What are the main causes of iliotibial band syndrome. How is iliotibial band syndrome diagnosed clinically. What conservative treatments are most effective for iliotibial band syndrome. When should corticosteroid injections be considered for iliotibial band syndrome. What surgical options exist for refractory cases of iliotibial band syndrome.

Understanding Iliotibial Band Syndrome: A Common Knee Injury

Iliotibial band syndrome (ITBS) is a prevalent knee injury that primarily affects runners and cyclists. It occurs when the iliotibial band, a thick band of fascia extending from the hip to the knee, becomes inflamed due to repetitive friction against the lateral femoral epicondyle. This condition can cause significant discomfort and hinder athletic performance if left untreated.

The iliotibial band is formed by the convergence of fascia from hip flexors, extensors, and abductors. It originates at the lateral iliac crest and runs down the outer thigh, attaching to the patella, tibia, and biceps femoris tendon. This anatomical structure plays a crucial role in stabilizing the knee during movement, particularly in activities involving repetitive knee flexion and extension.

Key Anatomical Features of the Iliotibial Band

• Originates at the lateral iliac crest
• Extends distally along the outer thigh
• Inserts on the patella, tibia, and biceps femoris tendon
• Composed of thick, fibrous tissue

Etiology and Risk Factors of Iliotibial Band Syndrome

The development of iliotibial band syndrome is primarily attributed to a combination of overuse and biomechanical factors. While the exact pathophysiology is clear, it remains uncertain why some athletes are more susceptible to this condition than others. Research has identified several potential risk factors that may contribute to the onset of ITBS:

• Preexisting iliotibial band tightness
• High weekly mileage in runners
• Prolonged time spent walking or running on a track
• Interval training
• Muscular weakness in knee extensors, knee flexors, and hip abductors

Interestingly, excessive pronation, which was once thought to be a contributing factor due to its effect on tibial internal rotation, has not been supported by current literature as a direct cause of ITBS.

The Role of Hip Abductor Weakness

Recent studies have highlighted the significance of hip abductor strength in the development and management of iliotibial band syndrome. Weakness in these muscles, particularly the gluteus medius, appears to be a key factor in the onset of ITBS. Strengthening exercises targeting the hip abductors have shown promising results in symptom improvement and should be considered an integral part of both prevention and treatment strategies.

Clinical Presentation and Diagnosis of Iliotibial Band Syndrome

The hallmark symptom of iliotibial band syndrome is lateral knee pain, typically caused by inflammation of the distal portion of the iliotibial band. However, in some cases, the proximal origin of the band may become inflamed, leading to referred hip pain. Recognizing the characteristic signs and symptoms is crucial for an accurate diagnosis.

Common Symptoms of ITBS

• Sharp or burning pain on the outer side of the knee
• Pain that worsens with continued activity
• Stiffness or tightness along the outer thigh
• Possible swelling at the site of inflammation
• Pain that may radiate up the thigh or down the calf

Diagnosis of iliotibial band syndrome is primarily clinical, based on patient history and physical examination. Imaging studies such as MRI may be used to confirm the diagnosis or rule out other conditions, revealing thickening of the distal iliotibial band and fluid accumulation in the potential space over the femoral epicondyle.

Conservative Treatment Approaches for Iliotibial Band Syndrome

The majority of patients with iliotibial band syndrome respond well to conservative treatment methods. These approaches focus on addressing the underlying causes of inflammation and improving biomechanics to prevent recurrence.

Key Components of Conservative Treatment

1. Activity modification to reduce inflammation
2. Stretching exercises for the iliotibial band
3. Strengthening exercises for the gluteus medius and other hip abductors
4. Foam rolling and manual therapy techniques
5. Correction of training errors and biomechanical issues

Can stretching effectively alleviate ITBS symptoms? Studies have shown that specific stretching exercises can significantly increase the length of the iliotibial band, potentially reducing friction and inflammation. One particularly effective stretch involves standing with the affected leg crossed behind the unaffected leg, then leaning away from the affected side while pushing the hip outward.

The Importance of Strength Training in ITBS Management

Strength training plays a crucial role in both the prevention and treatment of iliotibial band syndrome. Focusing on exercises that target the hip abductors, particularly the gluteus medius, can help address one of the key biomechanical factors contributing to ITBS.

Effective Strength Training Exercises for ITBS

• Side-lying hip abductions
• Clamshells
• Single-leg squats
• Lateral band walks
• Step-ups with emphasis on hip stability

How often should strength training exercises be performed? For optimal results, patients should aim to perform these exercises 2-3 times per week, gradually increasing intensity and complexity as strength improves. It’s important to maintain proper form throughout each exercise to maximize benefits and prevent further injury.

Advanced Treatment Options for Persistent ITBS

While most cases of iliotibial band syndrome respond well to conservative measures, some patients may require more advanced interventions. These options are typically considered when symptoms persist despite adherence to a comprehensive conservative treatment plan.

Corticosteroid Injections

Is there a role for corticosteroid injections in ITBS treatment? Corticosteroid injections can be an effective option for patients with persistent symptoms, particularly if visible swelling or pain with ambulation continues for more than three days after initiating conservative treatment. These injections can provide rapid relief of inflammation and pain, allowing patients to progress with rehabilitation exercises more effectively.

Surgical Intervention

In rare cases where conservative treatments and corticosteroid injections fail to provide relief, surgical intervention may be considered. Surgical options typically involve releasing or lengthening the iliotibial band to reduce tension and friction over the lateral femoral epicondyle.

What is the success rate of surgical treatment for ITBS? A retrospective study of 45 patients who underwent surgical release of their iliotibial band reported that 84 percent of patients rated their surgical results as good to excellent. However, surgery should be viewed as a last resort, only after exhausting all conservative treatment options.

Preventive Strategies and Long-Term Management of ITBS

Preventing recurrence of iliotibial band syndrome is as important as treating the initial condition. Athletes and active individuals can implement several strategies to reduce their risk of developing ITBS or experiencing a recurrence.

Key Preventive Measures

• Gradual increase in training intensity and volume
• Regular stretching and foam rolling of the iliotibial band
• Incorporation of hip abductor strengthening exercises into routine workouts
• Proper warm-up and cool-down routines
• Use of appropriate footwear and consideration of orthotic devices if necessary
• Cross-training to reduce repetitive stress on the knee

How can athletes modify their training to prevent ITBS? Implementing a gradual progression in mileage or intensity, known as the 10% rule (increasing weekly mileage by no more than 10% per week), can help reduce the risk of overuse injuries like ITBS. Additionally, varying running surfaces and incorporating strength training can improve overall biomechanics and resilience.

The Role of Biomechanical Assessment in ITBS Management

Understanding and addressing individual biomechanical factors is crucial in both the treatment and prevention of iliotibial band syndrome. A comprehensive biomechanical assessment can identify specific areas of weakness or imbalance that may be contributing to the development of ITBS.

Components of a Biomechanical Assessment

1. Gait analysis
2. Muscle strength testing, particularly of the hip and knee
3. Flexibility assessment of the iliotibial band and surrounding muscles
4. Evaluation of running or cycling technique
5. Foot and ankle alignment assessment

Can correcting biomechanical issues prevent ITBS recurrence? Addressing biomechanical factors identified through a comprehensive assessment can significantly reduce the risk of ITBS recurrence. This may involve targeted strengthening exercises, technique modifications, or the use of orthotics or specific footwear to optimize lower limb alignment and function.

In conclusion, iliotibial band syndrome is a common but manageable condition that primarily affects runners and cyclists. While it can cause significant discomfort and interfere with athletic performance, most cases respond well to conservative treatment approaches. Key to successful management is a comprehensive approach that addresses inflammation, improves flexibility and strength, and optimizes biomechanics. With proper care and preventive strategies, athletes can overcome ITBS and return to their activities with reduced risk of recurrence.

Iliotibial Band Syndrome: A Common Source of Knee Pain

RAZIB KHAUND, M.D., AND SHARON H. FLYNN, M.D.

Am Fam Physician. 2005;71(8):1545-1550

Iliotibial band syndrome is a common knee injury. The most common symptom is lateral knee pain caused by inflammation of the distal portion of the iliotibial band. The iliotibial band is a thick band of fascia that crosses the hip joint and extends distally to insert on the patella, tibia, and biceps femoris tendon. In some athletes, repetitive flexion and extension of the knee causes the distal iliotibial band to become irritated and inflamed resulting in diffuse lateral knee pain. Iliotibial band syndrome can cause significant morbidity and lead to cessation of exercise. Although iliotibial band syndrome is easily diagnosed clinically, it can be extremely challenging to treat. Treatment requires active patient participation and compliance with activity modification. Most patients respond to conservative treatment involving stretching of the iliotibial band, strengthening of the gluteus medius, and altering training regimens. Corticosteroid injections should be considered if visible swelling or pain with ambulation persists for more than three days after initiating treatment. A small percentage of patients are refractory to conservative treatment and may require surgical release of the iliotibial band.

Iliotibial band syndrome is a common knee injury that usually presents as lateral knee pain caused by inflammation of the distal portion of the iliotibial band; occasionally, however, the iliotibial band becomes inflamed at its proximal origin and causes referred hip pain. The iliotibial band is a thick band of fascia that is formed proximally by the confluence of fascia from hip flexors, extensors, and abductors. The band originates at the lateral iliac crest and extends distally to the patella, tibia, and biceps femoris tendon (Figure 1).¹

Key clinical recommendation	Label	References
Hip abductor weakness seems to contribute to the development of iliotibial band syndrome. Strengthening of the hip abductors has led to symptom improvement.	B	6
Strength training should be an integral part of any runner’s regimen; however, for patients with iliotibial band syndrome particular emphasis needs to be placed on the gluteus medius muscle.	B	6
The stretch seen in Figure 4C was consistently the most effective in increasing the length of the iliotibial band in a study of elite distance runners.	B	9
In a retrospective study of 45 patients who underwent surgical release of their iliotibial band, 84 percent of the patients reported that their surgery resulst were good to excellent.	B	10

Iliotibial band syndrome occurs frequently in runners or cyclists, and is caused by a combination of overuse and biomechanical factors. The syndrome can cause significant morbidity; however, most patients respond to a conservative treatment approach that involves stretching and altering training regimens.

Etiology

Iliotibial band syndrome is caused by excessive friction of the distal iliotibial band as it slides over the lateral femoral epicondyle during repetitive flexion and extension of the knee resulting in friction and potential irritation. In patients with iliotibial band syndrome, magnetic resonance imaging (MRI) studies have shown that the distal iliotibial band becomes thickened and that the potential space deep to the iliotibial band over the femoral epicondyle becomes inflamed and filled with fluid. ²

Despite a clear pathophysiology, it is unclear why this syndrome does not affect all athletes. Few studies^3–7 have shown any direct relationship between biomechanical factors and the development of iliotibial band syndrome. Excessive pronation causing tibial internal rotation and increased stress in the iliotibial band was believed to be a factor in the development of iliotibial band syndrome; however, the literature does not support this theory.

Some observational studies^4,6 have identified potential risk factors for the development of iliotibial band syndrome, including the following: preexisting iliotibial band tightness; high weekly mileage; time spent walking or running on a track; interval training; and muscular weakness of knee extensors, knee flexors, and hip abductors. Hip abductor weakness seems to contribute to the development of iliotibial band syndrome. Strengthening of the hip abductors has led to symptom improvement.⁶

Clinical Presentation

The primary initial complaint in patients with iliotibial band syndrome is diffuse pain over the lateral aspect of the knee. These patients frequently are unable to indicate one specific area of tenderness, but tend to use the palm of the hand to indicate pain over the entire lateral aspect of the knee. With time and continued activity, the initial lateral achiness progresses into a more painful, sharp, and localized discomfort over the lateral femoral epicondyle and/or the lateral tibial tubercle. Typically, the pain begins after the completion of a run or several minutes into a run; however, as the iliotibial band becomes increasingly irritated, the symptoms typically begin earlier in an exercise session and can even occur when the person is at rest. Patients often note that the pain is aggravated while running down hills, lengthening their stride, or sitting for long periods of time with the knee in the flexed position.⁷ The differential diagnosis for lateral knee pain is listed in Table 1.

Physical Examination

Patients with iliotibial band syndrome often demonstrate tenderness on palpation of the lateral knee approximately 2 cm above the joint line. Tenderness frequently is worse when the patient is in a standing position and the knee is flexed to 30 degrees. At this angle, the iliotibial band slides over the femoral condyle and is at maximal stress, thus reproducing the patient’s symptoms.^1,6 Swelling may be noted at the distal iliotibial band and thorough palpation of the affected limb may reveal multiple trigger points in the vastus lateralis, gluteus medius, and biceps femoris. Palpation of these trigger points may cause referred pain to the lateral aspect of the affected knee. Strength of the lower extremity should be assessed with particular emphasis on examining the knee extensors, knee flexors, and hip abductors. Weakness in these muscle groups has been associated with the development of iliotibial band syndrome.^4,6,7

The Ober’s test can be used to assess tightness of the iliotibial band (Figure 2). With the patient lying on the side with the unaffected side down and the unaffected hip and knee at a 90-degree angle, the examiner stabilizes the pelvis, then abducts and extends the affected leg until it is aligned with the rest of the patient’s body. The affected leg is lowered into adduction. If the iliotibial band is normal in length and unaffected, the leg will adduct and the patient will not experience pain. If the iliotibial band is tight, the leg will remain in the abducted position and the patient may have lateral knee pain.^1,6,8 A tight iliotibial band contributes to the excess friction placed on the iliotibial band as it slides over the femoral condyle during flexion and extension of the knee.

A clinical diagnosis is based on the history and physical examination. If the diagnosis is in doubt or other joint pathology is suspected, MRI can aid in the diagnosis and provide additional information about patients considered for surgery. In patients with iliotibial band syndrome, MRI shows a thickened iliotibial band over the lateral femoral epicondyle and often detects a fluid collection deep to the iliotibial band in the same region.²

Treatment

Treatment requires activity modification, massage, and stretching and strengthening of the affected limb. The goal is to minimize the friction of the iliotibial band as it slides over the femoral condyle. The patient may be referred to a physical therapist who is trained in treating iliotibial band syndrome. Most runners with low mileage respond to a regimen of anti-inflammatory medicines and stretching; however, competitive or high-mileage runners may need a more comprehensive treatment program.

The initial goal of treatment should be to alleviate inflammation by using ice and anti-inflammatory medications. Patient education and activity modification are crucial to successful treatment. Any activity that requires repeated knee flexion and extension is prohibited. During treatment, the patient may swim to maintain cardiovascular fitness. If visible swelling or pain with ambulation persists for more than three days after initiating treatment, a local corticosteroid injection should be considered⁶(Figure 3).

As the acute inflammation diminishes, the patient should begin a stretching regimen that focuses on the iliotibial band as well as the hip flexors and plantar flexors. The common iliotibial band stretches (Figure 4) have been evaluated for their effectiveness in stretching the band. The stretch shown in Figure 4C was consistently the most effective in increasing the length of the iliotibial band in a study⁹ of elite distance runners. Although this study⁹ demonstrates the effectiveness of stretching the iliotibial band, participants in the study did not have iliotibial band syndrome and studies have not demonstrated that stretching hastens recovery from the syndrome.

Once the patient can perform stretching without pain, a strengthening program should be initiated. Strength training should be an integral part of any runner’s regimen; however, for patients with iliotibial band syndrome particular emphasis needs to be placed on the gluteus medius muscle.⁶ A strengthening exercise geared toward the gluteus medius is shown in Figure 5.

Running should be resumed only after the patient is able to perform all of the strength exercises without pain. The return to running should be gradual, starting at an easy pace on a level surface. If the patient is able to tolerate this type of running without pain, mileage can be increased slowly. For the first week, patients should run only every other day, starting with easy sprints on a level surface. Most patients improve within three to six weeks if they are compliant with their stretching and activity limitations.¹

For patients who do not respond to conservative treatment, surgery should be considered. The most common approach is to release the posterior 2 cm of the iliotibial band where it passes over the lateral epicondyle of the femur. In a retrospective study¹⁰ of 45 patients who underwent surgical release of their iliotibial band, 84 percent of the patients reported that their surgery results were good to excellent.

Iliotibial band syndrome – aftercare: MedlinePlus Medical Encyclopedia

The iliotibial band (ITB) is a tendon that runs along the outside of your leg. It connects from the top of your pelvic bone to just below your knee. A tendon is thick elastic tissue that connects muscle to bone.

Iliotibial band syndrome occurs when the ITB becomes swollen and irritated from rubbing against the bone on the outside of your hip or knee.

There is a fluid-filled sac, called a bursa, between the bone and the tendon on the outside part of your leg. The sac provides lubrication between the tendon and the bone. The rubbing of the tendon can cause pain and swelling of the bursa, the tendon, or both.

This injury often affects runners and cyclists. Bending the knee over and over during these activities can create irritation and swelling of the tendon.

Other causes include:

• Being in poor physical condition
• Having a tight ITB
• Poor form with your activities
• Not warming up before exercising
• Having bowed legs
• Changes in activity levels
• Imbalance of the core muscles
• Injury to the area like a contusion or bruise

If you have ITB syndrome you may notice:

• Mild pain on the outside of your knee or hip when you begin to exercise, which goes away as you warm up.
• Over time, the pain feels worse and doesn’t go away during exercise.
• Running down hills or sitting for a long time with your knee bent may make pain worse.

Your doctor will examine your knee and move your leg in different positions to see if your ITB is tight. Usually, ITB syndrome can be diagnosed from the exam and your description of the symptoms.

If imaging tests are needed, they may include any of the following:

• Ultrasound
• MRI

If you have ITB syndrome, treatment may involve any of the following:

• Medicines or applying ice to relieve pain
• Stretching and strengthening exercises
• A shot of medicine called cortisone in the painful area to relieve pain and swelling

Most people do not need surgery. But if other treatments do not work, surgery may be recommended. During surgery, part of your ITB, the bursa, or both will be removed. Or, the ITB will be lengthened. This prevents the ITB from rubbing against the bone at the side of your knee.

At home, follow these measures to help reduce pain and swelling:

• Apply ice to the painful area for 15 minutes every 2 to 3 hours. Do not apply ice directly to your skin. Wrap the ice in a clean cloth first.
• Apply mild heat before stretching or doing strengthening exercises.
• Take pain medicine if you need to.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

• Talk with your doctor before using any pain medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
• Do not take more than the amount recommended on the bottle or by your doctor.

Try running or cycling shorter distances than you usually do. If you still have pain, avoid these activities completely. You may need to do other exercises that do not irritate your ITB, such as swimming.

Try wearing a knee sleeve to keep the bursa and ITB warm while you exercise.

Your doctor may recommend a physical therapist (PT) to work with your specific injury so you can return to normal activity as soon as possible.

Your PT may recommend ways to change how you exercise to prevent problems. Exercises are aimed at strengthening your core and hip muscles. It will also focus on stretching your tissue to allow less irritation. You may also be fitted for arch supports (orthotics) to wear in your shoes.

Once you can do stretching and strengthening exercises without pain, you can gradually begin running or cycling again. Slowly build up distance and speed.

Your PT may give you exercises to do to help stretch your ITB and strengthen your leg muscles. Before and after activity:

• Use a heating pad on your knee to warm the area up. Make sure the pad’s setting is on low or medium.
• Ice your knee and take pain medicine after activity if you feel pain.

The best way for the tendons to heal is to stick to a care plan. The more you rest and practice physical therapy, the quicker and better your injury will heal.

Call your health care provider if pain gets worse or does not get better in a few weeks.

IT band syndrome – aftercare; ITB syndrome – aftercare; Iliotibial band friction syndrome – aftercare

Akuthota V, Stilp SK, Lento P, Gonzalez P, Putnam AR. Iliotibial band syndrome. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 69.

Huntoon E, Dec KL, Caldwell M. Lower limb pain and dysfunction. In: Cifu DX, ed. Braddom’s Physical Medicine & Rehabilitation. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 36.

Riff AJ, Chalmers PN, Bach BR. Knee diagnosis and decision-making. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine: Principles and Practice. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 90.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Treatment of pulling pain in the knee

In this article I will tell you what diseases cause pulling pain in the knee joint, how they can be diagnosed and what are the methods of treatment.
Drawing pain in the knee joint may be associated with the pathology of the knee joint itself and the soft tissues surrounding it, or due to damage to other structures: herniated disc, osteoarthritis of the hip joint, damage to the venous wall in chronic venous insufficiency, compression of the femoral nerve.
For accurate diagnosis and proper treatment of knee pain, the doctor must understand the anatomy and biomechanics of the knee joint, conduct a detailed clinical examination, interpret examination data (X-ray, MRI, ultrasound), know effective methods of treatment and recovery time.

Anatomy of the knee joint

The knee joint is an articulation of three bones: the femur, tibia and patella (patella). It is strengthened by a ligamentous apparatus: anterior and posterior cruciate, collateral ligaments, articular capsule. The patellar ligament passes in front, passing into the tendon of the quadriceps femoris muscle.
Between the articular surfaces of the bones are the menisci, which evenly distribute the load on the cartilage and ensure the correct biomechanics of the joint.
Movements in the knee joint are due to the work of the quadriceps, biceps, adductor, popliteal, sartorius muscles.
Injury to each of these structures can produce nagging pain in the knee joint. Let’s take a look at some common problems.

Intra-articular pathology of the knee joint

• Osteoarthritis of the knee joint (gonarthrosis)
Increased stress on the knee joints causes deterioration of the articular cartilage and malnutrition of the bone, leading to osteoarthritis of the knee joint. The 1st and 2nd stages of this disease can give a pulling pain in the knee, especially when standing for a long time. In the 3rd and 4th stages, pain can be felt even at rest, joint deformity and severe limitation of mobility occur.
• Damage to the ligaments of the knee joint.
Knee ligaments are most commonly damaged by sudden movement in the joint, such as when playing football, skiing or slipping. Ligament rupture is accompanied by swelling and severe pain in the knee joint, a feeling of instability. And small injuries in the absence of adequate treatment can disturb the pulling sensations in the knee area for a long time.
• Injury to the meniscus
Pain in case of injury to the meniscus depends on the degree of damage and is localized in the projection of the joint space. Also a characteristic sign of a meniscus rupture is the sensation of a foreign body in the joint and its blocking during movement. Do not endure pain for a long time, as the damaged fragment may come off. In this case, only surgical treatment will help.
• Synovitis of the knee joint
Synovitis – inflammation of the capsule of the knee joint, which is lined with synovium – is a non-specific disease. The synovial membrane becomes inflamed in case of damage to any of the intra-articular structures of the knee joint, which leads to an increase in the joint in volume, pulling sensations, especially when the knee joint is flexed.

• Baker’s cyst
If you’re experiencing nagging pain down the back of your knee joint, it’s probably caused by a Baker’s cyst, an inflammation of the bursa and fluid in the popliteal fossa. Usually this disease develops against the background of other problems in the knee joint. Symptoms may appear with increased physical exertion, squatting or bending over with straight legs.

Extra-articular pathology in the area of ​​the knee joint

• Tendinitis of the knee.
As a result of excessive or incorrect loads on the tendons of the muscles of the thigh and lower leg, their inflammation develops – tendonitis. Drawing pain in front of the knee joint is caused by damage to the ligament of the patella and tendon of the quadriceps muscle – this is the most common cause of pain in the knee. Discomfort on the outside of the knee is caused by friction of the iliotibial tendon against the femur, a condition called runner’s knee. On the inside, the place of attachment of the thin, tailor and semitendinous muscles becomes inflamed – the “crow’s foot”. In the popliteal fossa are the tendons of the gastrocnemius, popliteal and biceps femoris muscles. Their damage can cause pulling pain along the back of the thigh and lower leg.
• Myofascial syndrome.
Painful tightness in the muscles, trigger points, causing discomfort and pulling sensations in the knees when walking, running, climbing stairs, squats. Diseases of the knee joint or microdamage to the muscles themselves lead to the appearance of such points.
• Lymphadenitis.
In the popliteal fossa there are lymph nodes, in which lymphatic fluid from the foot and lower leg accumulates. Infectious processes in the lower extremity or impaired lymphatic drainage lead to an increase in lymph nodes and the appearance of discomfort.
• Varicose veins of the lower extremities
Mild varicose veins are asymptomatic. Treatment requires swelling in the lower extremities, swollen veins and varicose veins, pulling sensations in the legs. If you notice a change in the color of the lower leg, severe unilateral swelling, pulling pain along the veins or pain during palpation, you should immediately consult a doctor. These are signs of thrombophlebitis, a dangerous condition requiring immediate treatment.

Also, pain in the knee joint is caused by herniated intervertebral discs L2-L4, inflammation of the femoral and sciatic nerves. In rare cases, pulling pain in the knee joint is a sign of arthrosis of the hip joint or overload of the ankle joint.

Diagnosis of diseases of the knee joint

Accurate diagnosis is already half of the treatment. The analysis of any situation begins with a survey: we find out what and where it hurts, for how long, what provokes it. Then there is a detailed examination of the knee joint, I conduct special tests. I often find a connection between knee pain and flat feet. To make an accurate diagnosis and start treatment, instrumental diagnostics is required. For this, the following is prescribed:
• MRI of the knee joints.
The most accurate method for diagnosing intra-articular pathology. Ligaments, menisci, articular cartilage, tendons and articular bags are perfectly visible. To get a high-quality image, the power of the device must be 1.5 Tesla. If the patient has a metal prosthesis, MRI is contraindicated. In this case, the combination of X-ray + ultrasound is informative.

• Ultrasound of the knee joints.
A good method for diagnosing periarticular tissues, Baker’s cysts, vascular conditions and lymph nodes. Ultrasound allows you to assess the condition of tissues at a considerable distance from the joint, where a standard MRI study lacks.
• Radiography of the knee joints.
X-ray of the knee joints is a standard examination in the polyclinic. Gives information about the condition of bones, articular cartilage, allows you to exclude a fracture. Most of the diseases that cause pulling pain in the knee joint are not associated with bone damage. Therefore, radiography is uninformative, this study is rarely prescribed.
• Computed tomography of the knee joints.
This study most accurately shows the condition of the bones, indirectly informs about the periarticular tissues. The main indications are a suspicion of a fracture, aseptic necrosis, or the presence of an endoprosthesis. With CT, the body receives a high radiation load; it is not worth conducting a study without a doctor’s referral.

Methods of treatment

When the diagnosis is established, treatment can begin. I do not recommend being treated according to the principle “it helped a friend / relative / acquaintance, let me try”. Above, I wrote how many diseases there are that cause similar pain.
Drawing pain in the knee joint rarely requires surgical treatment, so I will write about conservative treatment. I’ll list them in the order in which I use them most often. None of the methods is the best, but the right combination will help mutually reinforce the effect.
• Manual therapy.
Many causes of pulling pain in the knee are associated with incorrect biomechanics of the joint. Manual therapy helps to eliminate functional blocks, get rid of painful trigger points in the muscles, and increase muscle tone. Also, pain in the knee joints is regularly accompanied by back pain, which is quickly stopped by manual therapy.
• Shock wave therapy.
A method of treatment based on the impact of a sound wave on soft tissues. SWT improves blood circulation in soft tissues and accelerates their regeneration. An excellent method for the treatment of bursitis, tendinitis, tendinopathies and myofascial syndromes.

• Orthopedic insoles.
Flat feet lead to dysfunction of the muscles of the lower extremities, increased tension in the ligaments and wear of the articular cartilage. Modern insoles do not cause discomfort when worn and do not require getting used to. Many patients notice an improvement from the first week of wearing insoles.
• Therapeutic physical culture.
Performing special exercises allows you to eliminate muscle imbalance, reduce the load on the knee joint. Without them, it will not be possible to cure chronic pain, it is always associated with the weakness of certain muscles. Also, special rehabilitation requires recovery after injuries and operations.
• Medical treatment.
In case of severe pain, swelling, signs of inflammation, I prescribe non-steroidal anti-inflammatory drugs. Dosage and duration of administration are selected individually. For prevention, chondroprotectors can be used, usually in long courses.
• Kinesiology taping
Kinesiology tapes are special tapes that are applied to the skin and reduce pain, provide support, and improve blood flow. I use them for tendon and muscle problems. Their unique feature – not to interfere with movements – allows you to use teips before competitions or wear them for a long time.
• Knee orthoses.
Orthoses and bandages reduce the load on the ligaments of the knee joint. They must be used after trauma, meniscus surgery, cruciate ligament plasty. In other cases, their use is undesirable. Wearing a brace on a regular basis temporarily reduces knee discomfort, but relaxes the muscles and increases the risk of re-injury. Occasionally it is allowed to wear them during periods of increased stress.
• PRP therapy, hyaluronic acid.
Good effect brings local injection therapy – PRP, hyaluronic acid. PRP is platelet-rich plasma, its injections accelerate the regeneration and healing of joint tissues. Hyaluronic acid improves gliding in the joint, it reduces discomfort in arthrosis and osteoarthritis.
• MLS
MLS laser therapy is aimed at reducing swelling and restoring metabolism in the area of ​​inflammation. It goes well with acupuncture, which additionally stimulates the nervous system.

Conclusions

Drawing pain in the knee can be the result of various diseases. Even in the knee joint, dozens of structures can hurt. In addition to examining the joint itself, you need to examine the surrounding tissues, the lumbar spine, and feet. An MRI or ultrasound will help clarify the diagnosis.
Most often, conservative treatment is required. If surgical treatment cannot be avoided, then the rehabilitation course completed before the operation will help to recover without complications and in a shorter time.
By combining several methods, the doctor will cure you faster. Based on my practice, I can say that the treatment gives a result after the first procedure, and a significant improvement occurs after the third session. Regular exercise will keep the effect for a long time.
If you are concerned about pulling pain in the knee joint, you can make an appointment with me at the “Freedom of Movement” clinic. I will conduct a detailed examination, answer all questions, and explain your disease in plain language. Then I will appoint the necessary examination to clarify the diagnosis and the most effective method of treatment in your case.

How to diagnose a knee tendon rupture

How to diagnose a knee tendon tear – advice from an orthopedic traumatologist

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How to Diagnose a Knee Tendon Rupture : A knee tendon tear is a break in the integrity of the tendon in the area of ​​the knee joint. The initial diagnosis of knee tendon rupture will require an MRI of the knee joint and a subsequent consultation with an orthopedic traumatologist.

Which doctor treats a knee tendon rupture : If you have symptoms of a knee tendon rupture, you should first consult an orthopedic traumatologist.

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A knee and hamstring tear is a strain or tear in the tendons or large muscles in the back of the thigh or knee. This injury is often seen in athletes. The hamstrings are tissues on the back of the thighs that attach the large thigh muscle to the bone. The term “hamstring” also refers to a group of 3 muscles that run along the back of the thigh, from the thigh to just below the knee. The hamstring muscles are little used during standing or walking, but they are very active during knee flexion activities such as running, jumping, and climbing.

There are 3 degrees of injury to the tendons of the knee joint:

1 degree – slight sprain or tension of the muscles of the knee;

2 degree – partial rupture of the tendons of the knee joint;

3 degree – complete detachment of the tendons of the knee joint.

Recovery time and treatment after a knee tendon sprain or tear will depend on the severity of the injury. Rehabilitation from a minor strain or strain on a tendon may take days to heal, while recovery from a torn tendon may take weeks or months.

Causes of a knee tendon tear

A knee tendon tear can occur if any of the tendons are overstretched, which often occurs during sudden, explosive movements such as sprinting, lunging or jumping. It can also occur more gradually or during slower movements that overstretch the hamstring, such as cycling or long distance running. Regular stretching and strengthening exercises, as well as warming up before exercise, can help reduce the risk of a knee tendon tear.

Knee tendon rupture symptoms

A mild knee tendon strain usually causes sudden pain and tenderness in the back of the thigh or knee. Moving your leg can be painful, but it shouldn’t affect muscle strength. Partial tendon ruptures are usually more painful and the patient has limited range of motion of the knee. There may also be swelling and bruising on the back of the knee.

A complete rupture of the tendons of the knee joint is usually very painful, the knee immediately swells, and the skin becomes bruised. During the injury, a “pop” sensation may occur and the patient may not be able to fully move the affected leg.

Which doctor should I contact if I have a knee tendon rupture?

An orthopedic traumatologist deals with the diagnosis and treatment of knee tendon rupture. To assess the degree of damage to the knee tendon, the doctor will conduct an initial orthopedic examination and prescribe an MRI of the knee joint or a CT scan of the knee joint, depending on the type of injury. Computed tomography is more often used if the injury is associated with a bone fracture. Magnetic resonance imaging is indicated for signs of articular lesions.

Treatment

Most knee tendon injuries can be treated at home using the following methods:

• Rest – keep your leg as still as possible and avoid strenuous exercise.
• Ice – Apply cold compresses to the affected area for 20 minutes every 2-3 hours throughout the day.
• Elevated Position – Keep your leg elevated and supported as much as possible by the pillow to reduce swelling.
• Regular pain relievers such as paracetamol, non-steroidal anti-inflammatory drug (NSAID) cream or gel can also help relieve pain.
• Short-term use of oral NSAIDs, such as ibuprofen tablets, may help reduce swelling and inflammation.

Recovery from a tendon injury can take days, weeks or months depending on the severity. A completely torn knee tendon can take several months to heal.

Returning to intense exercise too quickly can aggravate the injury, but not exercising too long can cause muscle contraction and scarring around the tear. To avoid this, the patient should start doing a light knee tendon stretch a few days after the injury, when the initial pain has subsided.

A complete rupture of the knee tendon will require surgical treatment and repair surgery to fuse the tendon.

Author: Viktor Evgenievich Tolnikov

Specialization: Orthopedist, Traumatologist, Sports doctor Vredena

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