The tract syndrome is classified according to cause, location, and course:

1. **By cause:**

- **Mechanical:** Overload due to repetitive movements, e.g., running or cycling.

- **Biomechanical:** Misalignments or imbalances in the musculoskeletal system.

2. **By location:**

- **Lateral tract syndrome:** Irritation in the area of the lateral knee joint.

- **Proximal tract syndrome:** Rarer, with complaints in the hip joint area.

3. **By course:**

- **Acute:** Sudden onset of symptoms after intense exertion.

- **Chronic:** Long-lasting symptoms due to repeated overload.

The tractus syndrome is caused by friction of the iliotibial band on the lateral femoral condyle. The causes are often mechanical or biomechanical:

• Mechanical overload:
  • Repeated flexion and extension of the knee, e.g., when running, cycling, or hiking.
  • Increase in training volume without sufficient adaptation of the body.
• Biomechanical factors:
  • Misalignments such as knock-knees or foot misalignments (e.g., flat feet).
  • Muscle imbalances, especially weakness of the hip or thigh muscles.
  • Shortening of the iliotibial band due to lack of stretching or mobility.
• External factors:
  • Running on uneven terrain or sloped tracks.
  • Improper running technique or improperly fitted shoes.

The symptoms typically occur during or after exertion and include:

• Pain: Sharp or burning pain on the outside of the knee, often intensified by activities such as running or climbing stairs.
• Tenderness: Sensitivity to pain over the lateral femoral condyle.
• Movement restrictions: Discomfort when bending or extending the knee.
• Sensation of friction: Some affected individuals report a noticeable "snapping" or rubbing of the iliotibial band.
• Activity dependence: The symptoms increase with rising activity and improve during rest periods.

The diagnosis is made through medical history, clinical examination, and, if necessary, imaging techniques:

• Medical history:
  • Collection of training habits, stress patterns, and symptoms.
• Physical examination:
  • Palpation of the lateral knee area to determine tenderness.
  • Functional tests such as the Ober test or the Nobel test, which may provoke the symptoms.
• Imaging:
  • Ultrasound: Visualization of inflammation or thickening of the iliotibial band.
  • MRI: To assess soft tissue changes or to rule out other causes of knee pain.

Conservative Therapy

In most cases, the tractus syndrome is treated conservatively:

• Relief and adjustment of load:
  • Reduction or temporary avoidance of strenuous activities.
  • Adjustment of the training plan, e.g., by shorter running distances or alternative sports like swimming.
• Physiotherapy:
  • Stretching exercises for the iliotibial band and surrounding muscles.
  • Strengthening exercises for the hip and thigh muscles.
  • Fascia rolling for loosening and relaxing the iliotibial band.
• Medication therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Local injections of corticosteroids for persistent complaints.
• Manual therapy:
  • Mobilization of affected structures and correction of biomechanical misalignments.
• Cryotherapy: For acute pain reduction and swelling.

Surgical Therapy

In therapy-resistant cases or chronic complaints, surgery may be considered:

• Fasciotomy: Surgical splitting of the iliotibial band to reduce pressure on the lateral femoral condyle.
• Post-treatment: Physiotherapy to restore mobility and muscle strength.

The following measures are suitable for preventing tract syndrome and avoiding relapses:

1. Targeted training: Strengthening the hip and thigh muscles to improve stability.
2. Stretching exercises: Regular stretching of the iliotibial band and surrounding structures.
3. Running technique: Optimization of technique and use of appropriate running shoes.
4. Load adjustment: Gradual increase in training intensity and avoidance of overloading.
5. Ergonomic training: Avoidance of sloped paths and unilateral loads.