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Author Topic: Iliotibial band syndrome (IT band, ITBS, ITBFS)  (Read 9274 times)

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Offline Heather M.

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Iliotibial band syndrome (IT band, ITBS, ITBFS)
« on: March 23, 2003, 10:46:18 PM »
I'm posting here links to other kneeguru threads on ITB syndrome.  There are great bits of advice and some excellent links to articles, stretches, etc.

http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=1;action=display;num=1030368615;start=9

Heather
« Last Edit: March 24, 2003, 06:21:28 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Heather M.

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Re: Iliotibial band syndrome (ITBS) GREAT LINKS
« Reply #1 on: March 24, 2003, 06:05:54 AM »
Cat,

My ITBS comes and goes.  I'm about three months post op from the last surgery, and that seems to be the time that the adhesions start becoming fibrotic and putting tons of traction on the ITB.  It's been really sore for the last two days.  The best thing I've found so far is having the PT stretch me, and rolling on a foam roller.  I bought a swimming pool noodle and cut it up, I use it a couple of times a day on each side.  Can't say it's cured things, but they are a bit better.

MFR...need some context, but I'm guessing it's myo-fascial release.  The best thing for my ITBS when it was badly flared was ROLF work (special massage).  It loosened my IT band significantly.

Good luck.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Heather M.

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Re: Iliotibial band syndrome (ITBS) GREAT LINKS
« Reply #2 on: March 24, 2003, 06:15:22 AM »
Here's another article.  I'm trying to get stuff all in one place because there's not a lot out there on ITBS.  IT's currently driving me NUTS and I don't want to have to comb through the archives to find all the great exercises & stretches again....

THE BEST articles:
http://www.physsportsmed.com/issues/2000/02_00/fredericson.htm  [FABULOUS stretches] and
http://www.kneeguru.co.uk/html/rollercoaster/iliotibial_band.html

Summary of ITBS, often these sites contain other links:
http://www.itbs.info/html/treatments.html
http://www.webgate.net/~welchiro/inj-itb.html
http://www.itbs.info/html/what_is_itbs.html

Good stretches: http://www.itbs.info/html/body_stretches.html  here's a picture of a stretch http://www.rice.edu/~jenky/sports/itband_str.html

For the brave:  detailed overview of mechanics and some truly monstrous stretches.  If you're recovering from knee surgery, you probably won't be able to do this stuff.  Geared toward healthy runners or x-trainers.
http://www.sportsinjurybulletin.com/archive/0168-knee-injuries.htm



« Last Edit: March 24, 2003, 06:49:51 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ~*Heather*~

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #3 on: May 01, 2004, 04:05:09 AM »
((((((((((((((((((HEATHER M!!)))))))))))))))))))))))))))

I never saw this post or I never clicked on all the links! I just posted and asked about this kind of stuff!

Has anyone tried that PATT strap for IT Band relief? Wonder if it helps!? After my flare up today, I'll be the guinea pig! I wonder how you know if it's inflamed? Only by pain? It's not an area where you can readily see swelling usually. I can today but this is not typical. Anyway, THANKS SO MUCH!


((((((((hugs))))))))

Heather B.
R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #4 on: May 01, 2004, 05:07:08 AM »
Heather,

Glad you found the links useful.

Definitely look into the stretches.  The most useful one for me involved the Ober test as a a stretch, and the Thompson test as a stretch---HEAVENLY RELIEF if the PT did it just right.  It's tough to say which helped more.  While I saw stars, the pain was a beautiful thing....

The best thing at home for me was the full sized foam roller.  The swimming pool noodle just didn't do it, you need the foam roller with a diameter of 8 inches or so.  Most PT places have them, and mine ordered an extra for me.  I also got a lot of relief out of lying on my back with the foot of my bad leg through the loop of a dog leash.  I'd life the leg toward my face until it was right above my belly, then guide the leg down to the ground across the opposite hip, keeping it straight.  Keeping it at hip level was a stretch.  Putting traction on the leash to pull the leg (while keeping it straight) up tward my head was beautiful pain.  Pointing my toes down toward the ground while I did this could bring a tear to my eye, it hurt so good.  Check the links out, it's very hard to explain these.  

BTW, I never had much luck with some of the stretches that involved the wall.  Like you, I'd feel it more in my hip than down near my knee (which is where I feel it when the PT does the Ober test or when I use the leash).  However, the ITB is a long piece of gristle, so stretching up near the hip should theoretically loosen it.

The way to see if the ITB is tight is to do the Thompson (Thomas?  Can't remember) test while lying on the edge of your bed.  Pull your good knee to your chest and hug it tight, or you'll tweak your back.  I threw mine out  :-X  Anyway, if the bad leg is hanging in the air tense, instead of dropping down so the toe can touch the ground, then the ITB is tight.

Also, try piriformus stretches and the ones that do your outer and inner thigh & hip area.  The ITB isn't alone, it's part of a whole group.  

By far the most effective thing I did was a series of acupuncture and myo-fascial release sessions.  It reduced the pain by half, easily.  As for how you know if the ITB is tight or whatever, I go by pain.  It's tough to localize swelling on it, though I do get it down at Gerdy's tubercle, where the ITB attaches below the kneea (lateral to the tibial tubercle).  I also roll on the foam roller, and if it makes me see stars, the ITB is tight.  Lateral tracking is another giveaway.  And you can always massage along the ITB or have someone do it--chances are they'll hit tender areas and you know the ITB needs some work.

I want mine released, I swear.  Didn't it do any good at all?  Some nights I want to take a Swiss Army knife to my ITB and be done with it for good!

Take care.

H
« Last Edit: May 01, 2004, 05:07:49 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline ~*Heather*~

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #5 on: May 01, 2004, 05:26:42 AM »
Thanks for the response! I too get pain where it attaches towards the tibia. I only knew just to stretch it though. Today I was "shuffling" again and when DH and I got near the gym it flared up so bad it stopped me in my tracks and I immediately went into ITB stretch mode. Some kind person made the remark when I went insdie, "Hey! I saw you go "lame" out there." Okay and he's LAME in here I thought to myself! lol!

The ITB release was weird. I had gone through 2 LR already and since I only stretched, never strengthened, it never got better. I'd get some relief for a few days maybe weeks, but as soon as I hit stairs or went back to jogging.... :o OUCH!

My very first OS thought at this point, I had done PT (they did that stretch with my leg hanging off the table...it just hung straight out as if gravity didn't exist!) I had stopped exercising and walking was becoming painful that an ITB release was warranted. I'm not sure if that IS what I had really as far as surgical definitions go.

I have a small incision on the lateral part of my knee about 2-3 inches. I can see a piece of scar tissue floating in there to this day! My OS said he released it, but made it sound as if it was very conservative. He said a full out ITB release would only give me future problems...I didn't ask questions back then. I took his word as gospel....oh if I'd only had a crystal ball!

He mentioned something about splitting the band so it no longer could rub and cause inflammation. Obviously he was TOO conservative since 6 years later I'm on this board posting about the pain! It healed within days and I was weight bearing immediately. Fastest recovery I EVER had. Too bad it didn't work!

I should probably get my surgical notes from back then too. I have them somewhere just ITBS seems so little compared to the issues I have now. I always wondered if that is what initially gave me my tracking issues?

Do you have it in both knees? I did, can't say if I still do since I really can't use the knee as I can the good one . I don't trust it not to buckle yet. The lateral side of the baja/ttt leg is so numb still anyhow, hopefully I can't feel it anymore  ::)   Maybe overcompensation for all these years is finally making it scream!

Thanks for the suggestions on the stretches. The dog leash one is very creative and I can imagine the blissful pain you speak of! That's what I'm after! I can do all the "textbook" stretches with no pull. I made myself that flexible so I was at a loss. I will try your suggestions though.

You're such an asset here! THANKS!

Heather

R knee-2 LR's, 1 ITB Release. L knee-LR/medial plication (2/02).Fell postop 3/02 & ruptured quad tendon.Quad tendon repair (8/02).Led to Patella Baja.TTT w/ Quad tendon reefing 9/03.Screw removal 8/04

Offline Heather M.

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #6 on: May 01, 2004, 05:41:30 AM »
Heather,

I understand about being so flexible that none of the stretches work--my PT clinics (all of them!) called me Gumby.  When they did the hamstring stretch (me on my back, legs straight, PT picks up leg to be stretched and starts shoving it toward your head) they had to get my ankle in line with my NOSE before I could feel the slightest pull.  No joke.  The problem is that I have what my OS called gross joint hypermobility--ie hypermobile in all of the larger joints.  I can't dislocate my fingers or do party tricks with my elbows, but my hips, knees, and shoulders, even SI joint seems to have no stop feature--I just keep going.  I could pop my shoulder out throwing a pitch (stopped baseball, thanks).  On the dog leash stretch I mentioned, I can get my straight leg across my opposite hip and pull it halfway to my shoulder.  The PT's eyes bugged out.  

So my point is that if you are Gumby, form is everything.  Like the leash stretch--I don't feel much unless I point my toes down toward the ground while I do it.  Then I get the full stretch and then some.  Same with the Thomas test/stretch--I have to actively try to bend my bad leg as it's dangling before I can feel the pull.  My PT used to hook his leg over my foot and force it in directions I'm not sure it was supposed to go, and I'd beg him not to stop and at the same time be whimpering with pain.

So gumby has to have really good form to get a stretch, otherwise it just won't work.  Try talking to your PT for pointers.  Sometimes, health clubs have 15 minute stretch times with personal trainers, though I would be careful of the training/background.  My club had a trainer who was a former PTA, so I was okay with her stretching me.

Definitely look up the piriformus stretch that involves lying on your back with both legs bent.  Put ankle of bad leg on knee of good leg (like you're a guy who is seated and wants to cross his legs in polite company).  Then hook your hands behind the knee of the good leg, which has ankle of bad leg resting on it.  Be sure to keep the shin of your bad leg at a perpendicular angle to your body (i.e. make a cross).  With a firm, slow motion, pull on the hands behind your good leg to draw your good knee up toward your chin.  The bad knee will follow along sideways, and you'll feel God's own stretch in your butt and hip. It's great!  Hold for 30 secs, then release.  Repeat 5 times.  

When you're done with piriformus and ITB stuff, be sure to sit in a modified lotus posittion with the soles of your feet pressed together in front of you.  Push down gently on your knees with your hand to stretch your inner thigh.  You've got to stretch the opposing stuff, and strengthen it as well, if you want to have a balanced set of muscles.  I also do the adductor & abductor machines at the gym.  It's amazing you little I can open my legs because of the tightness of my hips and outer thighs.  Darned ITB!!

And yes, I have ITBS in both knees.  The 'good' kneecap is dramatically tilted on x-ray from the tightness.  Know what the OS recommended....?  That's right.  LR.   Not going to happen.

Hugs.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline hopeful1

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #7 on: August 03, 2004, 11:24:53 PM »
Heather -

These are great resources.  I have a symptom that I don't find well described in this literature, but both my OS and PT swear it is my ITB causing the symptoms I have.

Here's the issue - now that I am more active, I sometimes have a snapping sensation.  It is CLOSE to the same snapping, painful, neauseating unstable sensation I had when my patella subluxates.  The difference is the location.  I feel it on the side, really at the top of my fibula - no where near my patella. It ONLY happens when I am bending my knee, usually when I am stepping OFF and my knee is bent at about 15 to 20 degrees. It also frequently happens when I am going up stairs (this is a new trick for me!).  It makes a LOUD "pop" - anyone near me asks what it was!  It also causes a VERY sharp pain, then burns for awhile after(maybe 20 minutes or so) but it doesn't really hurt when you push on it, like everyone else describes.  

I do ITB stretches, and ice the area - and it does seems to help.  Does anyone else have this problem, and is it really caused by a tight ITB??  I am not convinced...

Thanks!

L.
Fell 3/02
TTT, lateral release, VMO transfer & meniscus repair on 4/20/04
Lysis of adhesions/MUA on 6/10/04
FULL ROM by 7/19/04
Normal minimal function (ie, stairs, walking, etc) by 8/23/04
NO probelms since!!
Pregnant spring 05 - Due 9/05!!!

Offline christinaz

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #8 on: September 09, 2004, 07:38:21 AM »
Hi guys,

Although I'm new to this issue, I'm not new to this site.  I tore my first acl graft on 12-27-03 and had my rev acl recon on 3-25-04.  I have had a very awful recovery( if that's what you want to call it) and have been through sooo much pain.  My OS thinks I have excessive scar tissue that continues to reform even though I can feel and hear it pop.  I have been fighting this for 6 months and have been on crutches more than not.  Lately, I have been usuing them almost non-stop...except in the house where I can hold on to things to walk.  My OS wants to do another scope to clean up my knee.  Today, at PT I was doing straight leg raises and ended up needing help doing them without even any weight.  So, after doing them in all directions, I laid on my stomach and they had me pull my leg with a belt, bending it as far as I could.  I told the therapist that it felt really tight from my hip to my knee like a rubber band pulled extremely taut.  Anyway, he said it sounded like my IT band was tight and did this stretch with me laying on my side and him pushing down on my leg over the side of the table.  After he stretched it for almost five minutes(with periods of rest), I sat up and could BEND MY KNEE!!!!!  I went from 103 flex to 138 flex and I could get my knee to lock from 11 ext to -3 ext.  I could walk with almost no limp.  I was sooo excited.  However, after only one hour(one very glorious hour) I couldn't bend my knee again or walk and had significant pain and this very wierd pins and needles feeling down my whole leg.  The pins and needles feeling is gone( thank G*d) but I still can't walk and the pain is back just like before.  Is it possible to keep the IT band stretched without reverting back to my normal everyday lurch?  I tried to stay as mobile as I could but it just froze up on me all over again.  Is there any other way to fix this problem without the OS doing any further surgery?  Is this caused by my weak quads or my scar tissue?  I know my top incision runs right about where it feels really tight and is about 3 inches long.  Could this be making the IT problematic?  I know this is a lot but I really don't know anything about the IT Band other than a few things I found on the site and my situation doesn't sound very typical as compared to the situations represented in the articles I saw.

Any help would be appreciated.

Love, Christina
3 scopes rt knee, acl recon pt graft rt knee,  rev acl recon allograft rt knee,  Hardware removal, lysis of scar tissue, ITBS, sublaxation, sensory peripheral neuropathy, DDD, arthritis, RSD, mystery hardware, flexion contracture, disuse atrophy, muscular wasting, constant fatigue, acl recon lt knee

Offline Heather M.

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #9 on: September 13, 2004, 12:07:42 AM »
I found a great new article that goes in-depth into the issues surrounding ITBFS:

http://www.emedicine.com/orthoped/topic404.htm

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline christinaz

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #10 on: September 13, 2004, 07:27:03 AM »
Heather,

As always, thanks for the great info.  I am calling my os in the am and discussing this with him.  I hope that I won't have to have any surgical intervention for this, but I am kind of worried because I experience excessive pain when walking and cannot straighten or bend the knee sufficiently on my own.  I really appreciate the information because I would like to be able to ex[lain this to my os properly and then get his opinion.

Thanks again,

Christina
3 scopes rt knee, acl recon pt graft rt knee,  rev acl recon allograft rt knee,  Hardware removal, lysis of scar tissue, ITBS, sublaxation, sensory peripheral neuropathy, DDD, arthritis, RSD, mystery hardware, flexion contracture, disuse atrophy, muscular wasting, constant fatigue, acl recon lt knee

Offline Heather M.

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #11 on: September 13, 2004, 09:32:40 AM »
Christina,

Be sure to discuss the possibility of scar tissue with your doctor--and don't let him tell you that you don't have it because you have good ROM.  How many times have I heard that??

Anyway, just wanted you to know that while I do have severe IT band syndrome...it is because of scar tissue.  This was identified during my last surgery, where the doctor said that the distal ITB (the part that attaches just below and lateral to the knee) was adhered to the bone with very thick scar tissue.  This tissue hardens as it ages, and puts traction on the IT band.  This causes severe pain and a sensation of unbearable tightness.  It got so bad that my IT band was literally snapping at the top of my thigh every time I stood up or sat down.  And when I rotated my ankle, I could pop the IT band at the lateral part of the knee--OUCH!  Scar tissue traction also causes the muscles around the area (especially the vastus lateralis in the quad and the anterior tibialis in the lower leg) to feel incredibly tight and spasm.

Anyway, what I'm trying to say is don't get too hung up on terms like IT band syndrome and soft tissue or myo-fascial restrictions...it's important to remember what is causing these issues.  In my knee, it is scar tissue.

You should probably read up on the topic so that you can discuss it with your OS in an informed way.  However, you run the risk of knowing more than your surgeon if you do that!!  Arthrofibrosis is a very rare condition, and many doctors don't see a serious case but once or twice in their careers.  The recommended treatment for arthrofibrosis depends on the length of time that you've had the condition.  But you should know that the IT band syndrome, fascial restrictions, muscle spasms and swelling that can accompany arthrofibrosis are possible to treat--usually, it takes a combination of therapies, but you can do it!  For my severe ITBS, the 'cure' was to have acupuncture, PT with phonophoresis (ultrasound with cortisone cream), and then a LONG session of myo-fascial relese or ROLFING.  All of this in the same morning.  The combination of treatments knocked back the worst of my IT band pain in about 1 week (I went three times the first two weeks, twice the next 3 weeks, then once for two more weeks).  So in six weeks or so I was 'cured.'  But you have to keep up on the stretching and such, or the IT band will tighten up.  So I used to do maintenance acupuncture once a month, and have deep tissue massage once a week.

Hope this information helps a bit.  Good luck with the doctor.

Heather

PS Be sure to discuss complications of scar tissue like fibrosis of the fat pad and patella baja...if you haven't ever had an x-ray to look at the position of the patella and the amount of joint space underneath it, then you should!
« Last Edit: September 13, 2004, 09:36:52 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline christinaz

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Re: Iliotibial band syndrome (IT band, ITBS, ITBFS
« Reply #12 on: September 15, 2004, 08:55:50 AM »
Heather,

So what you're saying is that most of this is caused by or related to this nasty scar tissue(  I HATE SCAR TISSUE!!!!!!).  I know I'm mal tracking badly and I have really stubborn scar tissue and pain and only achieve ROM when my IT is stretched.  You can feel it getting tighter almost.  There is a lot of pressure and some intense pain at my tibial incision.  What is your fat pad?  I'm not sure about patella baja, because I think that means when your patella rides too low because of different structures pulling it.  Mine kind of pulls medially and down a little but underneath it I have two areas that look swollen but feel denser than they would if they were swollen.   ??? ???

thanks again Heather

Christina
3 scopes rt knee, acl recon pt graft rt knee,  rev acl recon allograft rt knee,  Hardware removal, lysis of scar tissue, ITBS, sublaxation, sensory peripheral neuropathy, DDD, arthritis, RSD, mystery hardware, flexion contracture, disuse atrophy, muscular wasting, constant fatigue, acl recon lt knee















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