INITIAL EVALUATION

General Information
Patient’s Initials: A.L.
Age: 27
Sex: F
Address: Pasig City
Civil Status: Single
Citizenship: Filipino
Handedness: Right
Occupation: Businesswoman - Vlogger
Religion: Roman Catholic
Referring Unit: The Medical City-Pasig
Referring Dr: Dr. A.G (Sports Doctor)
Rehab Dr: Dr. T.A (Rehab Doctor)
Date of Consultation: March 19, 2024
Date of Referral: March 19, 2024
Date of I.E.: March 19, 2024
Diagnosis: (R) Chronic Iliotibial Band Friction Syndrome (ITBFS)

History of Present Illness (HPI):

Present condition started ~6 mos.ago prior to PTIE, after signing up for the
upcoming duathlon event with 5k run, 20k bike, 2.5k run. Pt. starts to train intensely
thrice a wk. c 5k running and followed by 10k in cycling in preparation for the said event.
Pt. rarely had time to cool down or stretch after cycling and running d/t scheduled
meetings after pt.’s training.

~ 5 mos.prior to PTIE, a day after the duathlon event, pt. suddenly felt localized
dull aching pain on (R) lateral knee (PS 3/10) while sitting. Pt. applies cold packs on the
area and stretches pt.’s legs and thought it was d/t the past duathlon event. Pt.’s Sx
come and go for a few months and doesn’t bother the pt. to cont. doing activities such
as cycling and running thrice a wk.

~ 1 mo. prior to PTIE, when pt. accepted an invitation to join in two duathlon
events with two days of interval. On the first event c 20 kms laps to finish, pt. suddenly
felt a localized dull aching pain on (R) lateral knee (PS 5/10) while running down the hill.
Pt. didn't bother the Sx and was determined to finish the 10 kms remaining laps. After

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the pt. finishes all the laps, pt. applied cold packs, did a proper stretching, and rested
throughout the day and felt dull aching pain on (R) lateral knee (PS 4/10) while sitting .
On the second event c 30 kms laps to finish, during cycling of 10 kms, pt. starts to feel a
localized dull-aching pain (PS 6/10) on (R) lateral knee and hip in every pedal and
doesn’t go away even after pt. rest and stretches. Pt. was fully determined to finish all
the remaining laps despite the nagging pain. When pt. gets home, pt. applies cold packs
on it, stretches but for the rest of the day, pt. have difficulty descending the stair and
feels localized dull-aching pain on (R) lateral knee and hip (PS 7/10) when standing up
after driving pt. 's car. Pt.’s Sx persisted for several days, took a pain reliever and was
reduced by (PS 7/10-3/10) and decided to rest for a few weeks.

~ 1 week. prior to PTIE, when manually mopping the floor, pt. had difficulty and
felt weak upon moving legs into abduction and thought that the pt. needs to exercise
and it was d/t a few weeks of resting. Pt. decided to do some exercise and try to ride pt.
's bike and still, pt.’s felt a localized dull-aching pain (PS 7/10) on (R) lateral knee and
hip upon pedaling becomes worse. Pt. applied ointment for pain relief and took a pain
reliever (PS 7/10-4/10) and decided to rest from cycling and running for a bit.

At present, pt.’s Sx such as weakness of (R) hip abductors, and localized

dull-aching pain on (R) lateral knee and hip cont. to persist and worsen (PS 8/10) during
ADLs and IADLs such as LE dressing, manual mopping, descending stairs, upon
standing up, cycling, and running and (PS 6/10) at rest. Pt. decide to seek consultation
at The Medical City-Pasig from Dr. A.G. Pt. underwent physical examinations (ST: Noble
Compression Test) to rule in. Dr. A.G medically diagnosed the pt. c (R) Iliotibial Band
Friction Syndrome- Chronic Stage and was given a higher dose of pain reliever, and
immediately referred the pt. to PT for initial evaluation and treatment program.

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PRESENT MEDICATIONS
Drug Name Indication Dosage Frequency/Mode of
Transmission
Diclofenac gel pain (as needed) - tid, topical
(Voltaren)
Naproxen pain 250mg bid, oral
(Nasporyn)

PMHx
➢ (-) Hospitalization
➢ (-) DM
➢ (-) HTN
➢ (-) Surgery
➢ (-) Trauma
➢ (-) Cardio dse
➢ (-) Pulmo dse

FMHx

MATERNAL PATERNAL

DM - -

HTN + -

OA - -

CARDIAC CONDITIONS - -

PULMONARY - -
CONDITION

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PSEHx:
➢ Pt. has type A personality, pt. is competitive, achiever and physically active
➢ Pt. has active lifestyle
➢ Pt. has a balanced diet of protein and vegetables
➢ Pt. is a non-smoker
➢ Pt. is non-alcoholic
➢ Pt. is financially stable

Work/Home Situation
➢ Pt. lives in a 2-storey concrete house
➢ Pt. lives together c parents
➢ Pt. bedroom is located on the 1st floor
➢ Main door is ~ 5m away from the bedroom
➢ Bathroom is ~ 2m away from the bedroom

SUBJECTIVE:
______________________________________________________________________
Pt. c/c: Pt c/o localized dull aching pain & weakness on her ® lateral knee & hip during
performing ALDs & IADLs such as lower extremity dressing, descending stairs, sitting at
rest, standing up & doing duathlon.

Pt’s Goal: Pt wants to improve strength on her ® hip & eliminate pain on her ® lateral
knee & will be able to perform ADLs & IADLs such as descending stairs, sitting,
standing up & able to go back to duathlon.

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OBJECTIVE:
______________________________________________________________________
Vital Signs

A DURING P
BP 120/80 mmHg 120/80 mmHg 115/70 mmHg
PR 73 bpm 85 bpm 75 bpm
RR 14 cpm 18 cpm 16 cpm
Temp. 36.5 °C 36 °C 36.4 °C
Findings: All VS are WNL
Significance: For baseline purposes and precaution for assessment & treatment.

Ocular Inspection
➢ Amb s AD
➢ A/C/C
➢ Mesomorph
➢ (+) Antalgic Gait
➢ (+) Genu Valgum
➢ (+) Pes Planus
➢ (+) Knee Support on ® knee
➢ (+) Postural Dev.
➢ (-) Swelling
➢ (-) Erythema
➢ (-) Atrophy

Palpation
➢ Normothermic on all exposed parts including the ant and posterior of the
neck,forearm, wrist and hand, (L) knee and hip, except hyperthermic on the ®
knee
➢ (+) Grade 2 Localized tenderness on the lat. femoral condyle of the ® knee
➢ (+) Crepitus
➢ (+) mm tightness ® LE
➢ (+) mm guarding ® LE
➢ (+) mm spasm
➢ (-) Contractures
➢ (-) Dislocation

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SPECIAL MEASUREMENTS

ROM
All joints of (B) UE/LE are WNL, actively and passively done in pain free with
Normal End feel, except for the following:
Diff
Joint (N) AROM PROM ACTIVE PASSIVE
Motion Value End-Feel
(R) (R) (R) (R)

Hip
0-20° 0-10° 0-20° 10° 0° Firm
Extension

Hip
0-20° 0-5° 0-10° 15° 10° Firm
Adduction

Hip
External 0-45° 0-35° 0-45° 10° 0° Firm
Rotation

Hip
Internal 0-45° 0-35° 0-45° 10° 0° Firm
Rotation

Knee
0-135° 0-105° 0-135° 30° 0° Empty
Flexion
Findings: Pt. has ↓ AROM in the (R) hip & knee d/t pain & weakness. Also, pt. exhibits
LOM in her (R) hip add d/t muscle tightness.
Significance: Findings may affect pt.’s ability to perform lower extremity dressing,
ascending & descending stairs, sitting, standing up, & doing duathlon.

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MMT

Grading
Grade Percentage Description
Complete ROM against gravity with maximum
5 Normal 100%
resistance
Complete ROM against gravity with some (moderate)
4 Good 75%
resistance
3+ Fair Plus Complete ROM against gravity with minimal resistance
3 Fair 50% Complete ROM against gravity
3- Fair Minus Some but not complete ROM against gravity
2+ Poor Plus Initiates motion against gravity
2 Poor 25% Complete ROM if gravity is eliminated
2- Poor Minus Initiates motion if gravity is eliminated
1 Trace Slight palpable contraction
0 Absent No palpable contraction

All major muscle groups on (B) UE & (L) LE are grossly graded 5/5 except for the
following:
Muscle Group GRADE
Hip Extensor 4/5
Hip Adductors 3/5
Hip Internal Rotators 4/5
Hip External Rotators 3/5
Knee Flexors 4/5

Findings: Pt. has decreased mm strength (4/5) on ® hip and knee d/t weakness of ®
hip extensors, internal rotators and knee flexors and (3/ 5) on ® hip adductors and
external rotators d/t mm tightness.
Significance: Findings may affect the Pt.s ADLs such as descending stairs, cycling
down the road, running on the long distance d/t pain and weakness.

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SPECIAL TEST

Name of Test Procedure Findings Significance

Ober’s Test The pt. is in the side lying (+) leg remain R/I tight, contracted
position c the lower leg flexed abducted or inflamed Tensor
at the hip & knee for stability. Fasciae Latae
The examiner then passively (TFL) and Iliotibial
abducts & extends the band (ITB)
patient’s upper leg c the knee
straight or flexed to 90°

Noble The patient lies supine, and (+) pain R/I Iliotibial Band
Compression the knee is flexed to 90° Syndrome
Test accompanied by hip flexion.
The examiner then applies
pressure with the thumb to
the lateral femoral epicondyle
or 1 to 2 cm (0.4 to 0.8 inch)
proximal to it. While the
pressure is maintained, the
patient slowly extends the
knee

GAIT ANALYSIS
Reference Leg: R

Phases of Gait Hip Knee Ankle

IC inc abd N N

LR Inc abd Dec flex N

MSt N N N

TSt N N N

PSw stance phase N Dec flex N

Isw dec flex Dec flex N

MSw dec flex Dec flex N

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 TSw swing phase dec flex N N

Findings: Pt presents with inc abd, dec flexion and dec knee flexion on most motion it
may be classified as antalgic gait. Pt. presents with dec stride length, shorter stance,
and shorter swing on unaffected side in finishing the gait cycle.
Significance: Pt present c antalgic gait that can affect with amb. Tx should incorporate
on managing pain and strengthening on mm during amb.

ADD POST DEV.

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OUTCOME MEASURE TOOL:
Lower Extremity Functional Scale

SCORE: 25 / 80
0 = Very low function, 80 = very high function

Minimum Level of Detectable Change: 9 points (a change of more than 9 points

represents a true change in the patient's condition)

Significance: The pt scored higher than 9 points, indicating that there is a functional
change. With 25 points, the patient falls under low to moderate function which indicates
that pt condition can be improved as pt. progresses with tx.

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Y Balance Test of the Lower Quadrant (YBT-LQ)

Affected leg standing (R) Unaffected leg standing (L)

x̄ of 3 trials x̄ of 3 trials

Anterior 48cm 56 cm

Posterolateral 40 cm 48 cm

Posteromedial 32 cm 44 cm

Composite reach score of ≥90-95% - sufficient ability of the player to return to their
sport.
Composite reach score of <89% - high risk for injury.

ASSESSMENT:
______________________________________________________________________
PT Diagnosis: Pattern 4E: Impaired joint mobility, Motor Function, Muscle Performance
and Range of Motion Associated with Localized Inflammation.

PT Impression:
Pt. was dx c ® Chronic Iliotibial Band Friction Syndrome (ITBFS) manifested c
LOM & weakness on ® hip & knee, along c pain graded 7/10 during ADLs & IADLs &
graded 5/10 at rest on ® lateral knee. Upon palpation, pt has grade II tenderness on ®
lateral knee, mm guarding of ® lateral knee d/t presence of pain, mm tightness, &
crepitus. Pt presents c pes planus on ® foot, antalgic gait manifested by inc abd, dec
flexion and dec knee flexion on most motion having dec stride length, shorter stance,
and shorter swing on unaffected side in finishing the gait cycle, & genu valgum. Pt’s
ROM showed LOM on hip & knee mm d/t presence of pain & tightness. Pt’s MMT
presents with 3+ & 4 on knee & hip mm d/t presence of pain & weakness having
difficulty in performing ADLs & IADLs that involve the LE such as putting on pants,
doing household chores, ascending & descending stairs, running & cycling. ST showed
(+) on Obber’s test & noble compression test which indicates (+) for ITBS. LEFS
showed a score of 26/80 which falls under low to moderate function which indicates that
pt can be improved and progress c Tx. should include management of pain on ® lateral
knee to further progress to stretching of tight mm on ® LE, strengthening of ® LE, &
reintroduction to previous done activities by pt such as running & cycling.

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Rehab Potential:
Pt. has good prognosis as nonsurgical treatment is needed c high success rate c
most pt. had complete symptoms relief and able to return to activity within 6-8
weeks (Hadeed & Tapscott, 2023). Furthermore, there is no atrophy and
contractures and early intervention was given.Pt. is cooperative and is willingly to
reduce or eliminate exacerbating activities such as cycling and running for pt.’s
faster recovery.
Problem List:
1. Pt. presents c LOM on ® lateral knee and ® hips towards ADD, IR, and ER
2. Pt. presents c localized dull-aching pain (PS 5/10 @ rest & 7/10 @ mvt.) on ®
lateral knee and ® lateral hip.
3. Pt. presents has ↓ mm strength on ® hip towards extension and internal
rotation, and on ® knee towards flexion (Grade 4/5) and on ® hip towards
external rotation and adduction on MMT
4. Pt. has difficulty upon performing ADLs and IADLs such as LE dressing,
descending stairs, running and cycling
STG:
In 2 weeks of PT session,
➢ Pt will be able to have a decrease of pain in (R) knee from 7/10 to 3/10 within 8
PT sessions.
In 4 weeks of PT session,
➢ Pt will be able to have an increased ROM by 10 deg in extension, abduction,
and external rotation of the hip and flexion of the knee, in 10 PT sessions.
➢ Pt will be able to improve ® LE mm strength from 4 to 5 in 12 PT sessions.
LTG: [3x/wk. in 2 mos(24)]
Rehabilitative
➢ Within 24 PT sessions, pt will no longer present c pain on ® knee
➢ Within 20 PT sessions, pt will have a significant increase on ROM in EXT, ABD
and ER of the hip, and FLEX of the knee.
➢ Within 24 PT sessions, pt. (R) LE mm pt will have a significant inc on LE strength
which will decrease any difficulty and return to normal ADL’s such as dressing,
long-walking, etc.
Preventive
➢ Within 22 PT sessions, pt. will acquire sufficient knowledge on progressing and
fortifying her newfound strength in her ITB and prevent further LE-related injuries
from occurring.

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Participative
➢ Within 24 PT sessions, pt. will be able to return to cycling and running.
➢ “ “, pt. will be able to do heavier tasks around the home and at work.
➢ “ “, pt. will be able to perform complex maneuvers to avoid accidents and protect
other participants in her sport, and field of work.
➢ “ “, pt. will be able to enjoy recreational activities such as travelling with friends
and family.

PLAN:
______________________________________________________________________
PT Mx:
1. Pain Management
a. Continuous Ultrasound on lateral aspect of the thigh, along ITB x 8 mins x
to dec pain & promote tissue healing
b. HMP c tens on ITB x 15-20 mins to dec pain & promote tissue healing
c. Myofascial Release using foam roller as tolerated to dec pain & improve
tissue mobility
2. Stretching
a. Supine stretch of ITB x 30sh x 3 reps x 2 sets x 1-2 mins rest interval to
inc flexibility
b. Figure of 4 stretch x 30sh x 3 reps x 2 sets x 1-2 mins rest interval to inc
flexibility of hip abd & hip ER
c. ITB stretch on wall x 30sh x 3 reps 2 sets x 1-2 mins rest interval to inc
flexibility of hips
3. Strengthening
a. Resistance band exercise towards hip abd x 10 reps x 3 sets x 1-2 mins
rest interval to strengthen hip abductors
b. Clam Shell Exercise x 10 reps x 3 sets x 1-2 mins rest interval to
strengthen hip external rotators
c. Glutes bridging exercise x 10 reps x 3 sets x 1-2mins rest interval to
strengthen hip extensors
d. Hamstring curls x 10 reps x 3 sets x 1-2 mins rest interval to strengthen
knee flexors
4. Functional
a. Forward step up exercise x 10 reps x 3 sets x 1-2 mins rest interval to
strengthen LE

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 b. Stationary Bike x 10 mins to strengthen LE and reintroduce to previous
activity
c. Walking and running on treadmill x 10 mins to strengthen LE and
reintroduce to previous activity and improve biomechanics
Home Instructions/ Education
1. Pt is able to understand the ITB and it’s function in hip and knee movement
2. Pt is able to understand the nature of ITBS
3. Pt is advised to reduce activities that aggravate pain such as long distance
running and cycling to allow healing
4. Pt is advised to do gentle stretches of the ITB & surrounding muscles
5. Pt is advised to do self-massage techniques using a foam roller to maintain
flexibility
6. Pt is advised using proper footwear with a good arch support and cushioning
during running
7. Pt is advised to gradually progress activities as pain improves and to avoid
complications of the injury

Home Exercise Program

1. Self stretching on hip ext, hip abd, hip ER, knee flex, knee ext
2. Piriformis stretch 30sh x 10 reps x 2 sets
3. Wall squats 10 reps x 2 sets

Suggested PT Mx:
1. Shoe inserts prescribed for foot orthosis to support arch for LE pain
2. Sit to stand exercise 10 reps x 3 sets
3. Manual resistance of towards the ff to improve strength 10 reps x 3 sets
a. Hip ext, hip abd, hip ER, knee flex, knee ext.

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PREPARED BY:

EVANGELISTA, FRANCHESCA MAE

GONZALES, MARI KRISTINE

LUCOT, CRESSA ASHLEY

LUY, WILLIAM AXELLE

MATEO, JULIAN MATHEW

PILON, PHILLIP

PUGAT, PAUL NEHEMIAH

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