Introduction:
In 1975, a scientist named Renee described iliotibial band friction syndrome (ITBFS) as consistent lateral knee pain seen in people who walk a lot, as it was first seen in the U.S. marine corps. And today, it is one of the most common causes of knee pain. The iliotibial band friction syndrome is a painful condition seen due to the weakening of the muscle band on friction with the thigh bone. This usually occurs in people with strenuous activity who run a lot or walk miles, for example, athletes or sprinters, cyclists, and mountain climbers, as they perform strenuous activities for a prolonged period by flexing and extending the muscle fibers.
What Is an Illio-Tibial Band?
The iliotibial band is a thick fibrous band that runs laterally along the thigh and inserts into the tubercle of the iliotibial tract, also known as Gerdy's tubercle. It originates from the iliac crest and the hip joint capsule, acting as aponeurosis (a pearly white flat structure that binds the muscles and connects them to other body parts like bone) for the gluteus maximus muscle and tensor fasciae. The iliotibial band's functions include lateral hip and knee stabilization, hip flexion, extension, abduction, and lateral and medial rotation of the gluteus maximus and tensor fascia. The superior gluteal artery and lateral circumflex femoral artery supply blood, and the superior and inferior gluteal nerves supply sensory and motor supplies. The iliotibial band is also referred to as the iliotibial tract.
What Causes Iliotibial Band Friction Syndrome?
The cause of ITBFS is a multifactorial origin, primarily overuse of the muscular band and friction. These factors include running on elevated surfaces, uphill climbing, improper training techniques, and unleveled intensity of training, where the anatomical reasons include torsion of the internal tibial bone, weakness in the hip abductor, increased foot rotation, and arthritis leading to increased tension in the tibial band. The etiopathology of ITBFS can also include incidence of iliotibial band friction syndrome.
The epidemiology of ITBFS is a very common condition around the globe, including around 1.6 to 52% incidence in the world involving 22% lower extremity injury. The incidence is higher in females and less common in males. It is also rarely seen in people with significantly less life activity. Studies have also shown that around 6.2% to 12% of incidence is seen in marine corps or army personnel.
How Does Illio-Tibial Band Friction Syndrome Occur?
ITBFS is caused by inflammation of the lateral synovial recess, continuous irritation of the intratibial band fibers, and inflammation of the left femoral epicondyle. The irritation of the soft tissue increases with recurrent irritation and a lack of healing time, resulting in further damage to the impugnment area.
What Are the Clinical Symptoms of Illio-Tibial Band Friction Syndrome?
ITBFS is most common in people who walk or run more than 40 kilometers per week. The clinical features include:
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Diffused Pain in the Lateral Knee Region - This appears to be aggravated at a constant and sustained pace during continuous activity. During limited training, the pain decreases, but the occurrence of sudden sharp pain with longer strides increases. No clinical evidence of swelling or discoloration exists. Uphill strides aggravate the pain, but flexion of the knee reduces it. The pain usually subsides immediately after movement stops and does not limit daily activities.
What Are the Other Ways of Evaluating Illio-Tibial Band Friction Syndrome?
Thorough patient history and clinical examination of the leg are critical in determining the problem. Bursitis, tendonitis, meniscal lesions or cysts or malignancies, sprains, and capsular ligament instability should all be thoroughly ruled out, and that is done using the:
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Radiographic Imaging: Such as X-rays, is critical in determining the cause of this condition. Arthritis, cancer, and fractures are the most likely causes, but radiographs may not show some accuracy because this condition involves the ligaments rather than the bone.
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MRI (Magnetic Resonance Imaging): When clinical and radiographic imaging is not adequate to provide a precise diagnosis, MRI (magnetic resonance imaging) is used to evaluate the soft tissues. The presence of ITBFS is confirmed by the increased intensification of the lateral epicondyle bone and distal thickening of the intratibial band. The use of ultrasound also improves diagnosis and treatment plans.
How Is Illio-Tibial Band Friction Syndrome Treated?
ITBS treatment can be divided into medical or non-operative management and surgical management. Medical or non-operative management is the first line of treatment of choice. The patient is advised to rest and refrain from any physical activities until the pain subsides. Cryotherapy is suggested in cases of a sudden increase in pain. Patients can gradually return to their regular functional activities with proper follow-up and physiotherapy, including knee strengthening, flexion, and abduction, by reducing tension in the fibers.
Nonsteroidal pain relievers, shoe modifications, and foot orthoses are usually the preferred medical treatment, but corticosteroid injections are recommended in severe cases. After six to eight weeks, the patient can return to work. Running or walking on flat surfaces is recommended during the initial healing period. Surgical management is considered if the patient is not recovering after six months of medical management. Multiple surgical options are available, including intra-tibial band (ITB) release, ITB lengthening with Z-plasty, open ITB bursectomy, and arthroscopic ITB debridement. Minimally invasive techniques, such as recessing synovial fat and lateral synovial recession, have improved patients' conditions.
What Are the Other Conditions That Look Like Illio-Tibial Band Friction Syndrome?
Other common causes of knee pain in the differential diagnosis include:
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Stress fracture of the lateral tibial plateau.
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Lateral meniscus tear (tear of the cushioning surface of the knee).
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Lateral collateral ligament strain is a strain occurring due to an excessive load of pressure.
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Radiation due to hip pathologies.
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Patellofemoral syndrome (pain in the front knee and patella bone).
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Popliteal tendinopathy (injury occurring due to the popliteal tendon).
What Are the Complications of Illio-Tibial Band Friction Syndrome?
The major complication in ITBFS is the recession and re-progression of the infection. In the case of non-healing scenarios, the patient is seen to develop extreme unending pain in all activities, even at rest. And also, as the band is so attached to the lateral part of the patella bone, it might progress into a patellofemoral syndrome.
What Are the Outcomes of Illio-Tibial Band Friction Syndrome?
The prognosis of iliotibial band friction syndrome is good, with results ranging from 50% to 90% after a four-to-eight-week rest period. The prognosis of all surgical treatments is also good. Educating the patient is also very important in the prognosis. The patient is asked to continue physical activities and change shoes regularly. Thus, the outcome of ITBFS is excellent when a multidisciplinary approach involving clinicians, physiotherapists, training nurses, and pharmacists is used.
Conclusion:
Illio-tibial band friction syndrome is a painful inflammatory condition of the bands supporting the knee. It is seen in people involving strenuous activity, like athletes and military personnel. The treatment requires management with painkillers, rehabilitation, and strengthening, where surgery is considered in severe distortions. But with proper medical care, rehabilitation, and follow-up, patients show a good outcome of about 90% recovery rate.
