The iliotibial tract is a strip of fascia that pulls down from the iliac crest, supports the muscles as an extensive tendon-like covering on the outside of the thigh and is anchored to the head of the tibia . The iliotibial ligament plays an important role in the human stance due to the principle of "tension belts", as it reduces the bending stress on the thigh bone. In addition, the iliotibial tract, like the Achilles or patellar tendon, could act as an "elastic energy store" in that it can store and release energy like a rubber band when it is lengthened.
For a long time, the pain-causing mode was seen in the fact that the iliotibial band rubs against the protrusion of the joint of the thigh ( epicondyle) , similar to a rope on the edge of a rock. Recent research suggests that the epicondyle presses on the tract and see pressure rather than friction as the cause. In the same way, especially in long-distance runners, this can lead to overloading and irritation of the periosteum and the bursa . The pain syndrome itself is known to many runners and cyclists and, as tractus syndrome, the most common in pain in the area of the outside of the knee joint.
While in the Anglo-American language area a distinction is made between the Runner's Knee ( Chondromalacia patellae ) and the Iliotibial Band Syndrome , in the German language area both are referred to as " runner's knee".
The ultimate cause of the pain syndrome is permanent strain on the musculoskeletal system, as is common in long-distance running or cycling. It is favored by leg axis deviations (bow or knock knees) and foot misalignment, such as those that occur in the long term. B. after ankle sprains (= twisting ankle) can occur. Furthermore, weakness in the pelvic stabilizers can promote the occurrence of ITBS. The unloaded hip sinks and there is excessive tension on the tract. Over- supination of the foot when running, different leg lengths and shortened, inflexible muscles, especially on the outside of the thigh, are further anatomical factors that can favor a runner's knee. On the other hand, too frequent training sessions on sloping roads, building up training too quickly and too many fast training sessions are methodological causes of a runner's knee.
The sharp pain in the runner's knee can become so severe that it makes running impossible and even normal walking is severely impaired. The pain is often only observed when walking for a long time, then when climbing stairs and then also when walking. The pain, which can emanate from muscles, tendons, capsule and joint cartilage, is usually indicated as stabbing on the knee joint or on the outside of the knee. This happens e.g. B. when "stepping into a hole" or a fall. However, redness and swelling are rare.
The clinical picture can be diagnosed relatively easily by a doctor, even without imaging procedures such as X-rays or magnetic resonance imaging . The area in which the iliotibial tract slides over the thighbone is painful to feel.
In less clear-cut cases, ITBS should be differentiated from knee joint damage with similar symptoms. In addition to other tendinitis , meniscus damage and arthrosis can also cause similar complaints in the outer knee joint in this area .
In the case of acute pain, cryotherapy ("ice packs"), anti-inflammatory ointments or plasters and a break from training are very helpful. Stretching exercises for the tract and strengthening exercises for the pelvic stabilizers and the abdominal and back muscles have a preventive effect. Good running shoes , warming up and stretching exercises before prolonged exposure can also prevent the occurrence of pain syndrome. In addition, it is advisable to use physiotherapy to prevent recurrence by using myofascial techniques and relaxing the muscles. After six to eight weeks, the injury has usually healed.
If the knee is reloaded too early or too heavily, this can lead to a so-called "injury cycle". Insoles or adapted running shoes may be helpful in the case of leg axis deviations.
As a further measure, if all of the therapy measures listed above have failed, there is still the possibility of an operative intervention . The tract is lengthened by a Z-shaped incision and thus relieved. Another procedure is the removal of the inflamed tissue between the iliotibial band and the epicondyle by means of a jointoscopy .
A knee misalignment , especially as a genu varum ( bow leg), can favor a runner's knee. Furthermore, inflexible and shortened tendons on the outside of the thigh and a shortened tract can be risk factors for favoring a runner's knee. In general, people are often affected who walk often and for a long time or who put intense strain on the knee at high frequency.
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