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A repetitive strain injury (RSI), also called repetitive stress injury, cumulative trauma disorder or occupational overuse syndrome, is any of a loose group of conditions from overuse of the computer, guitar, knife or similar motion or tool. It is an occupational overuse syndrome affecting muscles, tendons and nerves in the arms and upper back; hence it is also known as work related upper limb disorder or WRULD. The medically accepted condition in which it occurs is when muscles in these areas are kept tense for very long periods of time, due to poor posture and/or repetitive motions.
The Physical Therapy team at Great Lakes Orthopedics offer a wide range of programs and specialized services to help our patients restore and maintain their physical strength, performance skills, and levels of function. Our well-trained, professional staff utilize the most progressive treatment options and techniques to ensure the best possible recoveries.
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 considered.
Corticosteroid injection for iliotibial band syndrome. Gerdy’s tubercle and the femoral condyle are marked as landmarks. With the patient in a supine or side-lying position, the needle is inserted at the point of maximum tenderness over the femoral condyle.
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 have been evaluated for their effectiveness in stretching the band. Although this study 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.
Stretches of the right iliotibial band.
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.
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.
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.