ALH Guidelines for Treatment of Iliotibial Band (ITB) Syndrome
According to wikipedia, ITB is the second most common of knee pain condition. It occurs because of irritation on the outside of the knee where the band inserts into the knee. ITB is often considered a sports injury because it so often presents in runners or other athletes. That may account for the knee pain presentation, but the ITB is involved in many other leg pain conditions. For example, the following article is from the American Association of Orthopaedic Surgeon’ website (AAOS), and presents the Snapping Hip syndrome.
The core of any issue that involves the ITB is poor alignment of the leg, which allows the band to tighten or shorten. Often associated with this is knee or hip bursitis, as the dysfunctional ITB irritates the bursae around the knee or the hip. Bursitis in any area presents as hot, swollen, tender to touch and painful.
From a runner’s perspective ITB syndrome often seems to start with poor foot position; both flat feet and feet with very high arches influence the chain of muscle work, up the leg to the hip, pelvis and spine, which follows initial heel strike - when your heel first impacts the ground. The subsequent change in normal muscle function changes the contribution to motion of the ITB. Generally, it shortens. Sometimes, the most obvious malalignments associate with hip position. There may be associated muscle imbalances - of any of the lower extremity muscles.
From the perspective of the Snapping Hip, it is usually associated with too much sitting. The seated position requires the ITB to change position, but too long sitting can allow shortening of the ITB; which can’t then return to its usual position when standing. As with the ITB syndrome of the knee, there are muscle imbalances.
Treatment at our Clinic
Physiotherapy assessment, identification of misalignments and muscle imbalances is the first thing. Treatment will be determined once these are understood. However, in so much as the effect of the ITB is felt during activity, exercise is a critical aspect of care. The ITB is a tough, fibrous band, and often requires manual techniques to assist in recovery. Your physiotherapy use friction massage or other technique, as well as passive and assisted muscle work and HEP (home exercise program). In our clinic, massage therapy is recommended to supplement with deep tissue massage and trigger point therapy. These are essential components of a treatment care plan for ITB pain conditions.
We will recommend laser therapy if there is considerable pain. This usually indicates that there’s associated bursitis or tendonitis; and it is often difficult to make functional progress with addressing the pain. A benefit of laser is accelerated healing, the positive effect it has on scar remodeling; it minimizes adhesions and improves the quality of residual scar.