This topic contains 5 replies, has 2 voices, and was last updated by Andrew Wengert October 27, 2018 at 9:37 pm.
October 24, 2018 at 4:59 pm #4871
16 year old female.
Location: Lateral left knee above joint line. On distal IT Band.
Pain is Tight and Achy.
Provocative is running, (specifically the push off).
Rest is palliative.
Patient is a Lacrosse player playing or training every day.
Symptoms worse with use. She went for a run day before seeing me. First mile no symptom, second mile got up to a 6, third mile had to stop because of pain. This is how her practices and games go as well.
Knee flexion is touching with ease, no symptom.
Passive ext touching with 2″ under thigh, no pain, mild stretch
SLR 90 degrees bilaterally, no symptom.
Lunge showed quad dominance, and brought on mild reproduction of symptom when left leg was the trail leg, but motion was smooth.
Dorsiflexion on the right was 3″ Selective tension of toes positive (FHL/FDL)
Dorsiflexion on the left was 3.5″ Selective tension of toes positive (FHL/FDL)
Ober’s was negative.
Thessaly’s was negative.
Palpated adhesion in FHL/FDL. Running instrument over ITB is gritty.
What is the pain generator in this case?
Can adhesion in the IT Band cause pain at that intensity?October 25, 2018 at 7:35 am #4873
The pain generator is the distal IT band rubbing over the bone and yes that can create that level of pain. A bunch of things will contribute to this but the hamstring weakenss/quad dominance and limited dorsiflexion seems to be her biggest problems that you can help with. If the hamstrings aren’t doing a good job of stabilizing the knee then the IT band will have to work harder. The IT band will have a natural gritty feel so be careful of that. Make sure you check for junction adhesion between the IT band and vastus laterals. Restore as much dorsiflexion as you can, hopefully that limitation is not from a shape issue in the mortise joint because it will be difficult for her to stay injury free as a runner with that much limitation in ankle dorsiflexion. Start hip lifts right away and the most important thing to do is manage her load.October 25, 2018 at 6:06 pm #4874
Brandon Cohen DC, CSCSParticipant
What JJ said.
Assess with patient supine and knee extended. Press from A-P along the IT band as you might the sciatic nerve at ER. If its sticky, that could be your thing. If you haven’t done a bunch of those, maybe compare to the good side or other people to get a feel of what normal might feel like.
Treatment with instrument (I usually do it side-lying with varying degrees of knee flexion) does most of it, MAR might be needed if it is really deep.October 25, 2018 at 9:57 pm #4875
Thanks guysOctober 27, 2018 at 9:53 am #4876
Andy, I don’t understand. Can’t tell from your wording.
Was Passive Extension full?
That “mild stretch” means something to me – I’d guess “protective tension”.
If Ober’s is negative, how likely is it that adhesion is there? It’s basically a range test for the ITB. I know we don’t have standards for it –
Andy, did it seem to have full range? I can’t imagine what full range would be since I haven’t treated an ITB in years. But if it’s full and passive extension was positive, I’d wonder if quad adhesion (Prone Knee Flexion) or some other derangement inside the knee.
Interesting, Thessaly’s has over 90% sensitivity and specificity for meniscus. Good test.October 27, 2018 at 9:37 pm #4877
I totally messed up the wording and combined two tests
Passive extension was negative.
Rectus femoris length test was full. Heel to butt with ease with 2” block under flexed knee.
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