Treatment of Iliotibial Band Syndrome Cameron Goodman & Will Clayton
Introduction
The Iliotibial Band (IT Band) Thick strip of connective tissue connecting several muscles in the thigh The IT band stabilizes the knee constantly as the leg moves Proximal End: at the tendons of the tensor fasciae latae and gluteus maximus muscles Distal End: lateral epicondyle of the tibia
Anatomy
Iliotibial Band Syndrome (ITBS) or Iliotibial Band Friction Syndrome (ITBFS) Result of a tight or inflamed IT band Pain occurs at the femur's lateral epicondyle May sideline an athlete for weeks or months MRI is only definite diagnostic tool
Causes Friction Traditionally, ITBS has been thought to be caused by the IT band rubbing against the femoral condyle as the knee flexes at about 30 flexion Compression However, research suggests that compression of the IT band and surrounding tissue against the knee as flexion occurs
Background
Significance Affects many long distance runners and cyclists Makes up 12% of all running injuries Most common running injury and one of the most common knee injuries More than 200,000 cases per year Large population underrepresented Previous research has shown no conclusive difference in treatments Length of studies Low Participation Retention
Current Treatments Physical Therapy/ Stretching RICE: Resting, Ice, Compression, Elevation Taping Anti-inflammatory drugs or Corticosteroids to reduce inflammation In severe cases, surgery is performed to remove inflamed tissue or to lengthen the IT band
Proposed Research
Goals Compare current treatment methods Increase pain relief around 30 of flexion Decrease recovery time Produce more data on treatment methods Retain participants Offer rewards
Methods 3 groups of 20-25 subjects (age 25-40) Control (untreated but affected) Traditional Methods (stretching, RICE, tape) Corticosteroids Each group will participate in running 10km on a treadmill 6 times evenly spaced over the course of 2 years (3x a year). Each subject s pain will be subjectively measured before and after each run on a 1-5 scale 1 being the least pain and 5 being the most pain Pain level will also be measured periodically throughout each week.
Methods Cont. Follow subjects 2 years after diagnosis Every four months the following will be measured Pain during Noble Compression Test MRI of IT band to observe inflammation Further Research Impact of ITBS on gait parameters after injury and treatment Impact of ITBS on leg strength after injury and treatment Recurrence of ITBS after complete treatment Effectiveness of combination treatments Design of a new device or treatment
Potential Pitfalls and Concerns Getting a large enough enrollment of subjects Possible occurrence of other, unexpected injuries during the study Accounting for variance from person to person (age, weight, height, lifestyle, etc.) Access to imaging machinery
Questions?
References Goon, Tom. Iliotibial Band Syndrome. RunningPhysio, Running Physio, 11 Mar. 2012, www.running-physio.com/itbs/. Iliotibial Band Syndrome: Treatment, Stretches & Hip Pain. (n.d.). Retrieved November 20, 2017, from https://www.emedicinehealth.com/iliotibial_band_syndrome/article_em.htm Nucleus Medical Media, Inc. Tendons of the Lateral Knee. Accessed Nov 20, 2017, https://www.cancercarewny.com/content.aspx?chunkiid=11738 Grau, S., Krauss, I., Maiwald, C., Axmann, D., Horstmann, T., & Best, R. (2011). Kinematic classification of iliotibial band syndrome in runners. Scandinavian Journal of Medicine & Science in Sports, 21(2), 184-9. Orchard, J., Fricker, P., Abud, A., & Mason, B. (1996). Biomechanics of Iliotibial Band Friction Syndrome in Runners. The American Journal of Sports Medicine, 24(3), 375-379. Martens, M., Libbrecht, P., & Burssens, A. (1989). Surgical treatment of the iliotibial band friction syndrome. The American Journal of Sports Medicine, 17(5), 651-654. Ellis, Hing, & Reid. (2007). Iliotibial band friction syndrome A systematic review. Manual Therapy, 12(3), 200-208. Gunter, P., Schwellnus, M., & Fuller, P. (2004). Local corticosteroid injection in iliotibial band friction syndrome in runners: A randomised controlled trial. British Journal of Sports Medicine,38(3), 269.
References Cont. Noehren, B., Davis, I., Hamill, J., 2007. ASB Clinical Biomechanics Award Winner 2006: Prospective study of the biomechanical factors associated with iliotibial band syndrome. Clinical biomechanics 22, 951-956. Holmes, J.C., Pruitt, A.L., Whalen, N.J., 1993. Iliotibial band syndrome in cyclists. The American Journal of Sports Medicine 21, 419-424. Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., Best, T.M., Benjamin, M., 2007. Is iliotibial band syndrome really a friction syndrome? Journal of Science and Medicine in Sport 10, 74-76. Falvey, E.C., Clark, R.A., Franklyn-Miller, A., Bryant, A.L., Briggs, C., McCrory, P.R., 2010. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scandinavian Journal of Medicine & Science in Sports 20, 580-587. Fredericson, M., Cookingham, C.L., Chaudhari, A.M., Dowdell, B.C., Oestreicher, N., Sahrmann, S.A., 2000. Hip Abductor Weakness in Distance Runners with Iliotibial Band Syndrome. Clinical Journal of Sport Medicine 10, 169-175.