IT Band Syndrome & Deep Tissue Laser Treatments
IT band (Iliotibial band) Friction Syndrome
Iliotibial (IT) Band Syndrome is a common injury among runners and triathletes. Eventually, running's pounding miles overwhelms the tendon on the side of the knee creating dull or sharp stabbing pain. Initially the knee and leg feels tight and becomes increasingly sore. As the injury worsens, the pain increases and eventually stops a runner in his or her tracks.
Anatomy of Iliotibial Band
The IT band is a large sheath of tissue, called an aponeurosis. The tough group of connective tissue fibers runs on the outside of the quadriceps and inserts on the lateral tibia (outside of the knee). The tensor fascia lata and gluteal muscles attach to the top part of it in the upper leg. The tensor fascia lata starts on the front aspect of the pelvis and inserts on the front of the aponeurosis, while the gluteal muscle starts in the back of the pelvis and inserts on the back of IT band. These muscles help stabilize the hip during walking and running. The wide aponeurosis becomes a narrower, rope-like tendon near the knee as it crosses the side of the femoral epicondyle. As the iliotibial band attaches to the tibia, its rope-like structure spreads out to a wide attachment site.
The muscles work to pull and balance on the IT band which keeps the "hip and knee from wobbling side to side." Hip and knee stabilization is very important to running efficiency and speed. When the muscle hip stabilizers fatigue they are unable to contract with enough force to stabilize the lateral movements of the knee through the IT band.
With increased muscle fatigue the knee "wobbles" even more, creating strain on the bottom part of the tendon that attaches to the knee. The bottom part of the IT band tendon absorbs a significant amount of force when running. As the knee wobbles inward, or internally rotates, the strain is increased. As the run continues, the strain on the knee continues to increase with each mile, leading to micro tearing of the tendon and tissue damage. The chronic repetitive stress and accumulation of microtears lead to larger tears, sprains, inflammation, and pain.
Iliotibial band friction syndrome is a condition that keeps people from running or finishing their race. A mild or moderate injury feels stiff and sore at the beginning of the run, but eventually disappears. A few miles later knee stiffness and soreness begins and increases throughout the race with increased tendon damage and inflammation. A dull ache becomes a sharp and stabbing pain. Eventually the body will stop you from continuing to damage the tendon by making the pain unbearable to walk on, let alone run. It becomes very tender to touch the outside of the knee, and every runner can cause sharp pain by rubbing or putting more pressure on the IT band tendon insertion or outside of the knee.
Causes of Runner's Knee
Runners and triathletes often experience iliotibial band friction syndrome with increased training mileage or volume, especially as they near peak training volume. Training plans increase weekly milage and volume throughout the plan. Near the end of training, the ramp up increases the mileage beyond a runner's previous weekly high. The increased training is challenging the muscles, tendons, ligaments, and joints beyond their structural limits.
Athletes have most commonly felt IT band symptoms when ramping up for their event, such as moving from a 5K to a 10K or from a half marathon to a full marathon. People describe chronic runner's knee symptoms whenever they reach a certain distance on long runs. They come into the clinic trying to prevent the knee pain from developing in this training cycle because they are very concerned it will prevent them from reaching their marathon goal.
Lateral knee pain is more likely to develop on uneven or hard surfaces that place more stress on the knee stabilizers. Rocky trails or hard roads with a side slant require more strength and endurance of the hip and knee stabilizers. The more difficult roads fatigue the muscles and create tearing in the IT band tendon insertion at the knee. A nice, soft, smooth trail is easier to run on and does not challenge the stabilizers like a rocky trail. Running 10 miles on a canal or lake trail is not as demanding on the ankle, knee, and hip stabilizer muscles as six miles on a rocky up-and-down mountain trail. Variations of terrain, rocks, tree roots, inclines, and declines wear out and fatigue the muscles faster, which increases the likelihood of micro tears, sprains, and strains. Likewise, running on a road with a slight curve near the curb keeps the ankle slightly inverted and increases the forces on the lateral knee and IT band. Runners who always run on one side of a road often experience pain on the outside of the knee.
Diagnosing Iliotibial Band Friction Syndrome
Your physician or chiropractor may order x-rays or an MRI to evaluate the knee bone, muscles, tendons, and ligaments. Advanced imaging may be needed if the examination of the knee reveals possible internal cartilage or joint damage. If the exam does not indicate any internal damage, your provider may pursue a trial course of treatment for ITB, and if you do not improve as expected then order the tests.
Differential diagnoses may include patellofemoral pain syndrome, patellar tendinitis, knee meniscus tears, quadriceps tendinitis, bursitis, stress fractures, hip labral tears, and low back injuries. Functional strength testing will be performed to evaluate stabilizer hip and knee strength and endurance, and appropriate strengthening exercises will be given based on weakness.
Cold Laser Therapy Treatments
1. ACCELERATED TISSUE REPAIR AND CELL GROWTH
Photons of light from lasers penetrate into tissue and accelerate cellular growth and reproduction. Laser therapy increases the energy available to the cell so it can work faster, better, and quickly get rid of waste products. When cells of tendons, ligaments, and muscles are exposed to laser light they repair and heal faster.
2. FASTER WOUND HEALINGLaser light increases collagen production by stimulating fibroblasts. Collagen is the building block of tissue repair and healing. Laser therapy increases fibroblast activity and therefore collagen production to speed healing.
3. REDUCED FIBROUS TISSUE FORMATIONLow level laser therapy decreases scar tissue formation. Scar tissue can be a source of chronic pain and poor healing. By eliminating excessive scar tissue and encouraging proper collagen production, painful scars and chronic pain is reduced.
4. ANTI-INFLAMMATIONLaser therapy causes vasodilatation (increases size of capillaries) which increases blood flow. The treatments also increases lymphatic drainage to decrease swelling or edema. Therefore, laser therapy reduces swelling caused by bruising or inflammation while speeding the recovery process.
5. PAIN RELIEFCold laser therapy decreases pain by blocking pain signals to the brain. Some nerve cells sense pain and send signals to the brain. Chronic pain can be caused by overly active pain nerves. Specific wavelengths help "shut off" the pain signals, thereby; eliminating your pain.
Low level lasers are excellent at decreasing inflammation, which also increases pain nerve activity. Cold laser therapy also increases endorphins and enkephalins, which block pain signals and decrease pain sensation. Overall laser therapy reduces painful nerve signals and reducing your perceived pain.
6. INCREASED BLOOD FLOWBlood carries nutrients and building blocks to the tissue, and carries waste products away. Increased blood flow to tissues increases and enhances cellular healing. Cold laser therapy increases the formation of capillaries in damaged tissue. Specific laser frequency also increases blood flow to the area treated, to enhance injury repair.
7. INCREASED REPAIR AND REGENERATIONLow level lasers increases enzyme activity to improve metabolic activity that affects cell repair and regeneration. The enzymes are turned on "high" to speed the healing.
8. NERVE FUNCTION AND REPAIRNerves heal very slowly. Lasers speed up this process. Damage to nerves causes numbness, pain, muscle weakness, and altered sensations. Laser therapy treatments enhance nerve function, healing, and reduce pain.
9. INCREASED ENERGY PRODUCTION - ATPATP is like gasoline for cells, it is the energy source that cells operate. Injured cells often have low levels of ATP, which decreases their ability to heal and repair. By increasing ATP and "gasoline storage levels," cells have more ATP for healing and repair. Increased mitochondrial production is very important with nerve pain.
10. ACUPRESSURE AND TRIGGER POINTSLow level laser therapy decreases trigger points and stimulates acupuncture points to decrease muscle and joint pain.
We combine low level laser therapy with a variety of techniques and treatments. Cold laser therapy can be used alone as a single treatment modality, or in conjunction with other Chiropractic, Physical Therapy, massage therapy, or medical treatments.
Conservative Treatments
Therapeutic treatments for addressing soft tissue injuries involve massage therapy, manual therapy, trigger point therapy, Graston Technique, or Active Release Technique. These treatments increase blood flow, decrease muscle spasms, enhance flexibility, speed healing, and promote proper tissue repair.
When these treatments are incorporated into a treatment plan patients heal faster and are less likely to have long-term pain or soft tissue fibrosis or scar tissue in the injured muscle. These soft tissue treatments are incorporated with therapeutic exercise and flexibility programs.
Medical Treatments
NSAIDs are often prescribed for the initial acute injury stages. In severe cases that involve multiple joint regions, muscle relaxers or oral steroids can be given. Trigger point injections, botox, or steroid injections can be treatment options. Pain management is not usually required unless stronger medications or joint injections are required for treatment.
MRI and X-rays will not usually be ordered to evaluate mild to moderate muscle, tendon, and ligament injuries. Severe cases may utilize advanced imaging to rule out bone fractures, edema, nerve entrapments, tendon or muscle ruptures. NCV testing may be utilized in cases that also involve muscle, sensory, or reflex loss.
Sciatica is the term for radiating pain down the leg. Most commonly it comes from the back and radiates down the leg. Several back injuries and nerve entrapment injuries can cause sciatic pain in the leg. The pain patterns from a lumbar disc, lumbar joint sprain, sacroiliac sprain, or piriformis syndrome produces different patterns of radiating pain than trigger points. Proper identification of the pain pattern, along with reproduction of pain from palpation of trigger points allows the provider and patient to feel comfortable with the diagnosis.
Many leg injuries are associated with radiating pain. The two legs function as a system for movement. Injuries in one area area of the system are commonly associated with poor joint stabilization in the foot, knee, or hip. This leads to poor alignment and excessive forces being placed onto muscles and tendons. Knee injuries and IT band syndrome is common in runners because of weakness and poor stabilization of the leg and hip muscles. These runners have a combination of muscle weakness, poor coordination, and altered gait mechanics. Leg sprains and strains usually cause injuries in multiple areas in the leg, one spot usually just hurts more than the others.
Your chiropractor, physical therapist, occupational therapist, or physician will evaluate your condition and make a proper diagnosis and treatment recommendations. Ask them any questions you might have about your injury.
Conclusion
The lower extremity works as a comprehensive unit performing many of the repetitive tasks at home, work, and recreational sports. Injuries to one area of the musculature often indicate that additional damage has been incurred by other muscles.
Many therapeutic exercises can help restore proper strength and endurance to the leg muscles muscles. Isometric exercises are often the initial treatment exercises. Followed by single plane rubber band exercises for hip, knee, and ankle; flexion, extension, adduction, abduction, circumduction, inversion, and eversion. Dynamic exercises involving stability foam, rubber discs, exercise ball, and BOSU balls can be performed on the floor. The more unstable of the surface the more effort and stabilization is required of all the lower extremity muscles.
Vibration plates enhance neuromuscular learning throughout the ankle, knee, foot, hip, and back muscles. Additional strength exercises can be found on the hip, knee, and foot strengthening pages. More information for injuries and treatments for knee pain and foot pain.
Our Chandler, AZ Chiropractic & Physical Therapy clinic treats patients with a variety of muscle, tendon, joint, and ligament injuries. The clinic provides treatment for runners, tri-athletes, and weekend warriors in addition to common headache, neck, and back patients traditionally seen in Chiropractic, Physical Therapy, Massage Therapy clinics. We work with all ages and abilities of the residents in Phoenix, Tempe, Gilbert, Mesa, and Chandler AZ.