Part 3-How to diagnose ITB ‘Friction’ Syndrome

 In Running

A runner’s guide to the rehabilitation of  ITB ‘Friction’ Syndrome

Part 3-How to diagnose ITB ‘Friction’ Syndrome

In this post I will outline the most effective ways to diagnose ITB syndrome.

As with any running injury, in all cases of lateral knee pain you need to ensure you have an accurate diagnosis.  An accurate diagnosis is the mainstay of effective rehabilitation. An accurate diagnosis will save you in treatment costs, minimise the frustration of not being able to run or running with reduced volume, and ultimately get you back to your best as soon as possible.

An accurate diagnosis of your lateral knee pain is made possible by the conducting of a thorough assessment. I often say making a clinical diagnosis is the ‘easy bit’, it’s the comprehensive assessment looking to determine the reasons (contributory factors) as to why you developed the knee pain that in mind requires the greater skill and expertise (see below).

diagnose ITB ‘Friction’ Syndrome

The Best Tests to Diagnose ITB Friction Syndrome

In most instances orthopaedic testing performed in a consultation room yield poor results due to the difficult nature of reproducing the runner’s pain. Often times palpation of Gerdy’s tubercle on the lateral border of the tibia is not helpful in detecting unless the structure is irritated from a run preceding the assessment.

I tend to develop my diagnosis on the runner’s history alone and the region of their reported pain (ie the outside of their knee).

The tests that I do perform tend to be more directed towards assessing for the runner’s chief contributory, or causative factors that likely played a part in the development of the injury.

If I am looking to attempt to reproduce the runner’s pain my go to tests are:

  1. Single leg hop testing. I will ask the runner to hop anywhere up to 30 times on their affected leg. Click through to view the single leg hop test HERE>>
  2. Decline squat test. I will have the runner complete 6-12 squats on a decline board (angle of board approximately 30 degrees). Squatting with the back straight in this position tends to position the ITB in the 30 degree range of knee flexion where the pain from ITB friction syndrome is typically most reproduced.
  3. My personal opinion is that length tests for the ITB tract such as ‘Ober’s test’ do not offer sensitive insight into whether the ITB tract is tight or not. If a runner presents with ITB friction syndrome it can be expected that the band is tight. The research also surmises that to date no clinical study has correlated the Ober’s test with ITB friction syndrome (3).

On both test I am looking for the reproduction of pain, and also the level of pain (graded 0-10).

In addition to the above tests the runner’s running history & background, training routine, and goals all need to be understood and taken into account during the examination.

In the majority of histories given by a runner with ITB syndrome there has been a sudden ‘spike’ in their training loads. That is the runner has suddenly increased either their running volume (mileage), their intensity (eg added a speed session, or performed runs at faster speeds), added hills to their running program, or a combination of any of these.

It is these sudden spikes combined with other injury causative factors that will result in overload of the lateral thigh, and ultimately compression of the underlying fatty tissue beneath the ITB, and symptoms being experienced by the runner.

In the next blog post in this series I will outline the top 5 causes of ITB syndrome, before rounding out the series with the top 5 corrective exercises to overcome ITB syndrome.

Physio With a Finish Line™,

Brad Beer physiotherapist gold coast

Brad Beer (APAM)

Physiotherapist (APAM)
Author ‘You CAN Run Pain Free!
Founder POGO Physio
Host The Physical Performance Show

Featured in the Top 50 Physical Therapy Blog

pain free performance Gold Coast physio


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