Nobles Test

Lateral knee pain.

Nobles test, chiropractic help, ilio tibial band syndrome.

This orthopaedic manoeuvre is used to assess lateral knee pain especially in the absence of trauma for athletes, cyclists, and the general public.

The iliotibial band, or ITB, is a broad tendon that runs from the Tensor Fascia Lata muscle on the side of the upper thigh and pelvis, and has its insertion just below the outer side of the knee.

Repeated flexion of the knee, as in running and cycling, may cause a friction syndrome between the ITB and the lateral femoral condyle. It is in essence a tendonitis not unlike say tennis elbow.

There is tenderness just proximal to or higher than the lateral knee joint, where the tendon may rub over the femoral condyle, causing pain and sometimes swelling. Tests for the meniscus and the ligaments will be negative. The definitive test for this condition is Nobles test. Your chiropractor will place his thumb over the side of your knee and, whilst repeatedly flexing the joint, will look for a painful nodule in the ITB. She or he will compare the two knees, as it's a tender spot even in the normal knee.

Ilio tibial band syndrome

Should Nobles test be positive, it always wise also to examine the sacroiliac joint, and also look for signs of an old ankle sprain and foot pain. It's not unusual for the ilio tibial band syndrome to be a symptom of some other condition, rather than the primary condition causing the upper leg and knee pain. A short leg should also be considered; it's the underlying cause of so many leg and back problems. Authorities disagree on how many millimetres difference should be considered a leg length inequality. I've found that even five millimetres can make a significant difference.

If all the extremity tests are negative, the hip should also be carefully examined, as hip pathology often refers to the knee. Femero acetabular impingement syndrome is a condition not infrequently found in young athletes, and the presenting syndrome could be pain elsewhere, as in the ITB.

So too, Meralgia Paresthetica should be considered as it causes pain and or numbness on the side of the thigh.

Nobles Test


Last, and not least, we are assuming this is not a pinched nerve in the spine or buttock in which the classic Straight Leg Raise test of LASEGUE with a positive Braggard's test will be positive, and the more useful Slump test since it can be done at home by you the patient. A piriformis syndrome too, of course, can cause pain in the upper leg. Use the search function in the navigation bar to find our more about these tests.

Usually a sciatica will have associated LBP but this is not always the case. When the disc prolapses into the intervertebral foramen, or beyond, there may be minimal back pain, but there is a severe aching pain in the leg that may confuse the clinician, causing him to think of a muscular problem in the lower limb.

On a quite different tack, unrelated really, but are you ever at your wit's end when it comes to a gift for a friend or family member? Or perhaps your best friend's spouse or mother has died, and you simply don't know what to say or do. Then think about giving a memorial tree. It makes a lovely birthday present too, of course.

Chiropractic help

Noble's test confirms a classic tendonitis; given time, rest and chiropractic help virtually all cases will resolve satisfactorily.

The difficulty is with the athlete who wants to continue his sport during treatment; then any form or care, chiropractic help or other is likely to be difficult.


There are few more kind and charitable things to be done after the loss of a loved one; giving of a tree, and offering to dig the hole and plant it, can serve to remind your friend or relative of their loss in a positive way. 

Choosing the right tree of course is important; was he crazy about making salads for example? Then the giving of a lemon tree would have much merit. 

Your friend might even choose to bury their loved one's ashes among the roots of the tree. My own mother is buried under a yellowwood tree in our garden; I often imagine her peeping out from amongst the branches. She adored the garden.

Adding lemon juice to a salad becomes a daily exercise of picking fresh fruit. I becomes a ritual of honouring the loved one; a fond memory. 

You of course will probably choose a quite different tree, or plant; spend some time thinking about which would be most appropriate. Don't you love gifts that you know were lovingly chosen and give daily pleasure?

A lemon just happens to be a relatively small tree that adds so much by way of scent, colour and health to the garden. In a pot it can be brought in doors for the worst of the winter.

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Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.

Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?

Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.

You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.