Sunday, November 24, 2013

Iliotibial Pain (ITB) Syndrome

Iliotibial Pain Syndrome (ITBS) is the most common cause of pain on the outside of the knee which is not due to problems within the knee itself (intra-articular). Effusion (swelling) around the front of the knee, clicking, a history of twisting injuries and postive stress tests may locate intrinsic problems. Furthermore there are a few less common problems which can arise within other structures of the knee itself.  However stresses within the ITB, the band of connective tissue which arises in the pelvis and extends down to below the knee presents an interesting problem.

The forces which arise in the hip and lateral knee are considerable. Walking alone produces stresses in and down the outside of the thigh which can be three times body weight so it's easy to see how jogging and running (particularly when introduced too rapidly) may contribute to compression problems.  In addition a history of lower back and pelvic pain or stiffness can compound the situation. Why?  The gluteal muscles alone (indeed any local group of muscles) are not strong enough to stop the hip collapsing on itself when we walk (let alone run). It is the co-ordinated action of muscles bound together by the inelastic connective tissues of the ITB which produce significant strength and stability and if they do not work in unison the region is left vulnerable to injury.

What of the lower limb?  Do poor foot mechanics cause alot of ITBS?  While this is possible the literature suggests that most problems arise in the pelvic region however the foot and ankle must be considered as possibilities in each individual case.

Douglas Scown