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Meg Pike & Justine Allan. Overview. Anatomy What is ITB Friction Syndrome? Signs & Symptoms Mechanism of Injury Rehabilitation Return to play Prevention of Reinjury. What is ITB Friction Syndrome?. Overuse injury Runners, Cyclists, Individuals who exercise vigorously

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meg pike justine allan
Meg Pike

& Justine Allan

overview
Overview
  • Anatomy
  • What is ITB Friction Syndrome?
  • Signs & Symptoms
  • Mechanism of Injury
  • Rehabilitation
  • Return to play
  • Prevention of Reinjury
what is itb friction syndrome
What is ITB Friction Syndrome?
  • Overuse injury
  • Runners, Cyclists, Individuals who exercise vigorously
  • When ITB is tight or stressed it rubs against LFE more vigorously
itb anatomy
ITB Anatomy
  • Originates:
    • Anterior Iliac Crest
    • Ilium
    • Iliac Spine
    • Gluteal muscles
    • Tensor Fascia Lata Muscle
  • Inserts:
    • Tibia
    • Patella
    • Biceps femoris tendon
anatomical clues
Anatomical Clues
  • Tightness in hip adductors, iliopsoas, rectus femoris, gastrocemius and soleus
  • Weakness in hip abductors, especially gluteus medius
  • Overpronation
  • Lateral Pelvic Tilt
  • Leg Length discrepancies
signs symptoms
Signs & Symptoms
  • Tenderness on lateral side of the knee
  • Pain triggered during flexion or extension of the knee
  • Crepitus
  • Could have pain in the hip
  • Pain aggravated by running and during activity, could progress to pain while walking
mechanism of injury
Mechanism of Injury
  • Repetitive knee flexion
  • Repeated running in one direction
  • Old running shoes
  • Running on the side of the road
  • Training Errors: “Too much too soon”
    • Increase in intensity or duration too quickly
review the three phases of healing
Review: The Three Phases of Healing
  • Inflammatory Phase
    • 2-4 days
    • Acute Phase
  • Fibroblastic-Repair Phase
    • First few hours post-injury to 4-6 weeks
    • Subacute Phase
  • Maturation-Remodeling Phase
    • 3 weeks to several years
    • Recovery Phase
rhonda runners
Rhonda Runners
  • 21 year old female cross country runner
  • Been running for 5 years, never injured before now
  • Hates stretching and experiences tight hamstrings and hip flexors
  • Loves running EVERY DAY!
  • After long runs she complains of pain and tightness in the right knee and clicking in the right hip
  • Wearing very old, out dated cross trainers
  • Over pronates
rehabilitation overview
Rehabilitation Overview
  • Day 1
  • Day 2
  • Days 3-7
  • Days 8-14
  • Days 15-20
  • Return to Sport
day 1
Day 1
  • Injury Assessment
    • History
    • Observations
    • ROM
    • Palpations
  • Special Tests
    • Thomas Test (hip flexors)
    • Varus test (LCL)
    • Clark’s sign (PFS)
    • Nobel Compression (ITB)
    • Renee Creak Test (ITB)
    • Ober’s Test (ITB)
day 1 con t and day 2
Day 1 (con’t) and Day 2
  • Inflammatory (Acute) Phase
  • Cease injury-causing activity, curtail intensity of training program
  • PIER
  • NSAIDS
  • Acetaminophen
  • Ultrasound or electrical stimulation (IFC) for inflammation control
ultrasound and ifc
Ultrasound and IFC
  • Ultrasound
    • 3 MHz (superficial)
    • 50% or continuous intensity
    • 5 minutes
  • IFC
    • 80-150 Hz sweep pattern
    • 15 minutes
days 3 7
Days 3-7
  • Inflammatory (Acute) Phase
  • Continue Rx for Days 1&2 if needed
  • Corticosteroids if needed
  • Glute/ITB roll if inflammation subsides
  • GOAL: to control/minimize inflammatory response
days 8 14
Days 8-14
  • Fibroblastic-Repair (Subacute) Phase
  • Glute/ITB Roll (con’t)
  • Flexibility training:
    • Hip flexors (iliopsoas, RF/VI/VM/VL)
    • Hip extensors (gluteus maximus, BF/ST/SM)
    • Hip abductors (gluteus medius)
    • Hip adductors (adductor magnus/longus/brevis)
days 15 20
Days 15-20
  • Fibroblastic-Repair (Subacute) Phase
  • Flexibility Training (con’t)
  • Myofascial therapy
  • Manipulative therapy
    • GOAL: Restore overall hip function, promote formation of healthy scar tissue
day 21
Day 21
  • Maturation-Remodeling (Recovery) Phase
  • Strengthening exercises
    • Side-lying leg lifts (hip abductors)
    • Pelvic drops
    • Step-down exercises
    • GOAL: For the injured tissue to restore normal appearance and function.
return to sport
Return to Sport
  • Return to sport/running:
    • Strength/stretches without pain
    • Easy sprints, even surfaces, every other day
    • Gradually increase distance and frequency
    • Most return to sport/running within 4-6 weeks.
prevention of reinjury
Prevention of Reinjury
  • Maintain ROM and strength of hip muscles
  • Ensure adequate recovery between hard/fast training days
  • Avoid running on uneven surfaces
  • Wear proper shoes (attn: pronation/supination)
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