Iliotibial Band Syndrome

Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the thigh, generally associated with running, cycling, hiking or weight-lifting (especially squats).

IBS is one of the leading causes of lateral knee pain in runners. The iliotibial tract is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front while walking. The continual rubbing of the band over the lateral femoral epicondyle, combined with the repeated flexion and extension of the knee during running may cause the area to become inflamed.

IBS symptoms range from a stinging sensation just above the knee joint (on the outside of the knee or along the entire length of the iliotibial band) to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after activity. Pain may also be present below the knee, where the ITB actually attaches to the tibia.

ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. It commonly occurs during pregnancy, as the connective tissues loosen and the woman gains weight — each process adding more pressure. ITBS at the hip also commonly affects the elderly. ITBS at the hip is studied less; few treatments are generally known.

Sports activities to avoid while symptomatic

• Running
• Stair climbing
• Deadlifts or squats
• Court sports, such as tennis, basketball, or similar
• Martial arts, such as karate (especially where being bare foot emphasizes any symptoms being caused by leg/foot abnormalities)
• Cycling
• Bowling

IBS can result from one or more of the following training habits, anatomical abnormalities, or muscular imbalances:

Training habits:

• Running on a banked surface (such as the shoulder of a road or an indoor track) bends the downhill leg slightly inward and causes extreme stretching of the band against the femur
• Inadequate warm-up or cool-down
• Increasing distance too quickly or excessive downhill running
• In cycling, having the feet “toed-in” to an excessive angle
• Running up and down stairs
• Hiking long distances

Abnormalities in leg/feet anatomy:

• High or low arches
• Over pronation of the foot
• The force at the knee when the foot strikes
• Uneven leg length
• Bowlegs or tightness about the iliotibial band.
• Excessive wear on the outside heel edge of a running shoe (compared to the inside) is one common indicator of bow leggedness for runners.

Muscle imbalance:

• Weak hip abductor muscles
• Weak/non-firing multifidi muscles

While pain is acute, the iliotibial band can be rested, iced, compressed and elevated (RICE) to reduce pain and inflammation, followed by stretching. Massage therapy may also be beneficial. Using a foam roller to loosen the iliotibial band can help prevent and treat pain although the treatment itself can be very painful to some.

Preventing Injury and Increasing Your Performance

Athletes often neglect their number one supporter: their feet. Many of us rarely give them a second thought until they cause us pain. We force them into shoes that don’t fit, pound them into the ground and neglect to care for them properly. Yet, a small abnormality in foot function can have a large impact on the entire body causing pain, discomfort and interrupting an athlete’s game. With the strenuous activity athletes’ bodies endure, it is important to understand how to treat sports injuries, maintain treatment and ensure the feet receive the extra T.L.C. they deserve.

Athletes must not only be aware of sports related injuries but more importantly, how to prevent them before they occur. As proper biomechanics begins to gain more popularity and importance in the sports world, trainers and athletes are beginning to think more pro-actively about how to care for the feet. Yet, many are unaware that the symmetrical alignment of their feet affects their entire body. Any deviation can create a deleterious effect on their performance. Because no one person shares the same foot structure, the ultimate solution to preventing injuries, treating existing problems and increasing athletic performance is with precise custom-made functional foot orthotics.

Functional orthotic devices are fabricated by using a neutrally balanced and stable position captured impression of the foot. They are designed by a physician, experienced and trained in the field of Clinical Biomechanics. Medically prescribed, their purpose is to limit excessive motion and align the rear foot to forefoot. It is important that custom-made, functional foot orthotics are not confused with arch-support devices sold at pharmacies or shoe and sporting goods stores. Over-the-counter arch supports are a one-size-fits-all version that provides support to a patient’s arch based on average foot shape and function.

In our practice, we use the latest diagnostic technology to perform my biomechanical evaluations. A thorough study incorporates a medical and family history, video gait analysis, muscle strength testing and range of motion study. The combination of this information helps to determine the best method to increase performance, prevent and/or address injuries.

Some of the most common athletic ailments that we have encountered that could have possibly been prevented with the use of functional foot orthotics are:

Heel Pain

The most frequent cause of heel pain is plantar fasciitis. Plantar Fasciitis can be caused by an abnormal motion of the foot called excessive pronation. If your heel is rotating outwards too much and your arch is lowering too much then you have excessive pronation. It is this extra stretch in the arch that causes the partial pulling, straining or tearing of the plantar fascia and the possibility of spur formation.

Plantar Fasciitis can be controlled with a combination of treatments. Strapping of the feet with the foot held in a neutral position combined with a physical therapy program and an anti-inflammatory medication will usually improve the symptoms. A custom made orthotic will control the excessive pronation and also support the arch taking the tension off the plantar fascia.

If the patient continues to have pain, a physician could conduct injection therapy, the injection of a small amount of cortisone to decrease the inflammation. The patient could receive several injections while still performing the conservative treatment for several weeks or months. For the remaining small percentage of patients who fail to be relieved of the pain, the patient may choose to have Extra-Corporeal Shock Wave Therapy (ESWT). This innovative, non-surgical treatment involves the delivery of sound energy or shock waves to affected areas of the body triggering the body’s own natural repair mechanisms and stimulating healing. ESWT can be done in the office (low energy) and without the need for an anesthetic. Surgical correction is the last choice of treatment. Surgical corrections consist of releasing the part of the plantar fascia from the attachment to the heel bone.

Shin Splints

Medial Tibial Stress Syndrome (MTSS) is commonly known as Shin Splints. The people who are at the greatest risk for developing MTSS are beginning runners, people who over-train and people with a poor selection of shoe gear.

The usual mechanical factors that lead to MTSS are an imbalance between the posterior and anterior muscle groups. The posterior muscles may be both too tight and too strong. The effect of the tight musculature has an impact on the gait cycle at two points, just before and after heel contact and when the foot is leaving the ground at toe off. These stresses cause a repetitive inflammation in the muscle or at the attachment of the muscle to the bone. Other factors that may cause MTSS are continual running on a hard surface and a biomechanical abnormality in the foot such as excessive pronation.

The initial treatment for MTSS is decreasing the amount of training, adequate stretching exercises before and after running and proper shoe gear with shock absorption. Running on hard surfaces should be avoided. Icing immediately after exercise should also be done to control inflammation.

A physician should conduct a thorough evaluation of the training schedule, training surface, shoe gear being used and the biomechanics of the foot and ankle. If a biomechanical fault is found in the lower extremity a custom foot orthotic could help eliminate the fault and reduce the pain.

Leg Length Discrepancy

Another common problem that has been encountered are leg length discrepancies. During our evaluation, we can determine whether this is a functional or structural problem or combination of both. With a length discrepancy an athlete could experience pain in the knees, hips, lower back and neck. These difficulties and biomechanical faults can easily be accommodated with custom-made orthotics.

Turf Toe

Turf Toe is an injury that can occur in all types of athletics. The injury occurs when there is excessive motion behind the big toe which causes the tendon and ligaments of the first metatarsal phalangeal joint to become disrupted. If this injury is not addressed it can lead to a severe limitation of motion, fractures and early arthritis. This also can be treated with a functional foot orthotic with long term excellent results.

Other Injuries

Back and knee pain, ankle sprains, strains, instability and metatarsal issues can also be treated with foot orthotic therapy.

Case Study

In February 2007, Drew Stanton, a quarterback from Michigan State, was referred to Footcare Express to seek treatment for a persistent foot problem. A thorough examination was performed and functional foot orthotics were created to control his foot and accommodate his pain. With the orthotics in place Stanton was able to achieve the fastest time for a quarterback in the 40-meter dash at the 2007 NFL Combine. Stanton was later drafted to the Detroit Lions in the 2007 NFL Draft.

No matter your status on the playing field, it is important that you take care of your feet and not neglect clinical biomechanical problems. It is especially important that the coaches and parents of youth athletes understand the symptoms of sports related injuries.

As athletes improve performance and maximize efficiency, they rely on sports medicine to surpass their performance thresholds. Custom foot orthoses are increasingly making their way onto professional and recreational playing fields as sports medicine is focusing more on biomechanics and kinesthetic awareness to prevent and treat lower extremity injuries. When properly prescribed, foot orthoses can enable the body to work to its potential. Once an athlete’s entire system is in balance, he or she should notice improved performance and enjoy lower risk of injury.