Windscreen wiper syndrome, iliotibial band syndrome or tensor fasciitis-lata tendonitis - many names for a condition that many runners experience at least once in their lives! Always insidious, it doesn't take long for it to appear, often for no apparent reason, leaving the runner in the most problematic of predicaments! I'm going to try and tackle the problem using reason as a tool.
Preamble: with good reason?
I would like to make it clear that what is expressed in this article comes mainly from my own experience and does not replace medical advice.
The purpose of this article is to be rationally thought out. I'm going to tell you why I've determined MY protocol of care when this syndrome occurs in my home.
The reasoning, more than the protocol itself, will be useful to you for the simple reason that each pathology, each runner has parameters that differ and cannot form the basis of a single care protocol.
In the same way, I'll be popularizing quite a few points. I apologize in advance to my readers in the health field if there are any anatomical approximations, but this isn't medicine ;).
What is Fascia-Lata syndrome?
This syndrome is an inflammation of the tendinous part of the tensor fascia-lata muscle (TFL), in other words, tendinitis. The human body is a marvel of technology, except perhaps where the TFL is concerned.
This muscle is rooted in the iliac bone. In caricature, it originates just below the outer surface of the hip. It quickly becomes sinewy, forming a band that runs along the entire thigh, past the knee joint and anchors on the tibia.
This is where I think our body is a bit of a mess. This band passes over the joint. "The name "ice-wiper syndrome" comes from the fact that, in knee extension, the ilio-tibial band is located in front of the tuberosity of the lateral condyle, and that in flexion, it slides under the lateral condyle like an ice-wiper".(Source)
Basically, this band passes just above the femoral epicondyle without causing any problems. The famous syndrome occurs when there is friction on the epicondyle. The tendon becomes inflamed, and the problem begins. In fact, the whole problem with this syndrome is that it appears after a certain number of kilometers or after a set period of time... On a day-to-day basis, there is generally no pain and, paradoxically, sports involving irregular running (basketball, tennis, team sports, etc.) sometimes don't even cause pain.
The causes?
The first question is to try and determine what caused the friction, since friction doesn't happen in the first place. Even so, this first question is the most complex.
This can be caused by fatigue, footwear, posture, biomechanics, static disorders, etc. The causes are many and varied.
Treatment of windshield wiper syndrome
As the disease is insidious, it can be extremely complicated to determine the origin of the problem and thus contain it. We all know riders who have been suffering from this filth for weeks, months or even years without ever having managed to contain it.
Reasoning to adopt
- Make sure it's a TFL
It may sound silly, but TFL pain is located on the outside of the knee. It can be confused with other knee pathologies. If in doubt, consult a sports doctor!
However, there is an easy test to perform. Simply press on the femoral condyle (+- 3 cm above the "hollow" of the joint) while flexing the knee in a unipodal position. If pain is present, there is a strong presumption of TFL.
- Tendonitis = Care
You're sure you have TFL. The first thing to do is to treat the inflammation before anything else. As for the protocol, I'll refer you to your practitioner. Personally, I don't apply or take any anti-inflammatory drugs. I simply drink plenty of fluids and stretch:
- Check shoes
Before running to the physiotherapist, osteopath, chiropodist, etc., check that your shoes are not corrective (pronator vs. supinator shoes). If they are, before doing anything else, try running again in neutral shoes.
I personally developed TFL because I was wearing pronator shoes. The poor posture that the shoes gave me really pushed the onset of the syndrome.
In this case, a simple change of footwear can keep the pain at bay.
- Bodybuilding
Similarly, if it's not your shoes, it may "just" be a sign that your body is sending you abnormally tired. Running is traumatic. Failure to respect recovery phases, or simply fatigue, can be at the root of the problem.
Indeed, when a muscle is tired, it loses its dynamic power. It becomes stiffer, hence the importance of stretching. The TFL, as we've seen, is particularly "messed up" as it passes over the lateral femoral condyle. In order to pass over it without rubbing, the tendon must be kept taut.
Let's be logical: what can keep this tendon under tension? Obviously, there's a relaxed and well-sprung TFL, but more than that, it's the whole leg that maintains this tension. The quadriceps and ischios in first place.
In my case, when I caught a TFL, it was "simply" a muscular imbalance in the leg that a little strength training was enough to eliminate. All you have to do is work the quadriceps and ischios with resistance. Although the use of a machine is preferable to accentuate the work with a little weight. These exercises can also be performed at home. For the quadri, simply extend the leg while seated for 30s to 1 minute. Do 5 to 8 repetitions, alternating legs. For the ischios, you can simply contract them for 30s and do the same number of repetitions.
These exercises should be performed 3 times a day for 2 to 3 weeks. With a little luck, your TFL will be a bad memory. If not, it's time to take the next step:
- Practitioners
You've gone through all these steps without success. Is your TFL still getting in the way? In that case, you'll have to turn to a different practitioner. Here again, reasoning is key.
As we've said many times before, this TFL is a biomechanical problem. With this in mind, I think that after seeing your sports doctor. The most interesting thing would be to go to an osteopath who will rebalance your body and mind. Here again, you'll need to find out who your osteopath is, as there isn't just one osteopath but several.
If the problem persists, I think a more in-depth study of your problem will be necessary, and podiatrists and physiotherapists will become your best friends! And don't forget acupuncture, which has worked wonders for some of my acquaintances.
In conclusion
This syndrome is truly one of the most frustrating in a runner's life. Acting sensibly and systematically seems to me to be the best way of overcoming it.
Personally, my protocol boils down to a little stretching and strength training when the pain kicks in, but again, everyone will be different. And don't forget that your running technique can also play a role.
I hope, however, that you will find some of the ideas in this article useful.
Sources :
- http://www.lumen.luc.edu/lumen/meded/grossanatomy/dissector/mml/tfl.htm
- http://www.etudiant-podologie.fr/index.php/fiches/106-anat-physio/550-anatomie-et-physiologie-du-deltoide-fessier-et-du-tractus-ilio-tibial-bandelette-ilio-tibiale
Thank you for this excellent article. I felt a pain on the outside of my knee yesterday when I came back from the Transmolignée and I immediately thought "oh no, not that filthy windshield wiper syndrome". For now, rest, stretch and lots of water, as you recommend!
Take care of yourself! Don't hesitate to do a little resistance work, it works wonders in my house 😉
Your article is more than interesting, I've been suffering from this pain for more than two months, knowing that I started running at the beginning of June, the TLF quickly caused me problems, after 1 week of rest, ice, Mobilisin cream and stretching, training sessions are going better even if I feel a slight discomfort after 6 km, but much less painful than two months ago, I hope that now it's for the better. Thank you for sharing your experience.
I personally have this problem. The solution that seems to be working so far is shock waves from a physiotherapist who specializes in sports and who has his practice in the club of the former tennis world N°1. Some physiotherapists are not in favor of shock waves, but personally, after 18 sessions, I'm forced to admit that they work. Not all physiotherapists have this equipment because it's expensive and that's why this solution isn't widely known. The osteopath also seems to me a good solution, if the osteopath knows the problem. And I have no solution to find this pearl. When will there be a search directory with specialists and their pathologies, listing all professionals according to their specialties and geolocatable of course?
Hi, most of us are runners... so we jump, we leap, we land more or less well.... And many of us have a rather lanky build. Our bones are constantly moving. And sometimes gets stuck. Almost all of us have suffered from low back pain. But did you know that our fibula moves too? The forearm and lower leg have the same structure. A fixed bone and another that "moves". The tibia is the fixed link between the knee and the ankle. The fibula, on the other hand, can move upwards when subjected to stress. And, finally, I come to our subject, support on the TFL. The high "point" of the fibula suddenly starts rubbing against the TFL, causing discomfort and then pain. Ask your osteopath to teach you how to put your fibula back in place. Alternatively, try placing your hand behind your knee in an upright position, then doing the same as for stretching the quadriceps (the pink flamingo) in a fairly active way. If you hear a little "clack", the fibula is back in place.
I've been doing this for years, even while running.
Thank you so much for this article!
I've done quite a few tests, but not the one of resorting with neutral shoes, or muscling ischios/quads. Fingers Crossed 🙂
So this TFL is gone? 😉
Hello, since 20/09/16, following a semi where I had prepared poorly (I never did more than 12km) I felt this pain ... awful, impossible to go down the stairs etc ... it started with the left knee then the right. So I rested and tried to run again, but the pain returned after a km. The doctor put me on anti-inflammatories and gave me an ultrasound scan, but I couldn't see anything. I saw an osteopath who put my fibula back in place, and I was able to run 7kms on a treadmill without any pain. I tried running outside again today and both knees hurt and now it's again very difficult to go down the stairs and walking is painful. Back to osteo this afternoon and Kobe tomorrow, he talked to me about physiotherapy. Do you have any other ideas? I can't take it anymore and I wanted to do a half relay in April...
Thanks a lot! Any help is welcome!
Test quad strengthening. As soon as possible, stretch your leg and hold for 1-2 minutes, then release. Do this for 2-3 weeks with gluteal stretching 😉 You should see the difference.
Good evening, I'm going to start exercising! I saw a sports doc and it turns out that I lack quadriceps, ischios and adductor. So I need to strengthen and stretch my feet because I lack mobility.
Thanks for your advice!
Hello,
First of all I found the article good and complete. I had this problem during a run last August and I went to see an osteopath thanks to an article I put here(http://reflexosteo.com/le-syndrome-de-lessuie-glace/). It did me a world of good and I can now resume a normal sporting activity.
Hello,
A bit like Elisa, around the same time in fact, badly prepared semi (increase in km too fast, only 1 running workout a week, no stretching, no specific weight training, in short everything wrong).
I was diagnosed with TFL with bursitis (ultrasound), rest did nothing (I haven't run since, just light fitness).
I had an infiltration at the end of February. A horror, very painful for 3 days, impossible to walk normally for another 10 days, since then even walking hurts (after 15-20 min, or 15-20 sec when running).
The osteopath thought it was more than a simple TFL, so I went to see another sports doctor who sent me to a physiotherapist. The doctor + physio confirmed the TFL, musculature OK, everything pretty much OK, the physio even thought the TFL wasn't so critical.
Except that the pain is still there, and appears very quickly, even when walking.
What other pathologies could resemble TFL? I'm still convinced that the infiltration destroyed my knee...
PS: sorry for my desperate comment, this is not a medical blog... but if anyone has any ideas or similar experience. Thanks
PS: sorry for the desperate comment, this isn't a medical blog... But if anyone has any ideas or similar experience.
By the way, excellent site and your photos are magnificent.
Thank you very much Adeline, it's true that your case is problematic. I would advise you to see another osteopath, try acupuncture or other alternative medicine?
In the meantime, I had a 2nd appointment with the physio, who also came to the conclusion that it's not (just) a TFL. He's due to contact the sports doctor who sent me to him with his comments (meniscus to be checked, MRI, and my back too because it's not great, and one could lead to the other).
So I'm waiting for the rest, the physio seems competent, which is something.
If that doesn't help, I'm considering acupuncture.
Hello,
I have a rather similar problem and the TFL doesn't seem to be the only cause (I felt a slight crack when playing tennis and for 6 months I've had pain in the TFL slightly below the knee towards the outside).
Negative mri, negative ultrasound, physiotherapy, osteopathy, podiatry, ... nothing seems to make the pain go away.
I've been wearing orthopedic insoles for 3 weeks now.
Jogging, swimming, tennis... all cause pain to varying degrees.
Walking is not (too) much of a problem, but the discomfort is always there.
I'm going crazy.
Have you found a solution to your problem?
It went away on its own.
The day before my MRI, I ran to amplify the inflammation so that it would show up well on the image. The pain was unbearable that day, so I stopped for 2 minutes to explain to my husband that I wanted him to film me to show the physio/doctor what it looked like when I ran... And when I resumed running, miraculously the pain had disappeared.
The MRI still showed a very large inflammation (TFL) and a smaller one on the other side of the kneecap (tibio-peroneal joint I think).
The orthopedist's conclusion: my joint must have moved slightly (I'm hyperlax, which he thought might explain it) for no particular reason, and has now healed itself. I still have my TFL, but it doesn't bother me that much in comparison.
What helped to unblock the situation was when I localized the pain (on the side of the knee, like TFL, but lower, below the knee) because the diagnosis of TFL falls a little too easily I think...
Hello. I've been suffering from this injury since April 17 and I saw an osteo who told me that I have an imbalance of the pelvis and then I saw a podiatrist who put insoles in and I started to run and pooooof after 20 munites it comes back the pain. So I decided to stop running and change my sport completely.
Very good article, thank you, I'm going to try weight training and a new pair of shoes.
Inflammation is caused by the immune system, so you need to break down the inflammatory process.
Have you read my article? Did you understand it?
It doesn't seem to be. You've got the problem backwards. What's causing your inflammation? Perhaps you should look for the cause before doing infiltrations. If you're not osteopathically straight, if you have imbalances, your NSAID will only be a temporary palliative that won't solve the problem!
Hello, did your osteo straighten your pelvis? If he didn't, it's normal that you still have pain 😉 !
Honestly, do that! Before anything else indeed 😉
Hi, I've had a tfl since a 40 km run, I took 3 days off and then I started again with some fractional training, a bit violent, since then I've been bothered by this pain, but during my 40 km run I got an abused backache in my lumbar region, I'm going to see an osteo next week, I hope it will help.
I went to see a sports doctor who confirmed the tfl k I did physiotherapy and I did a recovery training session by increasing the running time which was good until 45 min then I did a 1h15 outing and the pain was back.
I'm banking everything on the osteo and keeping my fingers crossed.
Hello,
I too have this damn TFL syndrome. I used to feel pain sometimes after 25-minute sessions on my treadmill. I started running outside and it went away, then came back, of course. An MRI confirmed TFL on my left knee, so on my doctor's advice I stopped running for a month and a half, but the pain returned. At the beginning of January, I went to see a running specialist who sold me some new shoes. I didn't feel any pain at first, but I think I've compensated, since the pain has disappeared from the left knee and ended up in the right... I went to see an osteopath, but now it hurts even more than before... he recommended a podiatrist.... one of my last hopes, because today, after a 13km run, I can barely go down the stairs... Your exercise idea is great, but you'd need pictures, because when you're not an expert, it's not easy...!!!!
Hello,
I have a rather similar problem and the TFL doesn't seem to be the only cause (I felt a slight crack when playing tennis and for 6 months I've had pain in the TFL slightly below the knee towards the outside).
Negative mri, negative ultrasound, physiotherapy, osteopathy, podiatry, ... nothing seems to make the pain go away.
I've been wearing orthopedic insoles for 3 weeks now.
Jogging, swimming, tennis... all cause pain to varying degrees.
Walking is not (too) much of a problem, but the discomfort is always there.
I'm going crazy.
Have you found a solution to your problem?
I had made a long reply (with a lot of useless blabla I admit 🙂 ) which has disappeared.
In my case, everything went back to normal on its own, as if by magic (probably the joint which had moved slightly, and which recovered a long time later, probably due to the fact that I'm hyperlax, perhaps also the fact that I had compensated following my infiltration).
I still had to pinpoint the exact location of the pain for the medical profession to understand that it wasn't (just) a TFL, as they were a bit hasty in coming to that conclusion.
I'd advise you to sit back calmly and analyze the pain (where, when, how, why, description, intensity etc.), because it's only when I put my finger on it (literally) that they started looking elsewhere...
Good evening, I've also had the misfortune to have had a TFL, it must be two months now that I've been running very little, a few attempts here and there. I try to rest as much as possible (not easy, my job forces me to move all the time) and then stretch and use an ice pack when I can. The pain was very strong at first, then it's diminished a lot here, but it's still there and it's stagnating at this level. I don't feel like I'm progressing any further. I'm thinking of switching to shock waves with a doctor in my area. Have you already tried this method? What do you think?
hello , to answer jimmy (8 months later...), shockwaves are quite painful, 2000 or 3000 hammer blows in the tendon x 5 sessions, pain that doesn't last long after the session. But as far as I'm concerned, it's what cured my tendonitis.
Hello,
I've been suffering from windshield wiper syndrome for a year and a half now. I've tried everything. Physical therapy, stretching, muscle strengthening, mesotherapy, shock waves, infiltration, insoles, shoe changes, but nothing helped. I'm followed by a sports doctor. He tells me it's the shittiest injury there is. I still have bursitis in my knee and Tfl pain like sciatica. I can't run anymore. I do trail running. I'm desperate. I end up telling myself that I'll never be able to use it again. The pain is there every day when I go down the la4ches or if I walk too much during the day. I don't know what to do anymore because not running is really hard.
What does your sports doctor suggest?
I've resumed trail running with a 10minx1min walk x3 split if there's no pain, then I'll increase it to 15x1x3.
It wasn't bad until a 15km outing when I felt this damn pain and couldn't run downhill anymore .... I'm going to try osteo, because in my case I think something has moved, at least I hope so, but it's really hard not to be able to let go on outings, which is really frustrating.
In any case, I don't know if you've tried it, but I'd have changed doctors, physiotherapists and all that just to get another opinion and maybe some other tests.