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Successful Treatment Of The Underlying Cause Of ITB Syndrome: 2321 June 2, 3: 35 PM - 3: 55 PM.

HISTORY: Patient is a 28 yr. old female who developed pain at her L lateral knee at the end of a marathon. Pain persisted after the marathon and gradually extended to the hip and lateral thigh. She was treated with Active Release Therapy and foam rolling, as well as yoga to address her core strength. She returned to running with low-grade pain, which increased with more than 3-4 miles of running or an increase in her speed. Patient reported a VAS of 1/10 pain in the L hip and leg today, but symptoms will increase to a 7/10. PHYSICAL EXAMINATION: Pain noted along the L iliac crest, gluteals, along the iliotibial band (ITB) down to Gerty’s tubercle. Weakness of her L hip extensors, abductors and external rotators was also noted. The patient presented with a (+) Ober’s test, L>R. During running, she presented with a contralateral hip drop L>R during mid stance. Patient also exhibited increased femoral adduction L>R. At the foot, she presented with pes planus, decreased ankle dorsiflexion and lack of intrinsic and extrinsic foot strength. This was associated with prolonged midfoot pronation. Patient landed with increased impacts L>R. Impacts were reduced by half when running with a forefoot strike pattern. DIFFERENTIAL DIAGNOSIS: Sciatica from lumbar spine, LCL strain FINAL/WORKING DIAGNOSIS: ITB syndrome, associated with abnormal foot and hip mechanics. Hip adduction is associated with increased ITB strain, as well as ITB syndrome. Increased foot pronation leads to increased knee internal rotation, which is also associated with ITB syndrome. Increased impact loading has been related to the development of injuries in runners. TREATMENT: Goal: Reduce the mechanics associated with ITBS 1. Progressive intrinsic and extrinsic foot strengthening and hip strengthening exercises to provide capacity for improving foot and hip mechanics. 2. Soft tissue mobilization of tight ITB, increase ROM of ankle dorsiflexors to reduce compensatory pronation 3. Gait training to decrease contra-lateral hip drop, femoral adduction and foot pronation 4. Transition to a forefoot running pattern, in minimal footwear, to reduce impact loading as well as facilitate foot strengthening. OUTCOME: Hip adduction and foot pronation was reduced and patient was able to run for 3 miles pain-free at discharge.