Miami Sports Magazine May/June 2011

Although this starts out as a
basketball story, it pertains to any
athlete that runs in their sport
or runs when they train. A few
years ago I had a pro-basketball
center that presented to my
office with complaints of lateral
right knee pain. He described a
motion where he is passed the
ball, plants his right foot and
hooks around as he jumps to
shoot the ball. He does this again
and again throughout practice
and during a game. The history
certainly pointed to a potential
knee injury. However, after a
more in-depth history and an
examination of the right knee
(and examination of the left knee
for comparison), I determined
that his knee pain wasn’t really
caused by a problem with his
knee. Next on up the kinetic
chain was the hip, sacroiliac and
lower back. Everything in the
hip & lower back were normal
but it was the sacroiliac joints
where I eventually discovered the
problem.
Upon examining the knee there
was some pain in the distal aspect
of his lateral knee (the outside of
the knee). Yes it was tender and
sore, but the orthopedic exam of
the knee was absolutely normal
– as was the examination of his
hips and lower back. When I
examined the sacroiliac joints,
all standard orthopedic tests were
normal and didn’t cause any pain
in the back, hip or knee. Then I
did a technique quite common to
chiropractors, known as motion
palpation. This is where we apply
a little repetitive springy motion
into a joint to see if it has the
normal springy end feel that a
properly functioning joint should.
When I applied this examination
technique to the sacroiliac joint,
the joints had a hard or locked
end feel father than the springy
motion of a normally functioning
joint. Although there are several
causes for I.T.-Band Syndrome,
it’s typically thought to be from
overuse, misuse, overtraining
syndrome (not giving the body
enough time to recover between
training sessions), returning
from an injury too soon or faulty
biomechanics.
Although the sacroiliac (S.I.)
joints don’t move much, they
are supposed to move a little at
the end range of your walking
and running gate. Both S.I.
joints should flex and extend
a few millimeters as your legs
get to their most forward and
aft positions when running and
walking. During normal gait,
the Tensor Fascia Lata (TFL)
functions to flex and internally
rotate the hip while the Ilio Tibial
Band (ITB) functions to stabilize
the lateral knee. However when
the S.I. joint locks up, the TFL
and ITB pull with increased force
on the lateral structures of the
knee (where it attaches), causing
the iliotibial band to become
FITNESS
Natural Sports Medicine
Todd M. Narson, DC, DACBSP
Miami Beach Family & Sports Chiropractic Center
Diplomate of the American Chiropractic Board of
Sports Physicians
Ilito-Tibial Band Syndrome
A Case Of Lateral Knee Pain In An Athlete Without A “Knee Problem”
overstressed and ultimately
inflamed.
It’s my theory that when the
S.I. joints lock up it prevents the
normal pendulum like swing of
your legs and thus the TFL/ITB
will help move it laterally, pulling
slightly on the lateral structure of
the knee, ultimately causing the
inflamed distal I.T. band. Sounds
good, but again, that’s my theory.
In either case, the problem is
occurring at the sacroiliac joints
(part of your lower back) and
not at the knee. Remember what
I said initially, both the knee
exam and the low back exam
were virtually normal. Any
physician would have examined
it and found it normal. This is
why it’s important to take a good
history (know the sport and how
the injury occurred) and do a
good physical exam that includes
classic orthopedic test but also
examines the soft tissues AND
the intrinsic motion within a joint
complex. Without this last part,
this problem would never have
been properly identified.
This Iliotibial band friction
syndrome (I.T. Band Syndrome)
is commonly seen in runners,
triathletes and weight lifters that
include a lot of squatting in their
routines. Everyone that comes in
with this swears they have a torn
meniscus “or something” wrong
in their knee. But buyer beware,
this problem can present itself as
low back pain, hip pain, upper
thigh pain or lateral knee pain.
What’s the best way to tell the
difference? Get an examination
by a competent sports medicine
physician - AND always ask
for a detailed explanation as to
why you are in pain. If they
26 • MAY/JUNE 2011
can explain the mechanism of
the problem to you clearly, that
means they most likely have
a good understanding of your
problem and you’re in the right
place.
Remember…pain is merely a
symptom that alerts you to the
existence of a problem. It doesn’t
necessarily tell you what the
problem is or where the problem
is. Most of you are aware that
a heart attack can present itself
as pain in the left arm or left
shoulder blade and not in your
chest. In this case we saw
lateral knee pain being caused
by something other than a knee
problem.
So let me finish with this, while
the internet can provide you with
some background on your aches
and pain, nothing replaces a
good ole’ fashion medical history
and physical examination. If
you continue training and you
continue to experience pain, don’t
wait too long to get it looked
at by a trained sports medicine
professional. The faster you find
the right answer, the faster you’ll
find the right solution.
Train smart.
Dr. T
Todd M. Narson, DC, DACBSP
Specializing in the Treatment of Sports
Injuries
400 Arthur Godfrey Road (41st Street) -
Suite 412, Miami Beach, FL 33140
Phone: 305.672.BACK (2225)
Fax: 305.674.4449
Email: Miamibeachdoc@yahoo.com
Web: www.NaturalSportsMedicine.com
Blog: NaturalSportsMedicine.blogspot.com
Twitter: @SportsDocNarson
Skype: SportsDocNarson