Iliotibial Tract: Difference between revisions

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<div class="editorbox">[[File:Iliotibial tract.jpg|thumb]]'''Original Editor '''- [[User:User Name|User Name]]
<div class="editorbox">'''Original Editor '''- [[User:Eman Ammar|Eman Ammar]]


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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
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== Description ==
== Description ==
The '''iliotibial tract''' or '''iliotibial band''' is a longitudinal fibrous reinforcement of the fascia lata.runs along the lateral thigh and serves as an important structure involved in lower extremity motion.
[[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>.  Its main functions are pelvic stabilisation and posture control.<ref>Musculoskeletal Key Deep Dry Needling of the Hip and Pelvic Muscles Available:https://musculoskeletalkey.com/deep-dry-needling-of-the-hip-and-pelvic-muscles/ (accessed 28.12.2021)</ref> 


The part of the iliotibial band which lies beneath the tensor fasciae latae is prolonged upward to join the lateral part of the capsule of the hip-joint. The tensor fasciae latae effectively tightens the iliotibial band around the area of the knee. This allows for bracing of the knee especially in lifting the opposite foot.
The ITB runs along the lateral thigh and serves as an important structure involved in lower extremity motion.


The gluteus maximus muscle and the tensor fasciae latae insert upon the tract.
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>. 
* 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.<ref name=":2">Boulder sports Physio Iliotibial Band (ITBand) Syndrome Available:https://www.bouldersportsphysio.com/blog/blog-post-title-two-5k22t (accessed 27.12.2021)</ref>


=== Origin ===


=== It originates at the anterolateral iliac tubercle portion of the external lip of the iliac crest ===
'''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.


=== Insertion  ===
=== Anatomy ===
inserts at the lateral condyle of the tibia at Gerdy's tubercle
[[File:Iliotibial-band-itb-anatomy-diagrams.jpeg|right|frameless|495x495px|alt=]]
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.


=== Nerve ===
It traverses superficial to the [[Vastus Lateralis|vastus lateralis]] and inserts on the Gerdy tubercle of the lateral [[Tibial Plateau Fractures|tibial plateau]] and partially to the supracondylar ridge of the lateral [[Femur|femur.]] There is also an anterior extension called the iliopatella band that connects the lateral [[patella]] and prevents medial translation of the patella.<ref>Hadeed A, Tapscott DC. [https://www.ncbi.nlm.nih.gov/books/NBK542185/ Iliotibial band friction syndrome]. 2019 Available: https://www.ncbi.nlm.nih.gov/books/NBK542185/<nowiki/>(accessed 28.12.2021)</ref>
the ITB shares the '''innervation''' of the TFL and gluteus maximus via the superior gluteal '''nerve''' (SGN) and inferior gluteal '''nerve''' (IGN)


=== Artery ===
A small recess exists between the lateral femoral epicondyle and the ITB, which contains a [[Synovium & Synovial Fluid|synovial]] extension of the [[knee]] joint capsule (lateral synovial recess)<ref name=":0" />


The ITB, being a tendinous extension of the tensor fascia lata (TFL), shares the same arterial supply:
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.
* Ascending branch of the lateral femoral circumflex artery (LFCA)
* Superior gluteal artery (SGA)


== Function.  ==
Composition: The Iliotibial Band is made up of mostly collagen fibers. [[Collagen]] is the strongest [[Muscle Proteins|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 [[Stretching|stretch]] like a muscle<ref name=":2" />
The action of the muscles associated with the ITB (TFL and some fibers of Gluteus Maximus) flex, extend, abduct, and laterally and medially rotate the hip. The ITB contributes to lateral knee stabilization. During knee extension the ITB moves anterior to the lateral condyle of the femur, while ~30 degrees knee flexion, the ITB moves posterior to the lateral condyle. However, it has been suggested that this is only an illusion due to the changing tension in the anterior and posterior fibers during movement


== Clinical relevance  ==
== Function. ==
External snapping hip syndrome, or externa coxa saltans has the potential to cause chronic pain in the lateral aspect of the hip located over the greater trochanter of the femur. Pathophysiology comprises thickening of the posterior aspect of the ITB or anterior tendon fibers of the gluteus maximus muscle near its insertion. This portion of the band remains posterior to the greater trochanter in hip extension, however, moves anteriorly when flexed, adducted, or internally rotated causing a "snapping" mechanism. This snapping is the tense fascial structure catching on the greater trochanter as it moves in the before mentioned motions.
[[File:ITB.png|right|frameless|702x702px]]
Proximal ITB function includes:


== Assessment  ==
# Hip extension
Clinical examination testing for ITB dysfunction is best elicited utilizing the Ober Test.
# Hip abduction
# Lateral hip rotation


To perform the Ober test, have the patient lie on his or her uninvolved side in the lateral decubitus position.  The symptomatic side should be facing upward (i.e., closest to the ceiling).  Next, the examiner passively flexes the knee to about 90 degrees.  The hip is then brought passively into a flexed and abducted position.  Next, the examiner assesses the passive flexibility over the ITB with the hip brought into increasing levels of extension and adduction.  A positive test entails pain, tightness, or clicking over the ITB.
Distally, ITB function depends on the position of the knee joint


== Treatment  ==
# Full extension to 20 to 30 degrees of flexion: Active knee extensor, ITB lying anterior to the lateral femoral epicondyle
Treatment generally initiates with ITB stretching and physical therapy. NSAID use may be beneficial to reduce inflammation. Surgery is a last resort used for refractory cases
# 20 to 30 degrees of flexion to full flexion ROM: Active knee flexor, ITB lies posterior relative to the lateral femoral epicondyle<ref name=":1" />


== Resources  ==
== Physiotherapy ==
<ref>Evans P. The postural function of the iliotibial tract. Ann R Coll Surg Engl. 1979 Jul;61(4):271-80. [PMC free article] [PubMed]
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]
2.
Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec;19(12):728-36. [PubMed]
3.
Chahla J, Murray IR, Robinson J, Lagae K, Margheritini F, Fritsch B, Leyes M, Barenius B, Pujol N, Engebretsen L, Lind M, Cohen M, Maestu R, Getgood A, Ferrer G, Villascusa S, Uchida S, Levy BA, Von Bormann R, Brown C, Menetrey J, Hantes M, Lording T, Samuelsson K, Frosch KH, Monllau JC, Parker D, LaPrade RF, Gelber PE. Posterolateral corner of the knee: an expert consensus statement on diagnosis, classification, treatment, and rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2520-2529. [PubMed]
4.
Musick SR, Varacallo M.  StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Apr 28, 2020. Snapping Hip Syndrome. [PubMed]
</ref>


<references />
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.
 
It has been proposed that a tight iliotibial band (ITB) through its attachment of the lateral retinaculum into the patella could cause lateral patella tracking, patella tilt and compression. <ref>Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Manual therapy. 2009 Apr 1;14(2):147-51. Available: https://pubmed.ncbi.nlm.nih.gov/18313972/ (accessed 28.12.2021)</ref>This has implications in subjects presenting with [[Patellofemoral Pain Syndrome|patellofemoral pain syndrome]] (PFPS)
 
Image 3: Iliotibial band syndrome


== References  ==
[[Category:Anatomy]]  
[[Category:Anatomy]]  
[[Category:Muscles]]
[[Category:Muscles]]
<references />

Latest revision as of 02:00, 28 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]. Its main functions are pelvic stabilisation and posture control.[2]

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[3]. 

  • 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.[4]


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.

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.

It traverses superficial to the vastus lateralis and inserts on the Gerdy tubercle of the lateral tibial plateau and partially to the supracondylar ridge of the lateral femur. There is also an anterior extension called the iliopatella band that connects the lateral patella and prevents medial translation of the patella.[5]

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.

Composition: The Iliotibial Band is made up of mostly collagen fibers. Collagen is 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 like a muscle[4]

Function.[edit | edit source]

ITB.png

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[3]

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[6]. 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.

It has been proposed that a tight iliotibial band (ITB) through its attachment of the lateral retinaculum into the patella could cause lateral patella tracking, patella tilt and compression. [7]This has implications in subjects presenting with patellofemoral pain syndrome (PFPS)

Image 3: Iliotibial band syndrome

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. ↑ Musculoskeletal Key Deep Dry Needling of the Hip and Pelvic Muscles Available:https://musculoskeletalkey.com/deep-dry-needling-of-the-hip-and-pelvic-muscles/ (accessed 28.12.2021)
  3. ↑ 3.0 3.1 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)
  4. ↑ 4.0 4.1 Boulder sports Physio Iliotibial Band (ITBand) Syndrome Available:https://www.bouldersportsphysio.com/blog/blog-post-title-two-5k22t (accessed 27.12.2021)
  5. ↑ Hadeed A, Tapscott DC. Iliotibial band friction syndrome. 2019 Available: https://www.ncbi.nlm.nih.gov/books/NBK542185/(accessed 28.12.2021)
  6. ↑ 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]
  7. ↑ Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: a case-control study. Manual therapy. 2009 Apr 1;14(2):147-51. Available: https://pubmed.ncbi.nlm.nih.gov/18313972/ (accessed 28.12.2021)
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