Treatment of iliotibial band syndrome (ITBS)

Player characteristics:

Age: 27 years old
Height: 196 cm
Weight: 90 kg
Position: receiver

Injury description:

The player came to the consultation room with pain in the knee joint area on the lateral side. He did not remember any injury situation and he indicated a recurring problem after heavier training loads.

Iliotibial Band Syndrome – Diagnosis and functional examination

The physiotherapeutic examination revealed palpation tenderness in the area of the lateral condyle of the knee joint and the area of the distal 1/3 of the broad fascia stressor muscle, limited range of flexion (100 degrees), and extension (-10 degrees). Fluid was observed in the patella contour. Functional examination revealed the pain appearance with an attempt to jump and assume a receiving position (volleyball) with side-to-side stepping. The acute pain limited the muscle strength of the thigh and destabilized the pelvis.

The OBER test and THOMAS test indicated a contracture in the hip joint limiting range of motion,
The Janda test confirmed contracture of the hip flexor muscles and the iliotibial band,
The Noble test showed tenderness in response to compression in the lateral condyle region of the knee with passive extension motion (40 degrees – 0 degrees)

Diagnosis – right leg iliotibial band syndrome (ITBS).

Rehabilitation 1-7 day

1. Cryotherapy with compression 15 min, every 3 hours,
2. FDM fascial relaxation technique,
3. Pinotherapy in the lateral condyle area,
4. Manual therapy of the hip joint,
5. Shockwave (treatment every 4 days):

treatment of the lateral compartment between the lateral head of the quadriceps muscle and tensor fasciae latae muscle,
treatment of trigger points in the area of the proximal attachment of the tensor fasciae latae muscle,
treatment of the gluteus maximus, middle and small muscles, and trigger points,
treatment of the compartment between the tensor fasciae latae muscle and the gluteus muscles,
treatment of the lateral side of the thigh along the entire fascia and the area of tension accumulation (1/3 of the distal part),
treatment of the attachment in the area of Gerdy’s tubercle and the lateral condyle of the knee joint,

6. Kinesitherapy (stretching of the gluteus maximus muscle and the lateral side of the thigh, exercises to improve the range of motion in the hip joint, postural correction).

Rehabilitation 8-14 day

1. Cryotherapy with compression 15 min, 3x a day,
2. FDM combined with Chinese bubble – fascia and muscle relaxation techniques,
3. Pinotherapy in the lateral condyle area,
4. Manual therapy of the hip and knee joint
5. Shockwave (treatment every 4 days):

treatment of the lateral compartment between the lateral head of the quadriceps muscle and tensor fasciae latae muscle,
treatment of trigger points in the area of the proximal attachment of the tensor fasciae latae muscle,
treatment of the gluteus maximus, middle and small muscles, and trigger points,
treatment of the compartment between the tensor fasciae latae muscle and the gluteus muscles,
treatment of the lateral side of the thigh along the entire fascia and the area of tension accumulation (1/3 of the distal part),
treatment of the attachment in the area of Gerdy’s tubercle and the lateral condyle of the knee joint,

6. Kinesitherapy (strengthening the gluteal and adductor muscles, stretching the gluteus maximus muscle and the lateral side of the thigh, exercises to improve the range of motion in the hip joint, rolling, posture correction).

Rehabilitation 15-21 day

1. Cryotherapy with compression 15 min, 2x daily after physical effort,
2. FDM technique and sports massage of the thigh,
3. Manual therapy of the hip, knee, and pelvic joint,
4. Shockwave (treatment every 4 days):

treatment of the lateral compartment between the lateral head of the quadriceps muscle and tensor fasciae latae muscle,
treatment of trigger points in the area of the proximal attachment of the tensor fasciae latae muscle,
treatment of the gluteus maximus, middle and small muscles, and trigger points,
treatment of the compartment between the tensor fasciae latae muscle and the gluteus muscles,
treatment of the lateral side of the thigh along the entire fascia,
treatment of the attachment in the area of Gerdy’s tubercle and the lateral condyle of the knee joint,

5. kinesitherapy (strengthening the gluteal and adductor muscles, stretching the gluteus maximus muscle and the lateral side of the thigh, exercises to improve the range of motion in the hip joint, rolling, central stabilization exercises),
6. functional training for volleyball,
7. intermittent pressotherapy after training.

Rehabilitation 22-28 day

1. Cryotherapy with compression 15 min, 2x daily after physical effort,
2. Sports massage on the right thigh,
3. Manual therapy of the hip, knee, and pelvic joint
4. Shockwave (treatment every 4 days):

treatment of the lateral compartment between the lateral head of the quadriceps muscle and tensor fasciae latae muscle,
treatment of muscles: gluteus maximus, medial and small,
treatment of the compartment between the tensor fasciae latae muscle and the gluteus muscles,
treatment of the lateral side of the thigh along the entire fascia,
treatment of the attachment in the area of Gerdy’s tubercle and the lateral condyle of the knee joint,

PREVENTIVE MEASURES

Shockwave once a week (break from training about 24 hours),
preventive exercises: activation of gluteal muscles before training, strengthening of adductor muscles, central stabilization, thigh rolling, stretching of lower limb muscles,
cryotherapy with compression – after heavier physical effort.

Shockwave Impactis M+

Shockwave treatments on the course of the iliotibial band, the tensor fascia latae muscle, and the gluteal region using the ASTAR IMPACTIS M device.

Treatment	Operation mode	Frequency for the muscle / ligament [Hz]	Pressure [bar] for muscle and fascia / attachment, lateral condyle	Number of impulses for muscle and fascia / attachment, lateral condyle	Frequency of treatments
I	set frequency	6-10 / 18	3,0 / 2,0	3000 / 600	every 4 days
II	set frequency	6-10 / 18	3,2 / 2,0	3000 / 800	every 4 days
III	set frequency	6-10 / 18	3,2 / 2,2	3500 / 800	every 4 days
IV	set frequency	6-8 / 18	3,5 / 2,2	3500 / 800	every 4 days
V	set frequency	6-8 / 18	3,5 / 2,5	4000 / 800	every 4 days
VI	set frequency	6-8 / 18	3,5 / 2,5	4000 / 800	every 4 days
VII	set frequency	6-8 / 18	3,7 / 2,5	4000 / 800	every 4 days
VIII	set frequency	6-8 / 18	3,7 / 2,5	4000 / 800	every 4 days
preventive measures	set frequency	6-8 / 18	3,5 / 2,5	4000 / 800	once a week

Summary

The player had been complaining of pain in the knee joint area for a long time (while training and playing matches in the national team). The periodically repeated overloading of the lower extremities in training and the failure to accurate diagnosis resulted in chronic ITBS. The rehabilitation was focused on shockwave due to the transfer of high energy to fascial structures that are difficult to work with manually. The player followed the preventive treatment agreed upon with the physiotherapist and motor preparation coach during the season and no longer reported major problems in the treated area.

Case study: Treatment of iliotibial band syndrome (ITBS) Of BBTS volleyball player