Mid-Week MOT: ITB Support - The Iliotibial Band.
Much has been written about this pesky but important band of tissue running down the outside of your thigh from your hip to your knee.
So, where is it, what does it do and what happens when it all goes wrong?
Read on to find out.....
The ITB (iliotibial band) is a thickening of the thigh fascia (connective tissue present throughout the body) which runs from enveloping the Tensor Fasciae Latae (TFL) muscle on the iliac crest (top of pelvis, outer hip) down the outside edge of the thigh. It runs over the lateral condyle of the femur to attach on the outside/front of the tibia just below the knee (Gerdy's Tubercle). Within its course, it is attached via its fibres to the gluteal muscles, femur and patella and at its thickest is about 1-1.5" in depth.
The ITB supports the outer aspect of the knee predominately when walking, assists the muscles involved in lifting the leg outwards and resists the twisting actions of the knee. The band is very fibrous and not at all stretchy but moves backwards and forwards slightly during flexion and extension of the knee.
It was thought that a protective bursa lay underneath the band as it runs over the end of the femur but after several studies on cadavers, no bursa has been found, but researchers frequently saw a fatty pad that had nerve innervation, which they now believe may become irritated when the band moves excessively or pulls too much due to tightness at the hip. This then causes the familiar lateral knee pain which comes on during running, worsening when going downhill and when exercising for extended periods of time.
This condition is often more common in women due to the increase angle between the hip and knee alignment. Imbalance in quad to hamstring strength and poor biomechanics at the foot can also contribute to the ITB becoming inflammed and unhappy. Pain is usually worse at about 45 degrees of knee flexion and heavy weight lifting movements such as squatting, in men and women, can often upset the knee.
If you cycle, having a pedal position that causes your foot to turn toe-in can put stress on the outside knee too.
Good examination, history and assessment is required to adequately treat this condition.
Scanning and x-rays usually fail to reveal any abnormalities but should rule out other problems so this is where the manual therapists come into their own and can be really useful in getting you back to a pain free state. Your hips, low back and lower legs will be examined as problems with these areas may also cause knee problems.
Immediate reduction in activity levels which aggravate the condition is required, followed by ice therapy to reduce the inflammation. Cross train with swimming or cycling to maintain fitness levels. Get your bike set up professionally, paying attention to the pedal/foot position.
You may wish to take some anti-inflammatory medication such as ibuprofen or use the topical gels.
Replace old running shoes and get a specialist to analyse your gait and running mechanics to see if you are flat footed or rolling inwards, causing the knee to experience unusual forces. They should also measure your leg length to see if there are any discrepancies. Orthotic inserts may be prescribed to correct foot/ankle position.
Tightness in the ITB (contrary to popular belief) cannot usually be relieved by trying to stretch it out, the band is a thick fibrous tissue which, research has shown, does not respond to this. The band does actually need to be quite tight, in order fulfill its knee stability roll.
Loosening of the muscles at the hip, buttocks and either side of the band can, however, be very useful. Sorting out the foot biomechanics may also help.
Treatment may also involve using ultrasound to reduce inflammation at the site of friction and occasionally it may be necessary to have a corticosteroid injection into the area, although this and surgical intervention tend to be last resort measures.
In short, the prognosis for recovery is good but be patient and adhere to any rehab program you have been given.
As always, for osteopathy in High Wycombe and beyond call Lucy from OsteoFusion on 07833 321604, or visit www.osteofusion.co.uk
Thanks for reading