Case of the Week - Iliotibial Band Syndrome

Patient: 27 year old female legal assistant

The patient presents complaining of knee pain. The pain came on without any injury she can remember. It gets worse with jogging; she no longer jogs due to pain. She is a former dancer, now working a desk job. She reports mild numbness across the tops of her feet and some right sided buttock achiness. She has tried to increase her warm-up and cool-down, but this only helps decrease the pain slightly. She is concerned she will not be able to run anymore and wonders what sort of exercise she should be doing instead.

Examination: Significant tension and tenderness in both iliotibial bands from the medial portion, distally to the band’s insertion on the tibia. Pressure applied to the medial portion of the band increases the numbness perceived on the feet. The right piriformis and gluteus medius are also significantly tight and tender. Provocation of the sacroiliac joint was positive for local pain. Patrick’s test was positive for pain on the right hip. Ober’s test for ITB tension was negative bilaterally, but Renne’s test for ITB tension reproduced symptoms on both legs. Nerve and circulatory testing in both lower extremities were within normal limits. Low back orthopedics were negative.

Discussion:

The iliotibial band or ITB is a common source of complaint for many athletes, especially runners and cyclists. The ITB runs from its muscle at the hip, the tensor fascia lata, to past the knee on the outside of the thigh. Because of its location, it works to stabilize the hip and knee, and can even become involved in pelvis and low back problems. In this patient’s case, an increase in running and a decrease in other aerobic activity caused increased stress on her knee stability. The ITB became inflamed as it increased tension in an attempt to improve knee stability. As the tension increased, the symptoms traveled up the leg into the hip. As the ITB got tighter, it began to cause abnormal sensations in the foot. It is important to note that testing proved the patient did not have any actual nerve damage or irritation. The numbness she experienced was a result of deep-referred symptoms.

In this case, the patient was instructed to stop running for two weeks and underwent intensive treatment to reduce the tension on her ITB’s and related musculature. Once the tension was decreased, the patient was able to return slowly to exercise with a new program for warming up and cooling down that included stretching of the ITB’s.

Outcome: The patient has had a complete resolution of the ITB Syndrome in both legs. She uses a foam roller regularly to help maintain healthy tension levels in the ITB’s and related muscles. She receives maintenance chiropractic care approximately one time per month, as needed.

Suggestion of the Week: When you have knee pain, it is important to remember the knee’s muscles must be balanced for the joint to function properly. This means that both the front and back and the inside and outside of the knee must have equal support. One of the most commonly weak knee muscles is the Vastus Medialis Oblique or VMO. If this muscle is weak, the knee cap cannot track properly during knee bending, and this can cause many different problems, including ITB Syndrome. Get your knee evaluated for muscle balance to ensure good joint motion and biomechanics.

Exercise of the Week: Use a foam roller to self-massage difficult areas on your body. You can use the roller on your back muscles, buttock, thighs, calves, shins and shoulders. Make sure you only stay on an area for about 30 seconds, and be careful not to roll over a joint. Daily use of the foam roller on problem areas can help people decrease the frequency of their chiropractic maintenance visits because they are able to provide some maintenance care themselves. Follow this link for more detailed instruction: http://www.performbetter.com/catalog/assets/Exercisesheets/PDF/FoamRoller.pdf. Please be aware that this link also includes instruction for balance training exercises using the foam roller. While this is an excellent use of the product, this is not the intended use in reducing muscle tension.

Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.