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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)


Hip flexor stretch iliopsoas rf vi vm vl
Hip flexor stretch (iliopsoas, RF/VI/VM/VL)




Hip adductor stretch adductor magnus longus brevis
Hip adductor stretch (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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