Iliotibial band (ITB) syndrome is often considered an overuse damage frequent in runners and cyclists. Not way back, this controversial situation has gained better consideration on account of current articles that embrace my “IT-Band Friction Fallacy?”, Mark Charrette’s “Lateral Knee Pain and Orthotic Support”, and Whitney Lowe’s “New Perspectives on ITB Friction Syndrome”. When it comes all the way down to it, Myoskeletal bodywork practices are the one true resolution to the puzzle. Though many researchers and clinicians are satisfied that the patho-anatomy of iliotibial band friction syndrome (ITBF) is easy and understood, the jury remains to be out on the precise trigger(s) of this lateral knee ache situation. Blindly following standard knowledge could usually level good clinicians to the fallacious therapeutic path. The next instance clearly reveals how “chasing the pain” led physicians right into a linear remedy protocol leading to months of unwarranted ache and pointless medical interventions.
Case Examine Not too long ago a 44-year-old orthopedist, who for our functions might be known as Dr. Smith, was referred to me complaining of eight months of debilitating, self-diagnosed, IT-band friction ache. Throughout his historical past consumption, he admitted struggling sporadic foot, hip and low again soreness however considered these points as “unrelated.” A self-described “weekend-warrior,” Dr. Smith’s knee ache elevated with extreme working or biking. Each he and his workers (a bodily therapist and physiatrist) had rigorously scrutinized the painful knee and arrived at a undivided analysis of ITBF based mostly on outcomes from Ober’s Check (determines the tightness of the ITB), Renne’s check (specifies the realm of ache throughout weight bearing) and Noble’s check (identifies the realm of ache when the leg is flexed at a sure angle). To additional strengthen their analysis, MRI research displayed a thickened iliotibial band over the lateral femoral epicondyle. The end result: analysis confirmed as ITBF – case closed. Dr. Smith associated that his group’s preliminary remedy objectives centered on relieving the (supposed) irritation by way of ice therapies and anti inflammatory drugs adopted by a sequence of bodily remedy periods. Sadly, the “series” of bodily remedy slowly advanced into months of heartbreaking disappointment. Typical remedy modalities (stretching, ultrasound, electrical stim, cross-fiber frictioning and set off level work) introduced little aid. Discouraged with the dearth of progress, Dr. Smith and his physiatrist accomplice started a extra aggressive method with corticosteroid and proliferation injections. Though a lot of their ITBF sufferers responded positively to this remedy protocol, Dr. Smith didn’t. Determined to get again to his biking and working regime, Smith determined to undertake a surgical launch of the ITB on the posterior 2 cm the place it passes over the lateral epicondyle, however nonetheless no aid. So how did eight months of aggressive remedy result in unproductive failure? My Myoskeletal alignment house examine strategies will reveal the reply. Typical Knowledge ITBF is often considered a multi-factorial, non-traumatic, overuse situation wherein the distal facet of the iliotibial band rubs over the lateral femoral epicondyle throughout repetitive knee flexion and extension actions. This in time results in irritation of the iliotibial band, bursa and lateral synovial recess. On this common theoretical mannequin, the deep posterior ITB fibers are extra weak to back-and-forth rubbing on the knee’s epicondyle. Quite a few research have described a dynamic “impingement zone” at roughly 30 levels of knee flexion the place the ITB is topic to microfiber tearing and related irritation. Therapists who abide by this “conventional wisdom” usually seek for the sore spots across the condyle and cross-fiber friction the affected tissue in an effort to interrupt down weak-linked adhesions, improve fibroblastic exercise and encourage tissue reworking. Comply with-up therapies usually embrace elbow “fascia-mashing” and handbook ITB stretching routines. All of those strategies could be efficient if ITB fibers really are broken.
Erik Dalton, Ph.D., Licensed Superior Rolfer, began the Freedom From Ache Institute and created Myoskeletal Alignment Strategies to share his ardour for therapeutic massage, Rolfing, and manipulative osteopathy. Go to the Erik Dalton web site for data on workshops, conferences, and CE house examine programs. Learn Extra http://erikdalton.com/media/published-articles/chasing-the-pain/