PREFERRED PRACTICE PATTERN
4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated With Connective Tissue Dysfunction1
A 19-year-old female cross-country athlete is being seen in the clinic complaining of intense right lateral knee pain when she runs. She notes that she has been a cross-country athlete for approximately 5 years, but this is her first season participating in Division IA competition. She states that her practices are more intense than she remembered as a high school athlete. With her moving from the southern United States to the Northeast region of the United States, she is running more on hills. The athlete mostly complains of pain 5 miles into the run and it forces her to stop running.
Original presumed model of repetitive stress injury due to friction between the iliotibial band (ITB)2,3 and lateral femoral condyle, occurring at approximately 30 degrees of knee flexion4
Newer proposed model of the ITB being a thickness within the lateral fascia
Tightening is a result of the repetitive stress
Lateral extension of the knee synovial capsule, lateral synovial recess
Osseous edema with out evidence of fascial inflammation
Bursitis that develops deep within the ITB as it crosses the lateral femoral condyle3
Iliotibial band site. (A) The iliotibial band lies anterior to the lateral femoral epicondyle when the knee is in extension and passes posterior to it with flexion. (B) The coursing back and forth over this bony prominence is the cause of a symptom complex referred to as the iliotibial band syndrome. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007, McGraw-Hill Inc., New York, NY.)
External snapping hip syndrome. In the snapping hip syndrome, the iliotibial band courses over the greater trochanter. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007, McGraw-Hill Inc., New York, NY.)
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 ...