The fascia lata in the thigh thickens on the side and is known as the iliotibial band (ITB) or tract. It divides into superficial and deep layers close to where the tensor fasciae latae are located, securing this muscle to the iliac crest.
Trigger points are a type of pain caused by tense muscles. The iliotibial band is one of the muscles that can result in the formation of these trigger points, which is why this article is dedicated to it[1]Weller JL, Comeau D, Otis JA. Myofascial pain. InSeminars in Neurology 2018 Dec (Vol. 38, No. 06, pp. 640-643). Thieme Medical Publishers..
Particularly among runners and other athletes who engage in repetitive activity, the iliotibial band (ITB) trigger points are a frequent source of knee pain. We’ll go over the definition of these trigger points, their locations, and the reasons they hurt so much.
First, let’s talk about the anatomy
Anatomy of the Iliotibial Band
The ITB is typically thought of as a band of thick, fibrous connective tissue that crosses the lateral femoral epicondyle and joins Gerdy’s tubercle on the anterolateral side of the tibia.
The fascia of the gluteus maximus, gluteus medius, and tensor fasciae latae muscles combine to produce the thick iliotibial band
Collagen fibers dominate the iliotibial band’s composition. The most powerful protein in nature is collagen. It is better for force absorption during weight-bearing exercises when the collagen fibers are oriented in a very ordered, vertical manner. Its ability to be slightly elastic and malleable, which helps it function as a spring, is made possible by the modest number of elastin fibers present among the layers of collagen.
The ability to stretch like a muscle is not, however, provided by this. The iliotibial band runs between the lateral femoral epicondyle and the Gerdy tubercle without any bony attachments, yet this lack of connection allows it to move anteriorly and posteriorly during knee flexion and extension.
Function: It plays an essential role in stabilizing your hip and knee joints, as well as providing support for the tendons in your knee. The iliotibial band also acts like a shock absorber when you run or walk, helping to prevent stress on the ligaments and tendons in your knees.
Innervation: Superior and inferior gluteal nerve.
Blood supply: Superior gluteal artery and branches from lateral circumflex femoral artery.
IT Band trigger point symptoms
Iliotibial Band Trigger Points can cause a variety of symptoms, including:
- Pain on the outside of the knee or thigh that may radiate up or down the leg
- Pain that is worse when running or biking
- Sharp, burning, or aching pain in the area
- Tightness or tenderness in the iliotibial band
- Stiffness in the hip
- Decreased range of motion in the hip or knee
- Weakness in the hip or knee muscles
- Pain with climbing stairs or hills
- Pain when bending the knee or hip
Iliotibial Band – Diagnostic options
Iliotibial Band Trigger Points can be diagnosed by a variety of methods. These methods can include:
- Physical Examination: A physical examination can help to identify areas of tenderness, inflammation, and tension in the IT band.
- Imaging Tests: Imaging tests, such as an X-ray or MRI, can help to identify any potential structural issues that may be causing IT band pain.
- Ultrasound: Ultrasound is a test that can be used to identify any areas of inflammation in the IT band.
- Blood Tests: Blood tests can help to rule out other potential medical conditions that may be causing IT band pain.
Iliotibial Band Trigger points
An excruciating source of lower leg discomfort is the iliotibial band trigger points. They are situated slightly above the knee and an inch below it on the outside edges of both thighs.
These trigger points typically occur along with other muscle groups: gluteus maximus, hamstrings, quadriceps, and calf muscles.
What Activates Trigger Points?
ITB trigger points have a frequently complex etiology. Running over long periods of time can lead to activation of them, especially if the ground is slightly banked since the tiny drop of the outside of the foot stretches the ITB and increases the risk of injury. ITB trigger point activation can also result from abrupt increases in activity levels.
There are a few different schools of thought regarding how iliotibial band pain developed, even though recurrent tissue compression causing irritation is best supported by recent research.
Pain Patterns of ITB Trigger Points
The main symptom of ITB trigger point is a sharp pain on the outer aspect of the knee, particularly when the heel strikes the floor, that can radiate into the outer thigh or calf. The pain tends to be worse when running or coming down stairs.
There may be an audible snapping sensation when the knee bends due to the band flicks over the bony tubercle. There may also be some swelling on the outer side of the knee.
What is Iliotibial Band Syndrome?
Iliotibial band syndrome (ITBS) is a common knee injury that typically presents with pain and/or tenderness on palpation of the lateral aspect of the knee, superior to the joint line and inferior to the lateral femoral epicondyle. It is a non-traumatic overuse injury that is common in runners and is frequently associated with underlying hip abductor muscle weakness.
When it comes to the aetiology, pathology, and treatment of Iliotibial Band Syndrome, there has been a lot of debate.This is primarily due to the fact that the iliotibial band is a fascinating mystery in sports medicine.
The buttock and tensor fasciae latae muscles are the two primary muscles involved in IT band syndrome. As a result, the syndrome is also known as Tensor Fasciae Latae Syndrome, or TFL Syndrome.
Iliotibial band treatment options
Treatment for Iliotibial Band Trigger Points can include[2]Hong CZ. Treatment of myofascial pain syndrome. Current pain and headache reports. 2006 Sep;10(5):345-9.:
- Stretching and Strengthening Exercises: A physical therapist can help to identify the specific muscles of the hip and knee that need to be stretched or strengthened to help with IT band pain.
- Massage Therapy: Massage therapy can help to reduce pain and tightness in the IT band. -Foam Rolling: Foam rolling can help to relieve tightness and pain in the IT band.
- Ice and Heat Therapy: Ice and heat therapies can be used to reduce inflammation and pain in the IT band.
- Dry Needling: Dry needling is a technique that can help to reduce muscle tension and pain in the IT band[3]Criscuolo CM. Interventional approaches to the management of myofascial pain syndrome. Current Pain and Headache Reports. 2001 Oct;5(5):407-11..
- Anti-Inflammatory Medication: Anti-inflammatory medications can help to reduce inflammation in the IT band, which can help to reduce pain.
Shockwave therapy for IT trigger point pain
Shockwave therapy is a non-invasive treatment that uses high-energy sound waves to reduce pain and promote healing in the iliotibial band. It is used to treat a variety of musculoskeletal conditions, including iliotibial band pain[4]Jeon JH, Jung YJ, Lee JY, Choi JS, Mun JH, Park WY, Seo CH, Jang KU. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Annals of rehabilitation medicine. 2012 Oct … Continue reading.
Shockwave therapy can help to reduce inflammation and pain in the iliotibial band by increasing blood flow and stimulating the healing process. It can also help to break up scar tissue and adhesions that can form around the iliotibial band.
The treatment typically consists of several sessions, which are usually performed on an outpatient basis. The sound waves are directed at the area of pain, and the patient may experience a brief, mild discomfort during the treatment.
The results of shockwave therapy may not be immediate, and it may take several weeks to months to see the full benefits. However, many people with iliotibial band pain report a decrease in pain and improved function after treatment.
Conclusion: Iliotibial Trigger Points
Iliotibial band trigger points can be problematic for a variety of reasons. They can inflict pain on any part of the body, including the knee and buttocks. Long durations of sitting, squatting or getting up on one knee, or even just walking up a short slope, can all cause pain. Sitting has the tendency to make any discomfort brought on by these trigger points worse. If the pain is severe enough to affect your daily life, seeing your doctor is highly recommended.
MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.
References
| ↑1 | Weller JL, Comeau D, Otis JA. Myofascial pain. InSeminars in Neurology 2018 Dec (Vol. 38, No. 06, pp. 640-643). Thieme Medical Publishers. |
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| ↑2 | Hong CZ. Treatment of myofascial pain syndrome. Current pain and headache reports. 2006 Sep;10(5):345-9. |
| ↑3 | Criscuolo CM. Interventional approaches to the management of myofascial pain syndrome. Current Pain and Headache Reports. 2001 Oct;5(5):407-11. |
| ↑4 | Jeon JH, Jung YJ, Lee JY, Choi JS, Mun JH, Park WY, Seo CH, Jang KU. The effect of extracorporeal shock wave therapy on myofascial pain syndrome. Annals of rehabilitation medicine. 2012 Oct 31;36(5):665-74. |