University of North Dakota UND Scholarly Commons Physical Therapy Scholarly Projects Department of Physical Therapy 2009 Outpatient Physical Therapy Management of a Patient with Chronic Iliotibial Band Friction Syndrome Kaley Schultz University of North Dakota Follow this and additional works at: https://commons.und.edu/pt-grad Part of the Physical Therapy Commons Recommended Citation Schultz, Kaley, "Outpatient Physical Therapy Management of a Patient with Chronic Iliotibial Band Friction Syndrome" (2009). Physical Therapy Scholarly Projects. 530. https://commons.und.edu/pt-grad/530 This Scholarly Project is brought to you for free and open access by the Department of Physical Therapy at UND Scholarly Commons. It has been accepted for inclusion in Physical Therapy Scholarly Projects by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. ,.,'--- \ Outpatient Physical Therapy Management of a Patient with Chronic Iliotibial Band Friction Syndrome by Kaley Schultz Bachelor of Science in Physical Therapy University of North Dakota, BSPT 2007 A Scholarly Project Submitted to the Graduate Faculty of the Department of Physical Therapy School of Medicine University of North Dakota in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy Grand Forks, North Dakota \ ) May, 2009 ~ This Scholarly Project, submitted by Kaley Schultz in partial fulfillment of the requirements for the Degree of Doctor of Physical Therapy from the University of North Dakota, has been read by the Advisor and Chairperson of Physical Therapy under whom the work has been done and is hereby approved. ~tClufu (Graduate School Advisor) (Chairperson, Physical Therapy) r I '........J 11 PERMISSION Title Outpatient Physical Therapy Management of a Patient with Chronic Iliotibial Band Friction Syndrome Department Physical Therapy Degree Doctor of Physical Therapy In presenting this Scholarly Project in partial fulfillment of the requirements for a graduate degree from the University of North Dakota, I agree that the Department of Physical Therapy shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly purposes may be granted by the professor who supervised my work or, in her absence, by the Chairperson of the department. It is understood that any copying or publication or other use of this Scholarly Project or part thereof for fmancial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and the University of North Dakota in any scholarly use which may be made of any material in this Scholarly Project. Signature ~:Y:JUJl% Date 'OJ \AI05 111 TABLE OF CONTENTS LIST OF FIGURES .......................................................................v LIST OF TABLES ......................................................................VI ACKNOWLEDGEMENTS ............................................................... vii ABSTRACT ...............................................................................viii CHAPTER I. BACKGROUND AND PURPOSE ............................ 1 II. CASE DESCRIPTION .......................................... 5 Examination, Evaluation and Diagnosis ...................... 7 Prognosis and Plan of Care ..................................... 11 III. INTERVENTION ............................................... 13 IV. OUTCOMES .................................................... 18 v. DISCUSSION ................................... .................21 Reflective Practice ............................................... 23 REFERENCES ............................................................................ 26 ( I V IV LIST OF FIGURES 1. ITB STANDING STRETCH .......................................................... 15 2. REDUCTION IN PAIN (BY WEEK) ................................................ 18 3. IMPROVEMENTS IN ROM FOR HIP FLEXION, ABDUCTION, ADDUCTION AND INTERNAL ROTATION ........................................ 19 ( U v LIST OF TABLES 1. INITIAL HIP RANGE OF MOTION (IN DEGREES) ....................................... 7 2. INTRARATER RELIABILITY OF HIP SPECIAL TESTS ................................ 9 3. RELIABILITY AND VALIDITY OF KNEE SPECIAL TESTS ......................... 10 4. HIP RANGE OF MOTION (IN DEGREES) AT DISCHARGE .................................. 19 I '0 VI ACKNOWLEDGEMENTS This case report would not have been possible without the support of many individuals. I would like to thank everyone who helped me in the process of writing this case report. Many thanks to the physical therapy program faculty at the University of North Dakota for their knowledge, assistance and guidance. Special thanks to my student colleagues who have helped me in many ways, specifically those who were involved in the peer reviewing process for this paper. And finally, thanks to my boyfriend, parents, family, and numerous friends and classmates who endured this long process with me and for c always offering me love, encouragement and support. Vll ABSTRACT Background and Purpose. Iliotibial band friction syndrome (ITBFS) is one of the most common repetitive injuries treated in outpatient physical therapy and if left untreated, can lead to debilitating consequences for an individual. The purpose of this report is to describe the progression of conservative interventions that were used during outpatient physical therapy for a patient with the diagnosis of ITBFS in order for the patient to return to pain free activities of daily living. Case Description. The patient was a 29 year old male who experienced pain over his c right greater trochanter and pain and snapping over his lateral right knee with an accompanying tight iliotibial band (ITB). The pain and tightness prevented the patient from performing pain free activities of daily living, including caring for his children, walking, and climbing stairs. The intensity of his pain was assessed with a visual analogue scale and ITB tightness was assessed using the Ober's test. The treatment for this patient involved phonophoresis, range of motion, stretching, strengthening, and soft tissue mobilization/deep transverse friction massage. Outcomes. Following seven treatments of physical therapy interventions, the patient achieved almost full hip active range of motion, decreased pain over hip and knee, and increased ITB flexibility. The patient was able to return to caring for his children and had improved tolerance for activities of daily living. ( G V111 Discussion. This case report illustrates that patients diagnosed with ITBFS may significantly benefit from conservative physical therapy treatment, despite the lack of research supporting its use. c IX CHAPTER I BACKGROUND AND PURPOSE Despite being one of the most common overuse injuries of the lower extremity treated in outpatient physical therapy, there is lack of quality evidence supporting conservative treatment benefits with interventions for iliotibial band friction syndrome (lTBFS). ITBFS is a "repetitive stress injury that results from friction of the iliotibial band (lTB) as it slides over the lateral femoral condyle during approximately 30 degrees of knee flexion". 1 It is often associated with pain, tightness, and/or burning over the lateral aspect of the hip, thigh, and/or knee as well as an iliotibial band contracture?' 3 If c not treated; the syndrome can lead to chronic pain and decreased function for an individual. The prognosis of ITBFS, with appropriate treatment and correction of predisposing factors, is moderately good. 3 During the examination it is important to rule out other hip pathologies, such as greater trochanteric bursitis, or knee injuries. 1 Two important special tests, Ober's and Noble's, as well as palpation over the lateral femoral condyle to reproduce the patient's pain, may be performed during the clinical examination to determine a diagnosis ofITBFS. 1-3 Clinical assessment ofITB length to diagnosis a tight ITB remains under debate. However, the Ober's test, to evaluate hip adduction as an indirect measure of ITB length, has been found to be significantly reliable in measuring ITB tightness when using an inclinometer. 4 The incidence of ITBFS varies from 1.5%-52% depending upon the population.5 In a 9-week study of military recruits (N= 1261), ITBFS accounted for the third highest 1 incidence of overuse injuries; 88 total days were lost because of ITBFS, representing 3.6% of all days lost due to overuse injuries.6 With increasing numbers of individuals engaged in regular exercise, the incidence of overuse injuries such as ITBFS will likely increase in the coming years. Current treatment options of ITBFS involve alteration of activity, ice, non­ steroidal anti-inflammatories (N"sAIDs), orthotics, stretching, ultrasound therapy, deep transverse friction massage (DTFM)/soft tissue mobilization, phonophoresis, corticosteroid injections, and surgery if conservative treatment fails. 1-3,7 In spite of being a common diagnosis and with the multitude of treatment interventions, there has been a lack of quality evidence to determine the best possible conservative intervention for this syndrome. Of the investigations that have been done to date, there is a debate between which commonly used conservative treatments demonstrate the best outcomes and which offer little to no benefit in the improvement of pain and function for patients with ITBFS. Some studies have determined that ITBFS does not respond to conservative