ITB Syndrome

ITB-intro

What is iliotibial band syndrome

The iliotibial band (ITB) is a thick band of fascia on the outside of the thigh. It extends from the pelvis, over the hip and knee, and inserts just below the knee. This band is crucial to leg stabilization. An inflammation of the ITB on the side of the thigh, just above the knee joint, is referred to as iliotibial band syndrome. Although it is commonly referred to as “runner’s knee”, this is a frequent overuse problem for dancers.

How can it occur?

ITB Syndrome in dancers is an overuse injury from intense ballet training, and most often results from a number of different functional problems. Muscle dysfunction of the thigh and hip muscles will cause increased tension in the ITB and can seriously affect leg alignment and stabilization. It is therefore an important contributing factor to knee injury and overuse issues in the lower extremities.
Elevated tension of the ITB may cause a rubbing of the band over the lateral femoral epicondyle – a bony bump on the thighbone (femur), just above the knee. With such increased tension of the ITB, and repeated flexion and extension of the knee, the area can become inflamed.
Muscle overuse often occurs when the body fails to compensate for existing muscle dysbalance. Muscle dysbalances are very common and naturally occur as the body adapts to specific training demands over time. As long as compensation is effective – or, in other words, as long as the dysbalance is well managed by the body – this need not cause any problems. However, with high training loads, insufficient rest or after a minor injury, the body may struggle to compensate, leading to muscle dysfunction in the various muscle groups involved in the compensation. This is why symptoms may simultaneously occur in different parts of the body in an overuse situation.
The psoas muscle is probably the most important muscle involved with dance injuries. Psoas dysfunction leads to tightness of the rectus femoris muscle (a part of the quadriceps) and the piriformis (one of the smaller pelvic muscles inserting on the sacrum) and causes pelvic torsion and functional leg length discrepancy. The increased amount of stabilization work needed to compensate for leg length discrepancy will overcharge different groups of muscles including the vastus lateralis and the tensor fasica lata muscle – both muscles that directly influence the tension of the ITB.

What are the typical symptoms of iliotibial band syndrome?

Symptoms range from a stinging sensation to swelling or thickening of the tissue on the side aspect of the thigh, just above the knee joint in the area of the lateral femoral epicondyle. Snapping hip syndrome with a tightened ITB snapping over the greater trochanter (a bony bump on the hip bone) is often associated with iliotibial band syndrome.

How can iliotibial band syndrome be diagnosed?

Your doctor will examine your knee and may find tenderness on the side aspect of your thigh, just above the knee joint. Your quadriceps may be partly cramped ­– especially on the outside – and tension in your ITB may be high. An ultrasound scan can help to identify inflammation in the area of the lateral femoral epicondyle. Correct diagnosis of this issue demands a thorough functional clinical examination, including specific tests to identify joint and muscle dysfunction. Finding out the exact causes of ITB syndrome is sometimes challenging and your doctor may ask a specialist in manual medicine for his opinion.

ITB

This MRI scan shows an overview of the knee. Fluids appear white in this picture. You can easily spot the inflamed bursa between the femoral epicondyle and the ITB as it is filled with liquid.

What treatment options are there?

If you have severe or constant pain, you should take a break from your ballet training immediately. Ignoring the pain can have serious consequences, as the situation will become increasingly complicated the longer you train with pain.
The RICE concept (rest, ice, compression and elevation) is an easy guideline that can be used to initially treat acute as well as overuse injuries. Please read my “First Aid” post to obtain some background information that you will need to adapt this concept successfully and learn about the use of painkillers.
In order to handle a given overuse situation successfully, its underlying causes – namely muscle dysfunction and muscle dysbalance – have to be addressed specifically in the rehabilitation process. Muscle dysfunction can appear as muscle tightness (contraction) or weakness (inhibition) and the muscles affected have to be treated accordingly in the rehabilitation process. Some muscles will have to be stretched whereas others will rather have to be strengthened. A well-suited training program including corrective exercises as well as a general strengthening and endurance routine is the most effective way to deal with most overuse situations.
Manual medicine and especially deep myofascial release treatment is recommended to address present joint and myofascial dysfunction. Restriction of the fascia plays a key role in all overuse issues and can be addressed effectively with manual medicine.
Ensure that you follow your specific training routine after the rehabilitation is finished. Myofascial rollers (Blackroll, Triggerpoint Roll, etc.) as well as Lacrosse balls and resistance bands are easy to use in the studio and will help you remain balanced in the long run.

Next steps

Do you think that you might have an ITB problem and want to have it sorted out? These are the next steps:

  • See a doctor

Dancers seek help from various different kinds of therapists, many of whom may employ treatments that are outside of mainstream medicine. Before considering the use of such alternative medicine, you should see a doctor for an evaluation and diagnosis.
Finding a doctor who is familiar with the specific medical issues faced by dancers is often challenging and you may need to see several different specialists in order to get a full picture of your diagnosis. A good place to start is to ask your friends and fellow dancers for the names of their favorite doctors.

  • Find a specialist in manual medicine

Doctors who specialize in manual medicine practice a whole-body approach. They will try to identify and specifically treat the underlying causes of your problem, rather than just the localized symptoms. This approach is important in addressing all aspects of the often very complex overuse problems that dancers experience. A specialist in manual medicine will perform a functional examination on every part of your body and will treat you according to these thorough findings.
To find a physician who specializes in this field, search for “Manual Medicine”, “Osteopathic Manipulative Medicine” or “Osteopathic Physician” on the internet.

  • Start working on your problem

There is a lot that you can do to work on your problem after a proper diagnosis has been set. Ultimately, it often comes down to addressing the same fundamental issues. Here are some useful exercises that I recommend to my patients:

Flexibility trainingITB release, Rectus femoris release, Hamstrings release, Adduktor release, Psoas stretch, Lumbar spine releasePiriformis release,

Strength training: Core training – resistance band workout, Core training – Abs crunches, “The clamshell” – Piriformis training, “The monster walk” – Piriformis training

Please refer to your doctor to confirm that the exercises you choose to do are suited to your individual problem, and obtain supervision from a professional trainer to ensure that you are performing them correctly.

  • Talk to your ballet master or dance teacher

Technical issues and faulty dance technique are important predisposing factors of overuse and injury in dancers. Amending dance techniques often plays a crucial role in the treatment and prevention of overuse and injury and you should not hesitate to address any issues, if necessary.


 

 


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