Orthopedic Exam / Special Tests for Physical Therapy: KNEE
ITB Friction Syndrome:
The iliotibial (IT) band is a tough group of fibers that run along the outside of the thigh. The gluteal muscles and the tensor fascia lata muscle attach to the top, and the lower part attaches to the tibia, just below the knee. It functions primarily as a stabilizer during running and can become irritated from overuse. With ITB Friction Syndrome, pain is usually described at the outside part of the knee or lower thigh, often worsened by going up or down stairs, or getting out of a car.
Predisposing factors for the development of IT band inflammation include training error and abnormal biomechanics. Some runners make the mistake of only running on one side of the road. Most roads are higher in the center and slope off on either side. The foot that is on the outside part of the road is therefore lower than the other. This causes the pelvis to tilt to one side and stresses the IT band. The biomechanical abnormalities that may lead to IT band problems are, excessive pronation of the foot, leg length discrepancy, lateral pelvic tilt, and “bowed” legs. Tight gluteal or quadriceps muscles may also contribute.
Noble Compression Test/ Nobles Test:
- Tests for the presence of iliotibial band (ITB) friction syndrome.
Video Demo Instructions, Procedure, Positive Test:
Special Test: Noble Compression Test/ Noble’s Test: Video Demo (Procedure below):
Special Test: Nobles Test: PROCEDURE:
• Patient is supine, with both their affected side’s knee and hip flexed to 90° degrees
• Therapist compresses the iliotibial band (ITB) – 2 centimetres proximal to the lateral femoral condyle
• Instruct the patient to extend the knee and hip slowly while therapist maintains compression of the ITB proximal to the lateral femoral condyle
Noble Compression Test/ Noble’s Test: : POSITIVE SIGN:
- Pain over the lateral femoral condyle at about 30° degrees of knee extension.