Wiper syndrome |LEPAPE-INFO

The runners victims of a wiper syndrome know and fear the occurrence of pain located on the external face of the knee which characterizes this syndrome.This very large pain prevents running and imposing the runner with a return by walking, or even boxing.Once triggered, this syndrome, sometimes very difficult to take care of on a medical level, can exasperate the sportsman in an exasperating manner and prevent him from organizing regular training.We will describe the latest scientific and medical knowledge which, in 2017, will try to prevent and treat frequent and complex pain syndrome.

Un syndrome mondialement reconnu

To designate this very specific running pain, the terms are numerous: wiper syndrome, maissiat strip syndrome, fascia lata tensor (TFL), friction or friction syndrome.We will now have to agree to use the international term of ilio-tibial strip syndrome.For those who like to read English, the term "ilio-tibial band syndrom" typed on a search engine will allow you to access an exciting and very substantial literature.

Un syndrome très fréquent chez les coureurs à pied

The various studies that have sought to know the frequency of occurrence of this injury show that 7 to 10 % of runners are victims of this side knee pain.This syndrome is the second extra-articular frequency pathology behind the tendonopathy of the Achilles tendon and the first cause of knee pain in athletes practicing running running.If the figure of 10 million running practitioners in France is real, around a million runners can tell the same painful story and discuss the best treatments.

Un syndrome qui atteint tous les niveaux de pratique

Ilio-Tibial strip syndrome would be more frequent in beginner runners who have been running for less than two years.On this level, there are few reliable studies.But health professionals who follow and take care of runners with this syndrome may confirm that almost all levels of practice are affected.International runners and runners may be the victim of the ilio-tibial strip syndrome, suffering from this pathology for several months and having a very disturbed sports season by this terrible external knee pain.

Des circonstances de survenue stéréotypées

The runners who consult for an ilio-tibial strip syndrome all describe the same method of occurrence of pain.This pain appeared as a result of a change in training: lengthening distances or strokes, change of running surface, unusual competition, intensive internship, resumed too large after a stop of a few weeks, passage from cross toOff-stadium races, Trail on Trail road race, unusual endurance training for a collective sports sportsman or a tennis player, change of shoes.

Pain perfectly explained on the mechanical level

Athletes who suffer from an ilio-tibial strip syndrome will describe very well from what time of racing the pain arises and forces them to walk.Curiously, in the same runner the pains will appear practically always for the same time of race.The same runners will be able to specify the sports that they can practice without pain.Athletes adept at collective sports or racket sports are only victims of ilio-tibial strip syndrome when they start, for various reasons, to practice jogging.In conclusion, it is the axial, unipodal and repetitive support which, with fatigue and in a corner located between 30 and 40 ° of flexion, is aggressive for the knee.

Pain better understood on the anatomical level

For anatomists, the term tendinopathy cannot be used to define this lateral pain because pathological involvement is very different from tendon involvement as is the case, for example, in the damage to the Achille tendon.For this reason the term "syndrome" is used.But if the tendon is not reached, what is the structure that suffers and makes the runner suffer?The current anatomo-pathological explanations are as follows: the sliding structure located between the deep side of the ilio-tibial strip and the bone condyle of the femur is rich in fat, vessels and nerves.The repeated compression of this sliding structure by aggressing the vasculo-diligent fabric is at the origin of the painful phenomena.Therefore, the terms of friction, conflict, pathology of the interface are also used in scientific journals.

A clinical and radiological diagnosis

The clinical diagnosis is simple because the knee examination generally finds the pain that the sportsman recognizes when compressing the strip on the condyle in a bending angle located between 30 ° and 40 °.A training the day before or in the morning of the consultation makes it possible to raise awareness of the examination.Ultrasound should be prescribed systematically and will show the direct or indirect signs of ilio-tibial strip syndrome: thickening and modifications to the deep side of the strip, liquid collection (bursopathy, cyst or synovial recess),Dynamic conflict or projection, edema of the vasculo-grave fabric, Doppler hyperhemia.

Strip syndrome or other diagnoses?

In a runner on foot who suffers from an ilio-tibial strip syndrome and for whom the different treatments are ineffective, we must always ask the question of the possibility of other diagnoses.Indeed, all the side pains of the knee in a runner on foot are not syndromes of the ilio-tibial strip.Other mechanical pathologies can give pain that radiate towards the lateral face of the knee: damage to the external meniscus, tendinopathy of the crural biceps, fractigue of condyle or the tibial plateau, cartilaginous lesions of the femoro-tibial joint.The essential problem remains that of the patellar syndromes which, fills with difficulty, can be associated with a real ilio-tibial strip syndrome.This association can be explained by the fact that the ilio-tibial strip and the lateral patellar spoiler are very entangled in the anatomical level.

More frequent syndrome in women

A prospective study carried out for 4 years out of 400 runners on foot from the University of Delaware reveals that the incidence of the pathology of the ilio-tibial strip is 16 % in women.Other comparative studies show that the occurrence of this pathology is more frequent in joggers (around 10 %) than in joggers (around 7 %).At the knee level, the main biomechanical explanations concerning the frequency of the wounds of the runner on foot are as follows: in women, the internal rotation of the hip and the valgus of the knee (deviation of the axis of the leg towards theexterior of the axis of the thigh) are greater than in men during the race and participate in the ligament vulnerability of the knee.In addition to women, two muscles have a lower activity when supporting and receiving unipodal, hip abductive muscles and the crural biceps.

The axis of the race and the white line test

Very beautiful North American biomechanical studies prove that runners victims of ilio-tibial strip syndrome tend to run with an excessive adduction of the two knees.The supports are no longer made up of the hips but are located at the center on the same line (and sometimes meet) in the same way as the modeling approach.This type of race only worsens the internal rotation of the femur and the knee valgus.The ilio-tibial strip is then hyper solicited in its role of limiting the internal rotation of the knee and the leg, which explains the triggering of the syndrome.Take the white line test: if, at the race, your feet are systematically on the line and it is impossible for you to spread your supports of 5 cm, you will have to go back through the "Race School" box.

Medical treatments and rehabilitation

Local infiltration of corticosteroids are effective and legitimate but only in the event of a liquid collection (bursopathy, cyst, synovial recess) located between the deep side of the strip and the femoral condyle.In this case, they should always be carried out under ultrasound control.

Local care and physiotherapy practiced by a physiotherapist are essential but deep transverse massages (MTP) and shock waves are very aggressive.They cannot therefore be systematically advised.Stretching of lateral and anterior muscle channels should be practiced very regularly and according to different angles of hip and knee flexion.The strengthening of glutes and hip abductions is essential to stabilize the basin horizontally.A work of strengthening to all modes must therefore be systematically undertaken, understood and prosecuted.Different stabilization exercises of the lower limbs, the basin and the trunk will be set up by the physiotherapist as part of a global work of balance in the first place in unipodal support, then at the descent of the stairs and then during jumpsand race.

Ilio-Tibial strip syndrome: the advice of the sports doctor