Iliotibial Band with Highlighted Area of Pain. From An Atlas of Human Anatomy by, Carl Toldt, M.D. |
Understanding the mechanism of injury helps when determining
how to treat this common cause of knee pain. Many people will state that a
‘tight’ ITB is the cause; actually, this is somewhat incorrect. First, the ITB
is not a muscle and is not contractible, at least compared to a muscle. Second,
it is most often the case that the ITB is taut in ITB friction syndrome. What I
mean by this is that the ITB is often pulled into an overlengthened position.
To understand this, it is important to understand the role
of the gluteus medius and minimus in pelvic stability. During the weight
bearing phase of the gait cycle, these muscles fire to prevent an excessive
rising of the ilium. If you were to place your hands on your waist and press
down until you feel bone, you would be on the ilium. When walking (or running),
during the weight bearing portion, this bone should not rise too much. The
gluteus medius and minimus are the muscles most responsible for creating this
stability. If these muscles become inhibited and lose the ability to stabilize
the pelvis, it then will rise excessively and structures such as the ITB will
be pulled long with each step. To help
visualize this, you can consider that women naturally have more pelvic movement
and some women (Marilyn Monroe, historically, and many runway models) actually
practice exaggerating this movement for aesthetic reasons.
In the majority of the cases, the side where ITB friction
syndrome occurs is also the side where the greatest degree of inhibition of the
gluteus medius and minimus occurs. This can be assessed with manual muscle
tests which challenge these muscles. In addition, most patients presenting with
ITB friction syndrome will have a raised ilium when assessing standing posture,
and this raised ilium will be on the side of the lateral knee pain.
Treatment of ITB friction syndrome needs to include some
work to strengthen the gluteus medius and minimus for optimum results. Things
like foam rolling the ITB might help to soften it, but most often work needs to
be on the short and tight adductors on the inside of the leg, and strengthening
corrective exercises should be applied to the abductors such as the gluteus
medius and minimus.
Acupuncture can be extremely helpful as part of the therapy.
Acupuncture to motor points (approximately in the region of the entry site of
the motor nerve into the muscle) can help turn on inhibited muscles, which is
shown by the muscles strengthening after treatment when testing with manual
muscle tests. In addition, acupuncture to motor points of the overactive
antagonistic muscles (adductors in this case) will help reduce tension in these
muscles. This helps strengthen the effects of corrective exercises and allows
quicker recovery time so you can get back out and hit the trails.
No comments:
Post a Comment