CHIROPRACTIC CORNER
The Iliotibial Band Syndrome
September, 2004
The following information has been condensed
from a health article sent to professionals
by the International College of Applied Kinesiology.
This specific article was form the Take Charge
newsletter form June 2004, Volume7, issue 2.
The
iliotibial band (ITB) is a hard fibrous structure
that runs down the outer side of our leg.
It is usually just an extension of the fascia,
the shiny covering of two muscles of your
pelvis, the gluteus maximus and tensor facia
lata. It descends down the outer surface of
your upper leg and inserts just below your
knee into the top part of your major lower
leg bone. Its function is to give outside support
to the knee and pelvis. This support is crucial
in walking, running and just standing with
your leg straight. Tension on the band can
come from the muscles that attach to it or
from pelvis or lower extremity problems.
If it gets too tight or adheres to the underlying
structures, it will cause symptoms when you
are running, walking or climbing stairs.
The
band moves across the outer surface of your
knee while your knee is bent such that if
the band is too tight, it will run against
the underlying structures and inflammation
occurs. A commonly reported symptom is pain
localized over the outer upper portion of the
leg bone called the lateral femoral epicondyle.
This usually occurs during or after vigorous
walking, hiking, climbing stairs or running.
The pain usually decreases when you rest the
leg. If it is bad, you may find relief by walking
with your knee straight. The other common pain
site is on the outer aspect of your knee. Some
people will just experience a strong ache running
along the outside of their leg.
If you have tenderness, ache or pain along
the outer side of your leg, it is probably
coming from this ITB. Obviously other conditions
must be ruled out with the lower and upper
leg as well as the pelvis. Any imbalance
in these three areas can be the cause of the
changes in the ITB. For example, a dropping
of the foot arch will cause the lower leg to
rotate and the stress is taken up by the ITB.
Likewise, the misalignment and improper mobility
of the pelvis and sacroiliac joint will cause
the ITB to become too tight as well.
Another
problem with developing ITB problems is over
use of the leg. Overuse can cause shortening
of the ITB. Repeated motion can cause local
inflammation of the underlying structures
and consequently pain. This can be very common
in runners and cyclists. However, people
who have to climb stairs or walk on inclines
or declines may experience overuse symptoms.
Some of the symptoms related to ITB are the
following
- Pain localized over either the outer side
of the knee or the hip socket.
- Discomfort
relieved by rest when it first starts
- Pain
radiating down the outer surface of the
leg
- Pain worsens during continued use of
the leg. (Walking/running)
- Symptom on the
outer upper leg after walking or running
downhill.
If you have these symptoms we have to test
for and correct any ankle and foot problems,
especially dropping of the arch, pelvic imbalances
that cause one hip to be higher than the other
and muscle imbalances of the upper leg. The
treatment of this condition begins with correction
of the underlying cause along with treatment
to reduce the localized inflammation. Local
treatment to the ITB may include ice, heat,
massage, electrical muscle stimulation and
or ultrasound as well as muscle treatment to
insure proper muscle coordination. If your
arches are dropped you may have to wear an
orthotics and do foot and toe exercises to
correct the resulting muscle imbalances. Stretching
exercises will help keep this band at its normal
length. Nutritional suggestions may be made
to help reduce the inflammation. These suggestions
can come from natural anti-inflammatories such
as bromelain, turmeric or proteolytic enzymes.
Other aspects of nutritional care may be decided
through checking acupuncture relationships
related to the muscle itself. This type of
injury requires patience. If you don’t
slow down and reduce the stress you will not
break the injury cycle. People may have to
reduce their activity level for a month or
so. That means no running, biking or squatting
type exercises. Every time your knee bends
to a 45-degree angle your ITB is rubbing against
the hip and knee bones. Until this condition
is completely healed, this will just restart
the cycle of inflammation.
Working together
this is a condition that can be helped and
you can return to normal activities without
these nagging aches and pains.
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