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Weak hip abductor can cause ITB syndrome



This is the condition that causes knee pain especially in lateral side (outside) and is also called Runner’s knee. ITB(Iliotibial band) is the tough band of fibres (fascia)and moves forward and backward across femoral condyle. When the knee is flexed to 30 degrees, this irritates and stresses lateral side of the knee and called impingement zone. This is how ITB rubs femoral condyle and becomes ITB syndrome.

When the knee is flexed, ITB locates behind the femoral and bone is exposed whereas when the knee is extended, ITB moves forward and sits on the bone.

ITB (Iliotibial band)

 There are some muscles that attaches to ITB which are TFL (tensor fascia latae) and Gluteal maximus but gluteus medius, vastus lateralis and biceps femoris could affect ITB syndrome or occur similar condition. It inserts into Gerdy tubercle of the tibial plateau and partially to the supracondylar ridge of the lateral femur.

Weak hip abductor (gluteus medius) in distance runners with ITB syndrome

There is some researches as to the connection between weak hip abductor and ITB syndrome. *1 This research compares hip abductor strength between long-distance runners with ITB syndrome and long-distance runners with no issue. To measure hip abductor strength, Nicholas Manual Muscle tester (kg) and height and weight differences are normalized (% BWh).

With average pre-rehab hip abductor torque of female groups, affected leg was 7.82%BWh and non-affected leg was 9.82%BWh whereas 10.19%BWh was for the control group (runners without ITB syndrome). With male groups, injured leg was 6.86%BWh and 8.62%BWh was non-injured leg while 9.73%BWh was for the control group.

 All participants with ITB syndrome performed 6 weeks of rehab on gluteus medius. After that 6 weeks, 92% of them got back to exercises and running without pain. Moreover, there was no recurrence of symptom at 6-months follow-up.

Aetiology

  • Overuse (repetitive knee flexion and extension)
  • Weak gluts muscles, quadriceps and core muscles
  • Poor foot wear and arch control
  • Running including hill training, long distance running and repetitive stress on the knee
  • Bony prominence (Lateral femoral epicondyle) *3
  • Cycling, playing soccer and tennis, and skiing *4

Sign and symptoms

  • Swelling and inflammation over the outside of the knee
  • Pain when knee is flexed
  • Pain with movement such as running or squat
  • Sharp and burning pain over the lateral side of the knee

Treatment

  • Managing the pain with complementary health therapy such as dry needling, cupping, Trigger point and myofascial release
  • Needling on vastus lateralis could work for ITB syndrome
  • Strengthening the muscle such as gluteal maximus, TFL and gluteus medius *1
  • Improving the ROM (range of motion)
  •  Exercising to reduce the pain
  • See the podiatrist or physiotherapist to check your gait

Special tests to find out if the patients possibly have ITBS

  • Knee ROM

Strengthen Training on hip abductor

  • Side lying hip abductor activation
  • Crab walk with a resisted band
  • Single leg dead lift
  • Step up

Differential diagnosis

  • Biceps femoris tendinopathy
  • Lateral collateral ligament sprain
  • Patellofemoral stress syndrome
  • Osteoarthritis
  • Popliteal tendinopathy

Reference

  1. ITB syndromeFredericson M, Cookingham CL, Chaudhari AM,  Dowdell BC,Oestreicher N and  Sahrmann SA Hip abductor weakness in distance runners with iliotibial band syndrome Clinical journal of Sport Medicine 2000 10 (3):169-175
  2. Corey Beals and David Flanigan A review of Treatments for iliotibial Band Syndrome in the Athletic population 2013 j sports Med 367169
  3. Everhart JS, Kirven JC, Higgins J, Hair A, Chaudhari AAMW and Flanigan DC The relationship between lateral epicondyle morphology and iliotibial band friction syndrome: A matched case-control study 2019 26(6): 1198-1203
  4. Andrew Hadeed and David C. Tapscott Iliotibial Band Friction Syndrome 2020 StatPearls Publishing
  5. Ferber R. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010;40:52–8.

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