing aetiological factors are excessive mileage. running on crowned roads, sudden increase in mileage, caws feet, genu varum, tibia1 varum, rearfoot and/or forefoot varus, and leg length discrepancy

Diagnosis:

• diagnosis of ITB friction syndrome is based on clinical examination
  • patients typically present with tenderness over the lateral femoral epicondyle and report a sharp, burning pain when the practitioner presses on the lateral epicondyle during knee flexion and extension
    • pain is particularly acute when the knee is at 30 degrees of flexion

Management:

• non-operative surgical treatment consists of reduction and/or changing of activity, correction of structural abnormalities. cooling of the inflamed area, administration of anti-inflammatory medication, steroid injections and physical therapy including stretching
• surgery can be considered after unsuccessful non-surgical treatment

Reference:

• 1) Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med 2005;35, 451-459.