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ITB Syndrome….No cookie cutter approaches….

December 2, 2009

Since the recent F.A.P. Seminar over this past weekend I have received several messages requesting the reference that explains why Iliotibial Band problems are not due to frictional irritation….but rather are caused by irritation of the underlying fat pad.  Here is the reference…I highly recommend this article to all manual therapists:

Fairclough et al.  The Functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome.   J Anat (2006) 208, pp309-316.

Along with this request I have received a number of inquires as to how I treat “Iliotibial Band Syndrome”…including which muscles I target, which modalities I utilize, which exercises I prescribe.  Iliotibial Band Syndrome, like any MSK condition CANNOT be approached in a “cookie cutter” fashion if you want to attain efficient and effective results.  Once the initial diagnosis is made, we must consider several things:

1.  What is the histopathology of the involved tissue?  In the case of ITB Syndrome, the tissue involved is the underlying fat pad which has become inflamed (see article above).  Thus one of our first targets is to deal with this inflammation….whether you use cryotherapy, acupuncture, anti-inflammatory meds, etc, is your call.

2.  What is the biomechanical mechanism leading to the histopathology?  This is where each case must be viewed on an individual basis.  There are some more common findings associated with ITB Syndrome.  For example decreased lateral pelvic stability, subtalar pronation, squinting patella, etc.  However one cannot expect that these findings are always present, because they won’t be.  That means that you will be wasting valuable time and energy treating things that are not there …  there is no cookie cutter approach to any MSK condition that will work in each case….there is therefore no answer to the question “how do you treat” a particular condition because the answer is different for every case. 

The therapist must rely on their own physical findings (or “targets”)…then choose appropriate treatment modalities (or “weapons”) to battle said findings.  The more specific your examination findings, the more specific your diagnosis….and hence the more specific your treatment plan will be.

SPECIFICITY OF DIAGNOSIS = SPECIFICITY OF TREATMENT = SPECIFICITY OF RESULTS

…as always, I welcome any questions or topics of discussion.

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