Diagnosing Lateral Thigh Pain: IT band syndrome, Hip Bursitis and referred Back pain
Are you experiencing constant or intermittent lateral thigh pain? There are several musculoskeletal conditions that lateral thigh pain could be, such as bursitis, lumbar referred pain or IT band syndrome. Because pain on the outside of your thigh or leg is a common area for referred pain, it can be tricky to diagnosis. As you might remember from one of my previous blog posts – referred pain is pain felt in an area that may not necessarily immediate from where the pain is felt.
Directly underneath the skin layers of the lateral thigh is a structure call the iliotibial band, or IT band for short. The IT band is a piece of thick fascia that acts as a connection of the Tensor Fascia Lata muscle to the outside of the knee joint. Its main function is to help create a stabilizing force at the hip and knee while walking and to assist the glute muscles with an abduction motion (which is a lateral movement outward of your leg). Many physicians, physical therapists as well as other health care professionals tend to diagnosis and/or label pain in the lateral thigh as something called IT band syndrome. It is my experience that the IT Band syndrome diagnosis is slightly over utilized and there may be other reasons for the lateral thigh pain that people may experience.
The true mechanism of injuring the IT band and resultant pain production is found in joggers, long distance runners and occasionally cyclists. The runner typically has some sort of gunu varum at the knee (pictured below) or pronation of the feet which loads the IT band at the attachment point on the outside of the knee. This irritation will manifest as lateral thigh pain just above the knee joint and is usually localized. However, sometimes it can manifest as a diffuse ache along the lateral thigh making diagnosing it difficult. Ironically, there are patients who present to the clinic with an ache in the lateral thigh with little or no history of being a runner or a cyclist with a prescription from a doctor with the diagnosis of IT band syndrome. In these cases, the pain may not be coming from the IT Band but from another source. Interestingly, as a side point the term “runner’s knee” is reserved for pain in the front of the knee as seen in the picture below.
Other sources of lateral thigh pain include something called trochanteric bursitis. (A bursa is a fluid filled sac that acts as a lubricating device between two anatomical structures.) Actually, the greater trochanteric bursa has a more specialized name called the trochanteric subgluteus maximus bursa because it lies between the great trochanter and the deep fibers of the gluteus maximus muscle. The etiology of this condition is really more of an inflammation at the site where the gluteus medius muscle inserts on the femur or where the IT band passes over the greater trochanter itself. This type of patient usually complains of pain in the lateral hip. Pain can radiate down the thigh to the knee, causing a limp. There usually is tenderness along the lateral aspect of the greater trochanter as well.
Because both of the aforementioned conditions radiate or refer pain to the lateral thigh, having a skilled physical therapist to differentiate between the two is essential to recovery.
To complete the list of possible causes of lateral thigh pain, we must consider the most over looked and maybe the most common cause of lateral thigh pain, the lumbar spine. More than likely, everyone has heard of sciatica. Sciatica has become a term that has started to take on a meaning of any kind or referred pain in the leg that is caused from a more central source, like the lumber spine or compression of the sciatic nerve at the piriformis muscle. Of note, the low- back can refer pan in several different patterns, depending of what structure is causing it. If the pain seems to be more along the back of the buttock and leg and in the hamstring area, we tend to think the pain is coming from the L5-S1 area of the spine, possibly a degenerative disc or herniated disc. If the pain is more lateral we tend to think the pain is more from the L4-L5 area of the spine. This L4-L5 segmental area is where we should focus our attention regarding lateral thigh pain. These lumbar referred pain patterns are tricky to understand and visualize as causing pain along the lateral thigh. I have had many clients over the years not really believe us that their lateral thigh pain is coming from their back, but eventually they came to an agreement when their pain subsided after treatments targeting their lumbar spine.
If you are experiencing lateral thigh pain and you are not sure if the pain is a referred lumbar pain or possible due to a tight piriformis muscle, or maybe IT band tightness causing bursitis or perhaps you’re an avid runner and not sure if that is why are having lateral thigh pain, then contact us or an experienced Physical Therapist skilled in manual diagnostic evaluation.
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