How To Treat ITB Syndrome
The practice of Chiropractic involves maintenance of the structural and functional integrity of the human body. A doctor of chiropractic may manipulate any and all of the body's joints, muscles and connective tissues. During the course of treatment many physical agents, modalities, techniques and therapies are available to me as your chiropractor to assist in my treatment. While ITBS pain can be acute or chronic, the symptomatic band generally should be rested.
1. Chiropractic adjustments to the lower back immediately increase 50 % more blood flow into the hip and leg, reducing pain at the origin and insertion.
2. Using a foam roller to loosen the band can help prevent and treat ITBS, although this self massage treatment can be painful.
(IT Band Massage)
Iliotibial Band Syndrome
Isolated pain is also experienced commonly at the band's insertion point in the shorter leg's knee. Other ITBS causes include high or low arches in the feet, excessive supination of the foot, and excessive lower leg inward rotation due to over pronation, weak hip abductor muscles and weak, non-firing deep (multifidus) muscles in the lower back.
How To Diagnosis ITB Syndrome
After a consultation with a patient describing the painful area and activities that provoke the pain, I perform an orthopedic and neurological exam. This includes palpating or feeling the painful area, along with passive and active movements of the hip and low back regions. A gait analysis, walking and/or running, provides me with a visual inspection of both lower extremities including the foot movements. The history, exam, physical activity description, pain symptoms help me to identify the cause and make the diagnosis. I may use a special X-Ray to measure if there is an anatomical short leg. This is an unique X-Ray of the legs-femurs and tibias. The average leg-length difference in 98% of the population is 1/4". A MRI and Bone scan may help diagnosis.
What is Iliotibial Band Syndrome (ITBS)?
The iliotitial band is a thick fibrous band of connective tissue. It runs along the outer portion of the upper leg, extending downward from the outside of the pelvis, over the hip and anchoring into the outer portion of the knee.
3. Therapeutic ultrasound can be used on the painful areas by its gentle mechanical massage and anti-inflammatory function.
4. A therapy machine that utilizes electrode stimulation and relaxation therapy can be applied to help the area to further relax it.
5. Therapeutic massage by a sports doctor, physical therapist, licensed sports massage therapist or an athletic trainer will help reduce pain.
6. Natural anti-inflammatory (a-c) and natural relaxants(d):
a. White willow Bark
b. Citrus bioflavonoids
c. Essential fatty acids
d. Bone Up (Calcium and Magnesium source)
7. An effective treatment strategy is using kinesiology tape as seen in Kinesiology Tape IT Band. This is placed in a vertical way along the entire course of the attachments of the ITB, either starting at the origin on the outer hip area and making a vertical strip down the outside leg down to the outer knee region. If the pain is primarily in the knee, start the tape vertically from the lower outer knee area and pull lightly upward to the mid-leg region.
(Kinesiology Tape IT Band)
It originates on the ilium (hip) bone from the tensor fascia lata tendon and part of the gluteal tendon, inserting just below the knee into the tibia bone, hence the name, iliotibial band.
The continual tightening of the band over the outside of the outer knee (tibia) causes the area to become inflamed. ITBS symptoms usually consist of a sharp stinging sensation at its insertion just below the knee joint to pain, a pain at the point where the band originates on the outer hip area. The pain may not occur immediately during the physical activity, but may intensify over time, especially as the foot strikes the ground. Pain might persist after the activity as well.
What Causes ITBS?
ITBS is usually caused from ballistic exercising, i.e. running and/or playing sports involving running and jumping more than the leg can tolerate. It is the most common cause of outer knee pain in runners. It is also seen in other physical activities: walking, hiking, dancing, aerobics fitness classes/videos, and weightlifting. Cycling for extended times can produce the symptoms as well. Stair climbing, mountaineering and squat-type exercises in the gym can provoke the symptoms. ITBS is typically referred to as a "repetitive stress or overuse injury." The impact is made worse by walking or running on uneven terrain, uphill, downhill, or on hard surfaces. Improper footwear, inadequate shoe lacing technique, including worn-out shoes, can also contribute to the symptoms. ITBS commonly occurs during pregnancy, as special hormones allow the connective tissues to loosen as the woman gains weight, adding more hip strain. ITBS at the hip commonly affects the elderly with 200,000 plus miles on their legs. This may also happen at a child's or teenager's hip. The primary underlying cause of ITBS is an anatomical leg-length difference and symptoms are usually at the origin and/or insertion points of the band in the "anatomically" longer leg.
8. The less effective "McConnel Taping" off-loads the ITB's outer knee insertion region reducing the ITB's outward tension on the patella by pulling the kneecap inward.
9. As always, with most musculoskeletal painful conditions ice therapy consisting of either crushed ice in a zip lock baggie on top of a single paper towel for 20 minutes, or a 10-minute Dixie cup ice massage is beneficial for pain relief.
10. Dr. Paul's Custom Orthotics made with a correction for the anatomical leg length difference are the best long-term approach to treat and prevent ITB conditions from recurring. These orthotics correct the abnormal foot alignment and leg-length inequality, reducing rotation of the leg and knee and minimize abnormal tension of the band on the outside area of the hip and knee.
Dr. Paul R. Copeskey, DC, CCFC