Oklahoma Sports and Fitness May/June 2013 : Page 22

Iliotibial Band Friction Syndrome What to do about IT CLINIC | DR. CHRIS BARNES DC, ART, NKT, SFMA, CKTP Sometime during this running season, nearly 12% of the running population will experience IT ! By IT, of course, I’m referring to that burning, ice pick-like, stabbing pain in the outside of the knee. Iliotibial Band Friction Syndrome (IT Band Syndrome/ITBS) is the second most common injury among distance runners and occurs more often in females. It can be one of the most painful and sometimes devastating injuries that runners try to push through, as evidenced by the amount of taping I do for this condition each year at the Oklahoma City and Route 66 Marathon Expos. I commonly see runners at the gym cringingly foam-rolling the outside of their thighs with no real lasting relief. Like Plantar Fasciitis, this is an injury that can stick around for a very long time if the cause is not identified. There have been multitudes of runners who have given up running all together because of this agonizing malady, but with the proper diagnosis, treatment, rehabilitation, and running form tweaks, you can definitely outrun IT! So, What’s an IT Band Anyway? The Iliotibial Band (ITB) is a powerful stabilizer of the entire lower extremity during the gait cycle. The ITB begins in the fibers of the Gluteus Maximus (GMax), Gluteus Medius (GMed), and Tensor Fasciae Latae (TFL) muscles. It is reinforced by fascia (the body’s shrink-wrap) from the iliac crest above. The ITB derives the bulk of its strength from its attachment to the GMax. The ITB runs down the entire lateral thigh, across the knee, and into the tibial tuberosity (shin bone). The ITB has fibers that attach to and keep the kneecap from displacing medially during knee flexion. Tension within the ITB, enhanced by a contracting Vastus Lateralis muscle (lateral thigh), assists the GMed in preventing the opposite pelvis (hip) from dropping, which increases the body’s walking or running efficiency. The inferior ITB fibers keep the tibia (shin bone) from excessively rotating as a “burning sensation” or the aforementioned “ice pick-like” stabbing pain deep within the lateral knee. Orthopedic tests such as Noble’s and Modified Ober’s tests are typically used to diagnosis ITBS. Other injuries can mimic ITBS; therefore, the following conditions should be ruled out by a trained physician: patellofemoral stress syndromes, lateral meniscus injury, lateral patellar facet irritation, lateral retinacular irritation, biceps (hamstring) tendonopathy, joint disease of the knee, stress fractures, and lumbar disc pathology. Treatment Traditional medical treatments for ITBS include: anti-inflammatory drugs, local steroid injections, prolonged rest, or surgery. None of these interventions actually address the cause of ITBS, which may be why manual therapies and rehabilitation tend to be more popular among athletes. General self-treatments of ITBS can be detrimental because they tend to focus on symptoms rather than cause and can mislead an athlete into doing the opposite of what is needed. Weak or inhibited mus-cles may become shortened or feel tight to the runner, but continually stretching a weak or inhibited muscle may prolong recovery, as it robs the stability the body is trying to create. The primary goal of self-release techniques like foam-rolling and trigger point/LAX ball work is to increase flexibility of a muscle, but these methods are futile, since the ITB only stretches 0.2%. Further, the ITB itself is not the cause of pain, so continuous foam-rolling only treats the symptoms. 3 Self-release work may best be inward. Because of the ITB’s connections, it acts as a powerful brace that reduces bending strain on the femur during gait . So yes, IT is an incredibly important structure! Diagnosis ITBS pain is usually localized on or near the lateral condyle of the femur (outside of knee), which is about an inch above the joint line. The patient will often describe this pain 22 MAY / JUNE 2013 | OKSPORTSANDFITNESS.COM

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