Iliotibial Tract: Difference between revisions

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== Description ==
== Description ==
[[File:Iliotibial tract.jpg|560x560px|alt=|right|frameless]][[File:Iliotibial-band-itb-anatomy-diagrams.jpeg|right|frameless|399x399px]]
[[File:Iliotibial tract.jpg|560x560px|alt=|right|frameless]]The iliotibial band (ITB) is a thick band of fascia formed proximally at the [[hip]] by the [[fascia]] of the [[Gluteus Maximus|gluteus maximus]], [[Gluteus Medius|gluteus medius]] and [[Tensor Fascia Lata|tensor fasciae latae]] muscles<ref name=":0">Radiopedia ITB Available: https://radiopaedia.org/articles/iliotibial-band?lang=gb (accessed 27.12.2021)</ref>.   
The iliotibial band (ITB) is a thick band of fascia formed proximally at the [[hip]] by the [[fascia]] of the [[Gluteus Maximus|gluteus maximus]], [[Gluteus Medius|gluteus medius]] and [[Tensor Fascia Lata|tensor fasciae latae]] muscles<ref name=":0">Radiopedia ITB Available: https://radiopaedia.org/articles/iliotibial-band?lang=gb (accessed 27.12.2021)</ref>.   


* The ITB runs along the lateral thigh and serves as an important structure involved in lower extremity motion.  
* The ITB runs along the lateral thigh and serves as an important structure involved in lower extremity motion.
* There are multiple clinical conditions that can present secondary to a spectrum of ITB dysfunction  eg [[Snapping Hip Syndrome|external snapping hip syndrome]], [[Iliotibial Band Syndrome|ITB syndrome]]<ref name=":1">Hyland S, Graefe S, Varacallo M. [https://www.ncbi.nlm.nih.gov/books/NBK537097/ Anatomy, bony pelvis and lower limb, iliotibial band (tract).] StatPearls [Internet]. 2020 Aug 10.Available: https://www.ncbi.nlm.nih.gov/books/NBK537097/<nowiki/>(accessed 27.12.2021)</ref>.   
* There are multiple clinical conditions that can present secondary to a spectrum of ITB dysfunction  eg [[Snapping Hip Syndrome|external snapping hip syndrome]], [[Iliotibial Band Syndrome|ITB syndrome]]<ref name=":1">Hyland S, Graefe S, Varacallo M. [https://www.ncbi.nlm.nih.gov/books/NBK537097/ Anatomy, bony pelvis and lower limb, iliotibial band (tract).] StatPearls [Internet]. 2020 Aug 10.Available: https://www.ncbi.nlm.nih.gov/books/NBK537097/<nowiki/>(accessed 27.12.2021)</ref>. 


Image 1: The iliotibial band (ITB) is a thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius and tensor fasciae latae muscles.  
Image 1: The iliotibial band (ITB) is a thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius and tensor fasciae latae muscles.  
# Due to the ITBand’s insertion on Gerdy’s tubercle, it actually has no bony attachment along the femur. Therefore, it has the tendency to shift anterior/posterior (front to back) as your knee flexes and extends.
# The Iliotibial Band is made up of mostly collagen fibers. Collagen is a [[Proteins|protein]], the strongest protein found in nature. The collagen fibres are aligned in a very organized, vertical fashion as this allows for better force absorption with weight bearing activities. There is a small amount of elastin fibers amongst the layers of collagen, which allow it to be slightly elastic and pliable helping it act as a spring. However, this does not give it the ability to “stretch” or “change length” like a muscle<ref>Boulder sports Physio Iliotibial Band (ITBand) Syndrome Available:https://www.bouldersportsphysio.com/blog/blog-post-title-two-5k22t (accessed 27.12.2021)</ref>.


=== Anatomy ===
=== Anatomy ===
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# The superficial layer is the main tendinous component and inserts onto Gerdy's tubercle on the anterior lateral tibia
# The superficial layer is the main tendinous component and inserts onto Gerdy's tubercle on the anterior lateral tibia
# The deep layer inserts on the intermuscular septum of the distal femur  
# The deep layer inserts on the intermuscular septum of the distal femur


A small recess exists between the lateral femoral epicondyle and the ITB, which contains a synovial extension of the knee joint capsule (lateral synovial recess)<ref name=":0" />
A small recess exists between the lateral femoral epicondyle and the ITB, which contains a synovial extension of the knee joint capsule (lateral synovial recess)<ref name=":0" />
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The ITB shares the innervation of the TFL and [https://physio-pedia.com/Gluteus_Maximus?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal gluteus maximus] via the superior gluteal nerve and inferior gluteal nerve
The ITB shares the innervation of the TFL and [https://physio-pedia.com/Gluteus_Maximus?utm_source=physiopedia&utm_medium=search&utm_campaign=ongoing_internal gluteus maximus] via the superior gluteal nerve and inferior gluteal nerve


== Function. ==
== Function. ==
[[File:Iliotibial-band-itb-anatomy-diagrams.jpeg|right|frameless|399x399px]]
Proximal ITB function includes:  
Proximal ITB function includes:  


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== Physiotherapy ==
== Physiotherapy ==
The iliotibial band is one of the most common [[Assessment of Running Biomechanics|running]] injuries we see as physiotherapists. It is considered a non-traumatic overuse injury and is often concomitant with underlying weakness of hip abductor muscles. For more see [[Iliotibial Band Syndrome]]
The iliotibial band is one of the most common [[Assessment of Running Biomechanics|running]] injuries we see as physiotherapists. It is considered a non-traumatic overuse injury and is often concomitant with underlying weakness of hip abductor muscles. For more see [[Iliotibial Band Syndrome|Iliotibial Band Syndrome.]] Clinical examination testing for [[Iliotibial Band Syndrome|ITB dysfunction]] is best elicited utilizing the [https://physio-pedia.com/Ober%27s_Test Ober Test, see here]
 
External [[Snapping Hip Syndrome|snapping hip syndrome]] is another ITB pathology you may encounter<ref>Winston P, Awan R, Cassidy JD, et al.  Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007 Jan;35(1):118–126. [PubMed] </ref>.
 
Clinical examination testing for [[Iliotibial Band Syndrome|ITB dysfunction]] is best elicited utilizing the [https://physio-pedia.com/Ober%27s_Test Ober Test, see here]
 
Treatment generally initiates with ITB stretching ,therapeutic exercises and physical therapy. NSAID use may be beneficial to reduce inflammation. Surgery is a last resort used for refractory cases.
 
==== Here is some corrective exercises: ====
 
==== 1-'''Hip Bridge with Resistance Band''' ====
An effective yet simple exercise to begin with is the hip bridge utilizing a resistance band. Researchers Choi and colleagues found that gluteus maximus EMG activity was significantly greater while anterior pelvic tilt angle was significantly lower in the glute bridge with isometric hip abduction compared to the glute bridge without the band. Therefore, they concluded that performing glute bridges with isometric hip abduction against isometric elastic resistance can be used to increase gluteus maximus EMG activity and reduce anterior pelvic tilt during the exercise.
 
==== 2-'''Side Lying Hip Abduction''' ====
The Side Lying Hip Abduction is a great way to isolate the glute medius. Distefano and colleagues looked at gluteal activation among common exercises and identified this as one of the top exercises.
 
==== 3- '''Lateral Band Walk''' ====
Once you have isolated the gluteus medius you can now integrate a more functional exercise with the lateral band walk. Increased hip abduction strength has been shown to improve the ability of female athletes to control lower extremity alignment. (14) When performing this exercise, the stepping motion should be performed in a semi-squat position with the knees bent rather than an upright straight leg position in order to generate greater gluteus maximus and medius muscle activity<ref>Berry et al. 2015. Resisted side-stepping: the effect of posture on hip abductor muscle activation. Journal of Orthopaedic & Sports Physical Therapy" /></ref>.
 
==== 4-'''Side Plank''' ====
start by performing 3-5 repetitions for 10 seconds each, gradually adding more repetitions.
 
== Related articles ==
[[Iliotibial Band Syndrome]]


[[Snapping Hip Syndrome]]
External [[Snapping Hip Syndrome|snapping hip syndrome]] is another ITB pathology you may encounter<ref>Winston P, Awan R, Cassidy JD, et al.  Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007 Jan;35(1):118–126. [PubMed] </ref>. Snapping Hip Syndrome is a condition that is characterized by a snapping sensation, and/or audible “snap” or “click” noise, in or around the [[hip]] when it is in motion.


== References  ==
== References  ==

Revision as of 05:56, 27 December 2021

Original Editor - Eman Ammar

Top Contributors - Eman Ammar and Lucinda hampton

Description[edit | edit source]

The iliotibial band (ITB) is a thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius and tensor fasciae latae muscles[1].

  • The ITB runs along the lateral thigh and serves as an important structure involved in lower extremity motion.
  • There are multiple clinical conditions that can present secondary to a spectrum of ITB dysfunction  eg external snapping hip syndrome, ITB syndrome[2]. 

Image 1: The iliotibial band (ITB) is a thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius and tensor fasciae latae muscles.

  1. Due to the ITBand’s insertion on Gerdy’s tubercle, it actually has no bony attachment along the femur. Therefore, it has the tendency to shift anterior/posterior (front to back) as your knee flexes and extends.
  2. The Iliotibial Band is made up of mostly collagen fibers. Collagen is a protein, the strongest protein found in nature. The collagen fibres are aligned in a very organized, vertical fashion as this allows for better force absorption with weight bearing activities. There is a small amount of elastin fibers amongst the layers of collagen, which allow it to be slightly elastic and pliable helping it act as a spring. However, this does not give it the ability to “stretch” or “change length” like a muscle[3].

Anatomy[edit | edit source]

The iliotibial band (ITB) is a thick band of fascia formed proximally at the hip by the fascia of the gluteus maximus, gluteus medius and tensor fasciae latae muscles.

The band consists of deep and superficial layers:

  1. The superficial layer is the main tendinous component and inserts onto Gerdy's tubercle on the anterior lateral tibia
  2. The deep layer inserts on the intermuscular septum of the distal femur

A small recess exists between the lateral femoral epicondyle and the ITB, which contains a synovial extension of the knee joint capsule (lateral synovial recess)[1]

The ITB shares the innervation of the TFL and gluteus maximus via the superior gluteal nerve and inferior gluteal nerve

Function.[edit | edit source]

Iliotibial-band-itb-anatomy-diagrams.jpeg

Proximal ITB function includes:

  1. Hip extension
  2. Hip abduction
  3. Lateral hip rotation

Distally, ITB function depends on the position of the knee joint

  1. Full extension to 20 to 30 degrees of flexion: Active knee extensor, ITB lying anterior to the lateral femoral epicondyle
  2. 20 to 30 degrees of flexion to full flexion ROM: Active knee flexor, ITB lies posterior relative to the lateral femoral epicondyle[2]

Physiotherapy[edit | edit source]

The iliotibial band is one of the most common running injuries we see as physiotherapists. It is considered a non-traumatic overuse injury and is often concomitant with underlying weakness of hip abductor muscles. For more see Iliotibial Band Syndrome. Clinical examination testing for ITB dysfunction is best elicited utilizing the Ober Test, see here

External snapping hip syndrome is another ITB pathology you may encounter[4]. Snapping Hip Syndrome is a condition that is characterized by a snapping sensation, and/or audible “snap” or “click” noise, in or around the hip when it is in motion.

References[edit | edit source]

  1. ↑ 1.0 1.1 Radiopedia ITB Available: https://radiopaedia.org/articles/iliotibial-band?lang=gb (accessed 27.12.2021)
  2. ↑ 2.0 2.1 Hyland S, Graefe S, Varacallo M. Anatomy, bony pelvis and lower limb, iliotibial band (tract). StatPearls [Internet]. 2020 Aug 10.Available: https://www.ncbi.nlm.nih.gov/books/NBK537097/(accessed 27.12.2021)
  3. ↑ Boulder sports Physio Iliotibial Band (ITBand) Syndrome Available:https://www.bouldersportsphysio.com/blog/blog-post-title-two-5k22t (accessed 27.12.2021)
  4. ↑ Winston P, Awan R, Cassidy JD, et al. Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. Am J Sports Med. 2007 Jan;35(1):118–126. [PubMed]
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