Iliotibial tract syndrome

Findings

A normal knee, apart from local pain on palpation over the lateral femoral condyle, which is worse when the knee is moved back and forwards at 20-30 degrees of flexion. The athlete  may be bow legged, and the iliotibial band tight, with Ober’s sign positive. The modified Thomas test may show a tight iliotibial tract.

Cause

The iliotibial tract flicks backwards over the femoral condyle about 20-30 degrees of flexion, and then forwards as the knee returns to extension. This can cause irritation of the under surface of the iliotibial band, and sometimes to the bursa under this area.

Treatment

a)      Settle the soft tissue swelling with RICE 

b)      Electrotherapeutic modalities to settle inflammation and organize scar tissue, such as ultrasound and laser

c)      Massage, such as frictions, to organize chronic scar tissue. Core stability exercises to the pelvis will decrease pelvic rotation and reduce the tension on the iliotibial tract.

d)     A lateral forefoot wedge may reduce supination at lift off and reduce the pain.

e)      An injection of cortisone into the bursa.

f)       Z-plasty surgery to the iliotibial band at the femoral condyle.

Sports

This is rare finding in change of directions sports, being seen mainly in running and cycling. If direction change is often used and downhill running trained in order to increase speed, there is a bigger chance for this injury. Cyclists must have “play” in their cycle clips or cleats, especially if they cycle with an externally rotated foot, which will be forced into neutral by the cleat and thus tighten the iliotibial band.

This is a diagnosis that is easily missed by doctors. Although athletes mostly respond well to physiotherapy and injection, surgery may be required to partially divide the iliotibial band.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English