IT iliotibial band syndrome

[melancholy]

I see IT band syndrome a fair amount, generally patients who get hospitalized or deconditioned due to some sort of medical event or surgical recovery or even patients that have lumbar radiculopathy with resultant weakness and compensatory issues result in development of IT band syndrome +/- troch bursitis +/- knee pain. I feel that a lot of the times, lateral thigh pain gets diagnosed as radiculitis rather than a potentially musculoskeletal condition.

#1 - aside from usual PT, HEP for stretching and strengthening of hip stabilizers/core/lower extremities, self-myofascial release techniques (foam roller, tennis/lacrosse balls, massage stick, ice bottle massage, etc.) TENS, topicals, trigger point injection/therapy, sometimes ultrasound as part of PT program, heat, ice, etc, does anyone have any other tricks or things that have worked well for IT band syndrome?

#2 - given the distribution of IT band is generally just lateral thigh from hip down to knee while radiculitis would more traditionally wrap around the leg while descending, have any of you had experiences where clearly lateral thigh pain ends up being a radiculitis that is definitively treated with TFESI or surgery?

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[j4pac]

My patient population is much different than yours. I don't get the post-op patients...I get the overuse tendinitis/tendonopathy patients.

In regards to #1..I have made is it standard practice to explain the process of myofascial release. Patients often come to me foam-rolling...incorrectly...going directly over the lateral femoral condyle and lateral tibial condyle...which could easily increase pain/inflammation at the site of the ITB insertion. Foam-rolling, especially in the young and athletic is incredibly en vogue.

I also have seen that ITB syndrome is often secondary to hip abductor/flexor atrophy/weakness. This is especially true of patient who do not progress with the common modalities you previously mention.

Lastly, I see quite a bit of fibular head dysfunctions with ITB syndrome. Reduced Cobb angle causing a pseudo-genu-varus putting a loading on the fibular head...? I don't know...just an observation. Could be compensatory injury/response that contributes to lateral knee pain.

In regards to #2...I can't contribute there. Just not my patient population.

 

[melancholy]

My patient population is much different than yours. I don't get the post-op patients...I get the overuse tendinitis/tendonopathy patients.

In regards to #1..I have made is it standard practice to explain the process of myofascial release. Patients often come to me foam-rolling...incorrectly...going directly over the lateral femoral condyle and lateral tibial condyle...which could easily increase pain/inflammation at the site of the ITB insertion. Foam-rolling, especially in the young and athletic is incredibly en vogue.

I also have seen that ITB syndrome is often secondary to hip abductor/flexor atrophy/weakness. This is especially true of patient who do not progress with the common modalities you previously mention.

Lastly, I see quite a bit of fibular head dysfunctions with ITB syndrome. Reduced Cobb angle causing a pseudo-genu-varus putting a loading on the fibular head...? I don't know...just an observation. Could be compensatory injury/response that contributes to lateral knee pain.

In regards to #2...I can't contribute there. Just not my patient population.

Actually most of my population is not post-op, but I just tend to see IT band syndrome develop more in patients who become deconditioned or reduce activity due to some other medical issues which sometimes can include a surgery or hospitalization.

The hip stabilizers are definitely tested and important to work on, no doubt about that.

Interesting pt of fibular head dysfunction. I do see a fair amount of these patients who complain of pain distal to the knee down the lateral lower leg along the fibula actually.

 

[j4pac]

Actually most of my population is not post-op, but I just tend to see IT band syndrome develop more in patients who become deconditioned or reduce activity due to some other medical issues which sometimes can include a surgery or hospitalization.

The hip stabilizers are definitely tested and important to work on, no doubt about that.

Interesting pt of fibular head dysfunction. I do see a fair amount of these patients who complain of pain distal to the knee down the lateral lower leg along the fibula actually.

Cool...misunderstood about your patient population.

I get about 2 new ITBS per week. I will start charting fibular head dysfunction and let you know what I find.

 

[Fiveoboy11]

I see IT band syndrome a fair amount, generally patients who get hospitalized or deconditioned due to some sort of medical event or surgical recovery or even patients that have lumbar radiculopathy with resultant weakness and compensatory issues result in development of IT band syndrome +/- troch bursitis +/- knee pain. I feel that a lot of the times, lateral thigh pain gets diagnosed as radiculitis rather than a potentially musculoskeletal condition.

#1 - aside from usual PT, HEP for stretching and strengthening of hip stabilizers/core/lower extremities, self-myofascial release techniques (foam roller, tennis/lacrosse balls, massage stick, ice bottle massage, etc.) TENS, topicals, trigger point injection/therapy, sometimes ultrasound as part of PT program, heat, ice, etc, does anyone have any other tricks or things that have worked well for IT band syndrome?

#2 - given the distribution of IT band is generally just lateral thigh from hip down to knee while radiculitis would more traditionally wrap around the leg while descending, have any of you had experiences where clearly lateral thigh pain ends up being a radiculitis that is definitively treated with TFESI or surgery?

I'm not sure what usual PT means. Likely that heat/ice/estim/US are worthless. If you see it a lot in people who are deconditioned or recently hospitalized then consider temporary use of an A.D. (ie cane or walking stick on opposite side of symptoms or alternating sides if bilateral; or a FWW or 4WW) as this will lessen strain on post lat hip musculature. If obese then weight loss program. If working job with lots of standing especially on hard surface then consider better footwear. If secondary to low back induced weakness then treat depending on findings with regard to that, i.e. If ITB pain from radicular induced weakness then directional preference/centralization exercise, if no centralization or directional preference then traction. Post lat hip strenthening should be considered. Soft tissue mobilization of buttock insertions and along ITB might help with or without a tool. SL hip abd is probably the dumbest exercise ever, SL clams is a better way to strengthen the hip to abd and ER in these case IMO. As always the POC should be individualized and based on the assessment.

 

[truthseeker]

PT would be stretching the ITB and lateral patellar retinaculum. And, since the ITB, (although it primarily functions in the frontal plane) functions in all three planes, the stretching should be in all three planes. Gluteals are often very tight as well. Also, look at the foot, overpronation drives the hip into adduction and increases loads. varus thrusts at the knee can cause some irritation distally as well and they may need orthotics or at least a lateral wedge to reduce the varus thrust.

 

[melancholy]

Appreciate the rehab responses for this. Thanks.