2024-03-04 07:30:00
Running is enjoying undeniable success in France; it is today one of the most practiced activities in the world. In France, nearly 10 million French people regularly practice this sport, the convenience and free nature of which contribute to this growing success.
But this sport, like any sporting activity, is accident-prone, particularly for the knees.
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Indeed, the knee is the joint most prone to injuries, and it alone accounts for nearly a third of the injuries that can occur when running. After patellofemoral pain, windshield wiper syndrome is the second most common knee condition among runners and the fifth most common cause for all joints.
Anatomy of the iliotibial band
Windshield wiper syndrome affects a particular anatomical structure: the iliotibial band. This strip is a fascia, that is to say a membrane of fairly dense connective tissue, which stretches from the pelvis to the external surface of the knee while running along the lateral surface of the thigh. This band is neither a muscle nor a tendon, so iliotibial band syndrome does not fall into the category of tendinopathy. This fascia has two anatomical particularities which will be important, both in the physio-pathological process of appearance of pain and in the treatment.
READ ALSO Running, beware of windshield wiper syndrome! First, the iliotibial band is inserted on the very upper part of the tibia, on a bony tubercle – Gerdy’s tubercle – and is pressed against the end of the femur as it passes over the outside of the knee. It is precisely at this point that a friction mechanism, similar to the play of a windshield wiper blade, is where the pain occurs. The second anatomical feature is found at the other end, on the side of the pelvis, where we find two muscles which have a direct action on this strip, the gluteus medius muscle and the tensor fascia lata muscle.
Mechanism of injury
From a strictly pathophysiological point of view, windshield wiper syndrome results from excessive friction of the tape against the external surface of the knee. This friction would be due to excess tension in the iliotibial band, thus causing inflammation of the tissues in contact with the external surface of the knee.
Many factors can be the cause of this injury: the type of shoe, the rapid increase in the training load, local anatomical particularities or even the weakness of the pelvic muscles that we mentioned previously, the middle muscles gluteus and tensor fascia lata.
Diagnosis and treatment
The diagnosis of iliotibial band syndrome is essentially clinical, because it is perfectly identifiable. Patients complain of pain occurring after a certain distance – always the same – or after running. The painful point is one to two centimeters above the joint line and medical tests will confirm the suspicion. It is sometimes necessary to do medical imaging to exclude another pathology but not systematically.
There is no scientifically validated treatment protocol for windshield wiper syndrome, however, a broad consensus has emerged on the treatment which will mainly be based on physiotherapy sessions. In the acute phase, it will be appropriate to impose joint rest with stopping running, to ice the painful area if possible several times a day for 10 to 20 minutes and to begin rehabilitation with a physiotherapist who will practice a a number of technical gestures, including, among others, the application of radial shock waves. Once the acute phase has passed, the rehabilitation protocol will evolve more actively with the performance of stretching, muscle strengthening of the gluteal muscles and always manual therapy.
The physiotherapist will teach his patient self-stretching and pelvic muscle strengthening techniques so that he can perform them daily. The resumption of running can take place, under the control of the physiotherapist, before the pain has completely disappeared, respecting a gradual resumption while combining the prescribed stretching and strengthening. Finally, relying on the expertise of a podiatrist is often valuable, both for the making of orthopedic insoles and for his advice on choosing the most suitable shoes.
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