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  • Runner’s knee1
  • Tensor fascia latae syndrome (TFLS)
  • Iliotibial band friction syndrome (ITBFS)

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  • 728.89 Other disorders of muscle, ligament, and fascia

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  • M62.89 Other specified disorders of muscle

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Description

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  • Original presumed model of repetitive stress injury due to friction between the IT band3 and lateral femoral condyle, occurring at approximately 30 degrees of knee flexion4
    • Inflammation begins at IT band’s insertion and where friction develops between the IT band and lateral femoral condyle1
  • Newer proposed model of the ITB being a thickness within the lateral fascia
    • Tightening is a result of repetitive stress
    • Lateral extension of the synovial capsule in the knee, lateral synovial recess
    • Cyst formation
    • Osseous edema without evidence of fascial inflammation
    • Bursitis that develops deep within the IT band as it crosses the lateral femoral condyle3

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Essentials of Diagnosis

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  • Diagnosis usually made by clinical examination
  • Progression of symptoms often associated with changes in training practice (e.g., increased running mileage or change in training surfaces, especially downhill running1)
  • Pain from ITBFS so severe that activity must be discontinued

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General Considerations

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  • Most commonly occurs from overuse injury of the knee, especially in long-distance runners
  • Frequently develops in people with inadequate warm-up or stretching program before exercise
  • Associated with leg-length discrepancies, tensor fascia latae contractures, excessive pronation, tight heel cords1, 6
  • Though most common in runners, may occur with any activity requiring constant knee flexion and extension1

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Demographics

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  • Men and women equally affected
  • Distance runners, exacerbated with downhill running
  • Cyclists
  • Repetitive knee flexion, extension
  • Training on uneven terrain or graded slopes
  • Change in Q-angle as a result of leg-length discrepancy4

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Signs and Symptoms

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  • Localized tenderness and pain along lateral aspect of knee, especially with repetitive knee motion
  • Pain may be diffuse and general at onset, becoming more specific and intense as ITBFS progresses
    • Specific pain localized approximately 2 cm above joint line over the lateral femoral condyle with knee flexed 30 degrees3
    • Pain will radiate to lateral joint line and distally to proximal tibia1
  • Pain typically begins after completion of activity, but may occur during activity or periods of rest as condition progresses7
  • Crepitus upon palpation over lateral condyle3
  • Specific swelling over lateral condyle3
  • Increased pain after long periods of sitting4

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Functional Implications

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  • Pain with running (especially on downhill terrain) and cycling
  • Pain with walking and other activities that elicit knee flexion, especially as the condition persists
  • Pain with sitting for prolonged periods

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Possible Contributing Causes

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  • Biomechanical abnormalities
    • Leg-length discrepancies
    • Tensor fasciae latae contracture
    • Gluteus maximus contractures
    • Hamstring and ...

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