Dr.Bhat.A.Rangaprasad -Sarve janah Sukhino Bhavanthu || Sarve santhu Niramayah ||
Name, Age & Sex:
- Mr. X.Y.Z; 40 yrs; Male
Height & Built:
- 6 feet tall & lean stature.
Nature of job:
Standing for 6 to 8 hours, Machine operator in a Lathe factory
History of past illnesses:
- Nothing specific. He is adiabetic; normotensive & no cardiac
or respiratory ailments.
Presenting symptoms:
-
1.
Pain in the lateral
aspect of Lt.Knee
2.
Pain in the hollow
of the knee
3.
Radiation of pain
from the region of knee to the left hip & buttock
4.
Aggravating factor:
Walking fast; walking over uneven surface of road;
climbing down the stairs; inversion of foot; crossing the legs over knee &
squatting posture.
5.
Relieving factor: -
Sleeping straight; at resting posture of knee;
active hyper extension of foot or stretching of the calf muscle.
On examination:-
The range of movement
of the knee joint is normal, except the forced flexion which was painful in 110 degrees.
Negative
observation of scars; effusion; atrophy of local muscles; crepitus; Lateral
& medial joint lines non tender; Mc Murray’s & Appley Grind test
negative.
2+ Tenderness
present over the lateral femoral epicondyle.
Hip abductors
observed to be weak & the Tensor fascia lata was taunted
X-ray & MRI of affected joint – within normal limits
On questioning, whether he had any fall when at work some 20
days, got a negative reply from him. But, the taunting of the tensor fascia
lata, muscle weakness of the abductors along with the pain in the lateral
femoral epicondyle, were very much clinically akin to the condition of the ITBS (Ilio Tibial
Band Syndrome), which
usually occurs in sports persons due to sudden inversion of the foot or due
to change in the plane of the pelvis angle as seen in certain sports activities
like cycling.
On further questioning, regarding his way of standing while working, it is
then the cause for the strain of the IT band surfaced.
20 days
prior his job was in the loading and packing section, which he was
accustomed of doing it for the past 15 years. But, since 20 days, he
had been switched over to a new assignment of handling the compressing machine, as
a substitute for the absence of a regular worker.
 |
| Weight Bearing Lt.Knee |
|
And he explained that since he was new to the job of compressing, he used to feel
tired over legs due to prolonged standing. Hence
would be switching over his entire body
weight by slanting his body to either left side or the right side. Else would
keep his left foot over the foot rest beneath the machine with his hip diagonally
adducted to a degree of 5 to 10 in want of grip and comfort while working.
 |
| Diagonal Adduction |
|
But, most of the time he felt loading his body weight
over the left side, makes him feel comfort from the vague discomfort
felt at the lt. knee joint and was indulging in it.
And this was conclusive of coming to the diagnosis of
ITBS, clinically speaking.
The Literature about
ITBS from other web sources for better understanding:-
Iliotibial band syndrome is
one of the leading causes of lateral knee
pain in runners. The iliotibial
band is a thick band of fascia on the lateral aspect of the knee, extending
from the outside of the pelvis, over the hip and knee, and inserting just below
the knee. The band is crucial to stabilizing the knee during
running, as it moves from behind the femur to the front of the femur during
activity. The continual rubbing of the band over the lateral femoral
epicondyle, combined with the repeated flexion and extension of the knee during
running may cause the area to become inflamed.
·
Excessive lower-leg rotation due to
over-pronation
·
Positioning the feet "toed-in" to an
excessive angle when cycling
·
Muscle imbalance caused by Weak hip abductor
muscles &
·
Uneven left-right stretching of the band, which
could be caused by habits such as sitting cross-legged
The function of themuscles inserting into the ITB (Tensor Fascia Lata) is to abduct the leg.
If the hip abductors are weak, then the ITB is being overworked. The ITB does
not have an insertion that offers a favorable mechanical advantage. In fact, it
is at a considerable disadvantage for the purpose of hip and leg abduction
activity. Therefore when the hip abductors are weak, the tensor fascia lata
must contract harder and over a longer period of time thus straining the ITB.
Make sure that part of your cure is to strengthen your hip and leg abductors.
The treatment modality planned & clinical
observation:
The case involving the IT Band over its insertion point in
the lateral epicondyle of femur, gets responding well to the marma chikitsa in
giving a speedier relief from the pain.
But, the classical manipulation of the marmas with Tadana (application of pressure)
or Shrnga
application (Cupping method) are not suitable, since in certain
cases, we have observed the aggravation of pain immediately after the first
sitting, followed by relief from second or third sittings onwards.
