A 32-year-old recreational runner self-referred to an outpatient physical therapy clinic with a complaint of right lateral knee pain. He first experienced pain 6 weeks ago. Two weeks prior to symptom onset, he initiated a marathon-training program. His symptoms have gradually worsened; now, he is no longer able to run due to the immediate onset of the same pain. The patient's medical history is otherwise unremarkable. Signs and symptoms are consistent with iliotibial band syndrome (ITBS). His goal is to return to training for the upcoming marathon.
Based on the patient's suspected diagnosis, what do you anticipate may be the contributing factors to his condition?
What examination signs may be associated with this diagnosis?
What are the most appropriate physical therapy interventions?
CORE STABILITY: Ability of muscles within the "core" region (abdomen, lumbar spine, pelvis, and hips) to protect (i.e., stabilize) the lumbar spine from potentially injurious forces and to create and/or transfer forces between anatomical segments during functional movements
ILIOTIBIAL BAND SYNDROME: Overuse injury primarily experienced by distance runners, marked by lateral knee or lateral hip pain
TRIGGER POINT: Taut band of contracted muscle fibers within a skeletal muscle that may cause pain, decreased range of motion, and may be associated with muscular weakness1
Describe iliotibial band syndrome and identify potential risk factors associated with this diagnosis.
Prescribe appropriate joint range of motion and/or muscular flexibility exercises for a person with iliotibial band syndrome.
Prescribe appropriate resistance exercises during each stage of healing for a person with iliotibial band syndrome.
PT considerations during management of the individual with a diagnosis of iliotibial band syndrome:
- General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility and/or joint range of motion; increase lower quadrant strength; prevent or minimize loss of aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities and manual therapy to decrease pain; muscular flexibility exercises; resistance exercises to increase muscular endurance capacity of the core and to increase strength of lower extremity muscles; aerobic exercise program; orthotic fabrication
- Precautions during physical therapy: Monitor vital signs; address precautions or contraindications for exercise, based on patient's pre-existing condition(s)
The iliotibial band (ITB) is a thickening of the thigh's tensor fascia lata.2,3 Proximally, the ITB originates from the iliac crest, envelops the tensor fasciae latae (TFL) muscle, and receives tendinous attachments from the gluteus maximus muscle before extending distally to attach to the lateral patella, the lateral patellar retinaculum, and Gerdy's (lateral tibial) tubercle (Fig. 22-1).2,4 Whiteside et al.4 have identified three distal bands of the ITB: a broad band, a broad and dense central band, and a thin band (Table 22-1). Whiteside et al.4 suggested ...