Iliotibial tract friction syndrome

Friction syndrome of the iliotibial tract (tractus iliotibialis - ITT), which is situated along the lateral side of the upper leg. The iliotibial tract or ITT is a 4-6 cm wide tendon tissue running along the upper leg lenght from the medial part of the iliac bone, ie. the crista iliaca on its proximal part and descending toward the proximal lateral part of the lower leg. The ITT is static at its proximal and medial parts and more mobile in its distal part, where it moves according to the movements of the knee joint in the transversal axis, ie. knee extension and flexion. It moves in relation to the lateral condyle of the femur, ie. when the knee is straight the ITT is positioned in front of the condyle, in the 20-30° knee flexion the ITT is right above the condyle and with bigger flexion angles the ITT goes behind the condyle.

Friction syndrome, ie. ITT overuse syndrome commonly occurs when certain movements that encompass knee extension/flexion are repeated constantly. During running, moving downhill or cycling for example; ITT friction can happen due to excesive and constant repeating of knee extension and flexion movements. The ITT rubbs against the condyle which with time causes accumulation of microtrauma and possible tendon tissue damage leading to irritation, swelling, pain and sensitivity of the area in question. The most common extrinsic causes of this overuse syndrome are mistakes in the training approach, sudden intensity and extensity spikes, constant repeating of the same training regime, running on hard surfaces, bad uality or inadequate footwear. Intrinsic risk factors can be anatomic deformities of the foot (excesive foot pronation – leads to excesive lower leg rotation while running and causes higher pressure and friction of the ITT), muscle strenght deficits (medial-lateral part of the quadriceps strenght ratio, quadriceps-hamstrings strenght ratio), ITT being to stiff, shortened or not flexible enough. This syndrome is common with runners, especially long distance runners, cyclist, skiers, etc.

Symptoms include pain, swelling, soreness, tightness and sensitivity of the lateral part of the knee joint, right above the middle of the joint. The syndrome occurs gradually, with accumulation of microtraumas through sports activity which later results in irritation and above stated sypmtoms. The pain is in the initial stages related only with the start of the activity, during warm up and later when the tissue is warmed up it subsides. In later stages of this syndrome the pain can grow in its intensity as well as have prolenged period of its lasting time, it can linger during the whole activity, after the activity and in the final stage it is constantly present, during activity and during rest.

Therapy consists of a conservative approach, use of RICE methid in the acute phase (rest, ice compression, elevation) to reduce pain, swelling and irritation of the ITT. In the later, functional phase of the therapy, massage is used to relieve ITT tightness, different ITT, m. tensor fasciae latae (the muscle that tightens the ITT at its proximal part) and lateral quadriceps region stretching methods and progressive strenghtening of the medial part of the quadriceps and the hamstring region in order to reduce the muscle strenght deficits which are often with ITT friction syndromes.

Prevention: proper warm up and stretching regime implemented in the training process, timely changing and choice of adqeuate and good quality footwear, maintaining a balanced body weight, treating possible knee and foot deformations, use of orthopaedic foot pads if there is a necessity for them, etc.