Archive for June, 2009

Case of the Week – IT Band Syndrome

Thursday, June 4th, 2009

IT BAND SYNDROME 

CASE: 26-year-old female who developed outside knee pain two weeks prior to her presentation at the clinic for examination.

HISTORY: Recently increased mileage, ran through pain, added bicycling to routine, ran with dog who pulled on lead.  Replaced her high-quality running shoes regularly every 250 miles. 

PHYSICAL: Pronated feet, scoliosis of the lower back.  Tenderness outside of knee.  Tenderness lateral hip and buttock.  Sore when sitting in office chair.

DIAGNOSES: IT-Band syndrome [ITBS], Tensor fascia lata syndrome [TFL], Scoliosis (congenital curved spine), pronated feet, flattened arches.

TREATMENT PLAN: Ultrasound and cross friction massage 3x week for 2 weeks.  Stop all running and bicycling.  Check alignment of foot, ankle, knee, hip and lower back.  Home treatment ice/heat/stretching/strengthening.

OUTCOME: We determined that the patient sustained the ITB injury by increasing her mileage too quickly as well as from running off-balance from a dog pulling on a lead.  She had pre-existing scoliosis as a complicating factor.  We determined that she had a secondary case of TFL syndrome in the same leg, caused by compensating for the ITBS pain and climbing/descending her 2 flights of steps often at home.  Her high quality shoes mitigated the flat feet and pronation problem, so this wasn’t a significant factor. 

With treatment and rest, the ITBS pain resolved in 14 days, along with the TFL which we simultaneously approached with electrical muscle stimulation and restrictions on climbing/descending stairs.  We reintroduced run/walks on a trial basis on day 15 with a 5 minute run/walk.  Progressively adding minutes over the next two weeks, 5 at a time until she reached her goal.

DISCUSSION

Situated as we are on Lake Calhoun, surrounded by miles of running and biking trails, we have the opportunity to see a large number of exercise-related injuries, including what is primarily a running-related injury, IT Band Syndrome. 

Iliotibial Band Syndrome typically is noticed by the runner/walker/hiker as outside or lateral knee pain that occurs during or after running.  While many factors can predispose and/or cause a runner to come down with the syndrome, some of the more common causes we see in the clinic are a sharp increase in mileage, running on uneven surfaces, worn out or improper foot wear and biomechanical issues with the knees, hips and/or the lower back.

Treatment options are many.  Here, we utilize a conservative approach to care, tailoring non-invasive treatment to each individual presentation.

Our typical assessment of the running injury may include:

1) Review of running/training history.

2) Physical examination of the spine, hips and lower extremities to assess for biomechanical problems.

3) Assessment of flexibility, mobility and movement patterns.

Treatment may include:

1) Assessment of foot, ankle, knee, hip and lower back alignment.

2) Ultrasound, massage, cross friction massage, ice, heat and/or additional local therapy measures on the injury.

3) A stretching and strengthening program.

4) Reduced mileage, alternate exercises, cross-training, rest, and a step-wise return to activity.

5) Education.  We make it a priority for our patients to understand the injury and underlying causes of injury.

With our competent assessment and diagnosis, our patients have enjoyed good success with our conservative approach to treating their IT Band, and other exercise-related, injuries.  In most cases we are able to resolve injuries to avoid sending a patient on to more aggressive and potentially difficult treatments including prescription medications, cortisone injections and beyond.  If you think you have IT Band syndrome, or any other injury and you would like an opinion, please contact our office for an appointment.

Remember, this is a case history and general discussion of injury conditions we see here.  It is not to be considered specific advice to follow without proper medical or chiropractic evaluation.