Iliotibial band syndrome: an examination of the evidence behind a number of treatment options

Abstract

Iliotibial band (ITB) syndrome (ITBS) is a common cause of distal lateral thigh pain in athletes. Treatment often focuses on stretching the ITB and treating local inflammation at the lateral femoral condyle (LFC). We examine the area's anatomical and biomechanical properties. Anatomical studies of the ITB of 20 embalmed cadavers. The strain generated in the ITB by three typical stretching maneuvers (Ober test; Hip flexion, adduction and external rotation, with added knee flexion and straight leg raise to 30 degrees ) was measured in five unembalmed cadavers using strain gauges. Displacement of the Tensae Fasciae Latae (TFL)/ITB junction was measured on 20 subjects during isometric hip abduction. The ITB was uniformly a lateral thickening of the circumferential fascia lata, firmly attached along the linea aspera (femur) from greater trochanter up to and including the LFC. The microstrain values [median (IQR)] for the OBER [15.4(5.1-23.3)me], HIP [21.1(15.6-44.6)me] and SLR [9.4(5.1-10.7)me] showed marked disparity in the optimal inter-limb stretching protocol. HIP stretch invoked significantly (Z=2.10, P=0.036) greater strain than the SLR. TFL/ITB junction displacement was 2.0+/-1.6 mm and mean ITB lengthening was<0.5% (effect size=0.04). Our results challenge the reasoning behind a number of accepted means of treating ITBS. Future research must focus on stretching and lengthening the muscular component of the ITB/TFL complex.

Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome

“…Therefore, the ITB, GM, and TFL work as a single complex [5]. The current literature reports the ITB is the main cause of an external snapping hip, but the ITB is closely related to the GMT, and by relaxing the GMT, the ITB may relax as well [5]. Despite the good results [12], an ITB release acts at the effect not at the cause of the ITB tension.…”

“…The main reason for the increase in tension of the ITB complex is still unknown, as are the biomechanical consequences of its resection. The anatomic and functional relation between the GMT and the ITB [5] stimulated us to formulate the hypothesis that a GMT tenotomy could decrease the tension to the ITB. We therefore describe a novel technique for endoscopic release of the GMT and report the preliminary clinical results of this procedure.…”

“…The ITB is tensioned anteriorly by the TFL and posteriorly by the GM, both working synergistically in normal conditions [5]. Therefore, the ITB, GM, and TFL work as a single complex [5].…”

“…The ITB is tensioned anteriorly by the TFL and posteriorly by the GM, both working synergistically in normal conditions [5]. Therefore, the ITB, GM, and TFL work as a single complex [5]. The current literature reports the ITB is the main cause of an external snapping hip, but the ITB is closely related to the GMT, and by relaxing the GMT, the ITB may relax as well [5].…”

Diagnosis and Management of Snapping Hip Syndrome: A Comprehensive Review of Literature

“…Many surgical techniques have been reported in literature for the treatment both for ESHS and ISHS ( In order to preserve the abductor complex, Polesello et al [25] proposed the release of the gluteus maximum tendon (GMT), based on the hypothesis that the ITB, the gluteus maximum (GM) and the tensor fascia late (TFL) muscle work as a single complex. In fact, the ITB is pulled by the TFL anteriorly, and by the GM posteriorly, which work in synergy, and they are currently considered the main responsible of ESH [33]. Therefore, the selective release of the GMT is the main act to solve the functional abnormality without compromising the all complex.…”