Iliotibial Band pain

The Psoas Minor lays on top of the psoas originating at T11/12 but dose not continue to the lesser trocantor with the psoas but attaches to the ramus of the pubus. My interactive palpation and personal experience has convinced me that the opposit psoas minor fires to resist the moment of the femur head in the socket. Though it seems to be the optimum muscle to do so there are many synergists that will substitute. Rectus abdominus and obliques are common substitutes which have their own complications.
Repetitive strain on the attachment of any of these can be source of a report of groin pain. Internal compensations can be a source of testicular cord pain, as I have personally experienced.
Fallowing the initial source of this thread: If the lady is not able to initiate the lifting of the leg from the iliopsoas complex, the next synergistic choice is the saratoris which externally rotates the knee and then the adductors correct that just before heel strike. [even more stress on the ramus of the pubus] With the lady standing on one leg, the piriformis is pushing the pelvis to the opposit side to place the weight over that leg and the femur is balancing between the adductors and IT band. Now when she repositions the saratoris may be snapping the IT band.
As for foot orthotics: Te reflex in the feet for T11/12 is at the proxamal head of the first met. The cauves arch may be an attempt to create mor lordosis at T11/12.

Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist
http://reflexposturology.weebly.com/

 

O.K. finally managed to upload this video - Thanks Ian. I had it slowed down but it seems to have speeded up again. Hopefully you can give me some suggestions as to why this lady suffers from IT Band pain from this footage. From front knees face outwards during swing and then rotate in just before contact. Can the slight Genu Valgum be a factor - have read much about genu varum and IT Band pain.

Anyway appreciate thoughts.

 

Have you got video of her pelvis Issy?

 

Only with trousers on and they are quite baggy but did get her to pull jumper up abit so trouser level could be seen during walking. I can upload this for you if you want.

 

Sorry couldn't just get far enough back to get whole body in but I did ensure waistband of trousers was level before starting.

 

In my opinion her proximal mechanics may be more informative than looking at foot level. However I'm still not even convinced of the worth of dynamic analysis when it is standing which is the main aggravating factor.

Any pictures of her standing/work position?

 

Definitely the pelvis moves more to the left than right. If you want to see if a temporary arch support will help her change you can try the test I gave in response to another question.
Place your finger tips under the medial arch [I put the back of my fingers on the floor and push in to the opposite side,both at the same time] have her shift her hips left and right. If one arch pronates more than the other try a pad under that arch and see if it improves the gate and or gives her any relief. This has reduced repetitive stress for some clients long enough so that the underlying cause of the pattern was able to heal.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist

 

Ian, I think I must have givng information badly along the way. Working is not only aggravating factor. Its sore all the time when weight bearing so standing hairdressing is certainly going to big part in her weightbearing day. But it is sore all the time, weekends also, climbing stairs etc makes it worse. Just thought I should point this out incase my info. has been misleading.

 

That wasn't clear from your previous posts.

It is clear you posted up this case as you want others opinions on the mechanical contributor to this ladies ITB pathology (assuming that is definately what you are dealing with?). From the very limited information given (+ short videos) I personally would say that there is not an obvious one.

Either way, in my opinion and experience this is not the sort of patient that responds fantastically to Podiatric intervention alone. Get a good Physio involved in her management from the start. Not much more I can say on this that I haven't said already.

 

Many Thanks to everyone for trying to help me with this case. It is great to be able to ask people with more expertise than myself about cases I'm unsure of. I certainly will try and refer her to a better Physio. Would a small heel raise to right side (even though no discrepency found in supine position) possibly help balance hips better and lead to less stretch on left IT Band?

 

Here are some questions I have:

1. What is the quality of her symptoms. Is she having any lateral burning along the (L) thigh, or is it typical muscoloskeletal-type symptoms?

2. What is her strength like on physical exam? In particular her hip rotators, hip abductors, hip extensors and knee extensors?

3. Have you ruled out derangement of the knee? Does she have lateral joint line pain of her knee? Any mechanical symptoms here? Does she get increased lateral knee pain at extreme knee flexion or extension?

4. What was the initial mechanism of injury (if any)?

I would tend to agree that the patient would likely benefit from a comprehensive exam from a PT, but I think I would definately start addressing a lot of her proximal issues first - i.e. joint mobilization to her T-L junction and L-S juntion, hip joint mobilization, and a significant focus on hip abductor and hip rotator strengthening.

 

Patient described pain as 'aching' along length of IT Band and hip insertion but particularly at insertion area of knee, no anterior or medial knee pain. I didn't ask if pain was burning - I can always see the questions I should have asked after! I'm afraid this is as much imformation as I can give you as I would not be confident in checking the strength of the hip abductors or doing mobilization - would refer to Physio. for this.

 

For my patients with iliotibial band syndrome (ITBS), if they have what I determine to be excessive pronation during running, I will start them with varus heel and medial arch wedge on their running shoe sockliner, put them on hip abductor strengthening, have them purchase a foam roller from the local running shoe store to help stretch/massage the iliotibial band (see video below), and have them ice the sore areas 20 minutes once to twice daily. I don't see ITBS commonly in patients who are only walking and standing and not running. These initial treatments nearly always work in relieving much of the pain of ITBS within 2 weeks of initiating the treatment program.

Hope this helps.

 

This is highly unlikely to solve your query Issy but I thought I would post up a patient I saw recently who has had Rt ITB problems for 2 years and despite a lot of input, he has had to stop running which, as a personal trainer, is quite tough.

I saw him before also and missed this as I wasn't aware of the effects of proximal mechanics at the time - shame on me. Thanks to some great explanations on this thread and a better understanding of the pathomechanics, he is hopefully on his way to recovery


Regards,

RP

 

Gday Ian

Just a query about where you got your posture grids from in your image? Been looking around for a bit.

Cheers

Mark

 

Hi Mark,

They are from MAR Systems.

Linky.

Ian