History and exam
Key diagnostic factors
common
presence of risk factors
Factors increasing the risk of iliotibial band syndrome include a history of athleticism (particularly running or cycling), female sex, high weekly mileage, interval training, lack of running experience, use of worn out running shoes, downhill running, or running on a cambered or slippery surface, and muscular weakness of knee extensors, knee flexors, and hip abductors.[27][12][21]
sharp or burning pain superior to the lateral joint line
Initially, patients with iliotibial band syndrome (ITBS) report diffuse pain in the lateral region of the knee, although, as the condition progresses, this pain usually localises and becomes sharper.[30][31] Often, ITBS pain occurs several minutes into or after the completion of physical activity, but with worsening ITBS, symptoms can occur even at rest. Patients may complain of pain flaring at specific instances such as when running down hills, lengthening their stride, or sitting for prolonged periods of time with their knee flexed, and may radiate proximally or distally.
positive Noble's test
A special (provocative) test used to support a clinical diagnosis of iliotibial band syndrome (ITBS). The Noble's test specifically assesses pain associated with ITBS. In a positive test, pain occurs when the knee is flexed at around 30°.
positive Ober's test
A special (provocative) test used to support a clinical diagnosis of iliotibial band syndrome (ITBS). The Ober's test is recommended to assess ITB tightness. In a positive test (i.e., the ITB is tight), the affected leg cannot be passively adducted to horizontal.
positive modified Thomas's test
A special (provocative) test used to support a clinical diagnosis of iliotibial band syndrome (ITBS). The modified Thomas's test is recommended to assess the flexibility of hip flexors (iliopsoas, rectus femoris, and the tensor fascia lata [TFL]/ITB complex). In a positive test, the angle of the femur is below horizontal.
Other diagnostic factors
common
reduced hip abductor muscle strength
Hip abductor muscle strength is evaluated in the side-lying position. Patients often compensate for weakness or inhibition of the gluteus medius with substitution of the tensor fascia lata, the quadratus lumborum muscles, or both. Hip abduction may be obtained by internal rotation and flexion of the hip owing to the tensor fascia lata, or hip elevation may be noted because the quadratus lumborum over-activates. A dysfunctional firing pattern may also be the source of chronic tensor fascia lata tightness. The normal firing pattern is gluteus medius, followed by tensor fascia lata, ipsilateral quadratus lumborum, and erector spinae.[31]
genu varum (bow leg), hindfoot and forefoot varum, and pes cavus (high arch)
Intrinsic factors that contribute to ITB tightness and muscle weakness (quadriceps and gluteus medius).[34]
prominent lateral femoral epicondyle
May contribute to iliotibial band (ITB) tightness.
Repetitive irritation of the ITB can lead to chronic inflammation, especially beneath the posterior fibres which are thought to be tighter against the lateral femoral epicondyle than the anterior fibres.
uncommon
swelling, local oedema, or crepitations
Swelling of the distal iliotibial band may be evident on palpation. In more severe cases, local oedema or crepitations may also be noted on examiantion.
Risk factors
strong
athlete
Iliotibial band syndrome (ITBS) is primarily seen in runners and cyclists but may also be observed in athletes participating in volleyball, tennis, soccer, skiing, weight lifting, and aerobics. More experienced runners may be less likely to develop ITBS.[12] It is unusual in non-athletes.
high weekly mileage
interval training
muscular weakness of knee extensors, knee flexors, and hip abductors
Biomechanical studies have demonstrated that weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilise the pelvis and eccentrically control hip abduction. As a result, other muscles must compensate, often leading to excessive soft-tissue tightness and myofascial restrictions.[12][21]
lack of running experience
May lead to over training with a sudden increase in mileage, or running at an improper pace.[12]
use of worn-out running shoes
Lack of proper foot support increases the pressure on the bursa and iliotibial band.
downhill running, or running on a cambered or slippery surface
Increases the pressure on the bursa and iliotibial band, as excessive friction of the distal iliotibial band (ITB) sliding over the lateral femoral epicondyle occurs as the knee flexes during deceleration into stance-phase running.[5]
female sex
A risk factor for the development of iliotibial band syndrome (ITBS).[27] One retrospective analysis of 2002 patients with running injuries reported ITBS occurred in 62% of women and 38% of men (P <0.05).[13]
Proximal ITBS (which occurs secondary to stress at the origin of the iliotibial band at the iliac crest) is uniquely reported in female runners and in older overweight or obese women.
weak
pre-existing iliotibial band tightness
Weak evidence exists for iliotibial band syndrome (ITBS) runners as being less flexible than age-matched non-ITBS runners.[20]
leg-length discrepancies
Leg-length discrepancies may contribute to iliotibial band syndrome.
step width and strain rate
knee varus in male runners
Results from one small study demonstrated that men with ITBS exhibit significantly greater knee adduction angles during running compared with men with no ITBS.[23]
muscular weakness in hip external rotator muscles in male runners
Results from one small study demonstrated that men with ITBS exhibit weaker hip external rotators compared with men with no ITBS.[23]
excessive hip internal rotation in male runners
Results from one small study demonstrated that men with ITBS exhibit significantly greater hip internal rotation during running compared with men with no ITBS.[23]
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