Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping. Localized tenderness over the superior, anterior aspect of the greater trochanter typically indicates a strain of the tensor fascia latae [TFL] muscle.
The tensor fascia latae arises from the anterior part of the outer lip of the iliac crest and the lateral aspect of the anterior superior iliac spine. It descends and attaches to the iliotibial band [ITB], generally ending around mid-thigh.
The action of the TFL pulls the iliotibial band superiorly and anteriorly. It assists in the flexion, abduction and medial rotation of the hip joint, and extension of the knee joint. It also helps to stabilize the pelvis on the femurs and the femurs on the tibial condyles.
Diagnosis
Contracture of the ITB may be evaluated using Ober's test. Have the patient lie on the unaffected side and passively abduct the involved leg with the thigh in extension and the knee flexed at 90 degrees. When the abducted leg is released, the thigh remains in an abducted position without pain or weakness.
Muscle testing of the flexion portion of the TFL can be performed by having the patient lie supine with the affected hip flexed 90 degrees and the knee bent. Gradually apply footward force through the thigh, just above the knee, in an attempt to break the patient's resistance.
Testing of the abduction aspect of the TFL can be performed with the patient in side-lying position with the involved side up. Have the patient abduct the thigh and gradually apply force to the leg just above the knee joint. Muscle power output can be graded from zero resistance to maximum resistance using a 1-5 scale.
Treatment
Correcting a dysfunctional TFL requires addressing the proprioceptors in the insertion points. Corrective force is applied superiorly into the iliac crest at the osteotendinous junction and inferiorly into the ITB about mid-thigh.
Adjusting instruments can target the insertion points. Pin-and-stretch protocols: Apply pressure into the belly of the muscle and then have the patient flex and abduct their leg.
