Iliotibial Band Syndrome Research Articles

The effect of three-dimensional postural change on shear elastic modulus of the iliotibial band

To understand and treat iliotibial band (ITB) syndrome, caused by excessive compression between the ITB and lateral femoral condyle, it is important to identify factors contributing to an increase in ITB stiffness. The purpose of this study was to clarify the factors that contribute to an increase in ITB stiffness by examining the relationship between three-dimensional postural changes and ITB stiffness. Fourteen healthy individuals performed one-leg standing under 7 conditions (including normal one-leg standing as a control condition) in which the pelvic position was changed in three planes. The shear elastic modulus in the ITB was measured using shear-wave elastography, as a measure of ITB stiffness. The three-dimensional joint angles and external joint moments in the hip and knee joints were also measured to confirm the changes in joint angles and external load. Compared to the normal one-leg standing condition, ITB stiffness was significantly increased in the pelvic posterior tilted position (i.e. hip extension), contralateral pelvic dropped position (i.e. hip adduction), and contralateral pelvic posterior rotated position (i.e. hip external rotation). The findings suggest that interventions to reduce hip extension, adduction, and external rotation might be useful if these excessive positional changes are detected in patients with ITB syndrome.

Does a new implant design with more physiological kinematics provide better results after knee arthroplasty?

BackgroundImproved knee kinematics is one of the major goals to obtain better satisfaction after total knee arthroplasty. This study examined whether a guided motion knee design improves functional outcome and satisfaction as compared to a conventional design. MethodsIn a retrospective manner, from January 2005 to December 2008, patients with two different kinematic TKA designs were enrolled. The 150 patients were divided into two groups: guided motion group (77) with kinematic design (Journey) and control group (73) with no kinematic design (LCS). All the patients had the same surgical technique and postoperative protocols. The functional and radiographic results were interpreted with the Hospital for Special Surgery (HSS) knee score and WOMAC score. ResultsAfter a mean follow-up of 84.2months, the guided motion group had higher mean postoperative range of motion (p=0.022), functional status in the WOMAC function subscale (p=0.002), but had higher residual pain in the WOMAC pain subscale (p=0.018 and p=0.013) and higher iliotibial band syndrome incidence (6.6% vs 0%; p=0.02). There were no significant differences in HSS score between the two groups. No differences were seen between groups in patient satisfaction in the WOMAC total score (p=0.46) and survival rate. ConclusionThe guided motion design can improve functional status according to WOMAC but not to HSS knee scores. Poorer pain scores and no higher patient satisfaction were observed with this kinematic design.

Anatomic Reconstruction of the Proximal Tibiofibular Joint

Proximal tibiofibular joint (PTFJ) instability can be easily missed or confused for other, more common lateral knee pathologies such as meniscal tears, fibular collateral ligament injury, biceps femoris pathology, or iliotibial band syndrome. Because of this confusion, some authors believe that PTFJ instability is more common than initially appreciated. Patients with PTFJ subluxation may have no history of inciting trauma or injury, and it is not uncommon for these patients to have bilateral symptoms and generalized ligamentous laxity. Currently, the optimal surgical treatment for patients with chronic PTFJ instability is unknown. Historically, a variety of surgical treatments have been reported. Initially, joint arthrodesis and fibular head resection were recommended. More recently, temporary screw fixation, nonanatomic reconstruction with strips of the biceps femoris tendon or iliotibial band, and reconstruction with free hamstring autograft have been described. The purpose of this report is to present our surgical technique for treatment of chronic PTFJ instability using an anatomic reconstruction of the posterior ligamentous structures of the PTFJ with a semitendinosus autograft.

Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome.

Although different conservative treatment options have been proposed, there is a paucity of research on the management of iliotibial band syndrome (ITBS) in runners. To compare two treatment protocols for ITBS; radial shockwave therapy (RSWT) and manual therapy (ManT). Both therapies were administered concurrently with an exercise rehabilitation programme. The study was designed as a randomised controlled clinical trial. Twenty-four runners with ITBS received 3 treatments at weekly intervals of either RSWT (n= 11) or ManT (n= 13). In addition, all subjects followed an exercise programme for at least 4 weeks. Main outcome measures were established as mean differences (MD) in pain during treadmill running. There was no significant difference in pain reduction between the two interventions at 4 weeks (p= 0.796), and 8 weeks (p= 0.155) follow-up. Thus, both groups reported similar magnitude of reduced pain during the intervention (p= 0.864). The shockwave therapy (SWT) group reported a 51% decrease in pain at week 4 (p= 0.022), and a 75% decrease at week 8 (p= 0.004). The ManT group showed a 61% reduction in pain at week 4 (p= 0.059), and a 56% reduction at week 8 (p= 0.067). RSWT and ManT were equally effective in reducing pain in subjects with ITBS.

Iliotibial Band Syndrome: What Does the Evidence Show?

Iliotibial Band Syndrome: What Does the Evidence Show?

Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review.

BackgroundIliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail. The aim of this systematic review is thus to provide an up to date quantitative synthesis of the trunk, pelvis and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance.MethodsAn electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible.ResultThirteen studies were included (prospective (n = 1), cross-sectional (n = 12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance.ConclusionFindings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.

Effect of hip and knee position on tensor fasciae latae elongation during stretching: An ultrasonic shear wave elastography study

BackgroundDecreased flexibility of the tensor fasciae latae is one factor that causes iliotibial band syndrome. Stretching has been used to improve flexibility or tightness of the muscle. However, no studies have investigated the effective stretching position for the tensor fasciae latae using an index to quantify muscle elongation in vivo. The aim of this study was to investigate the effects of hip rotation and knee angle on tensor fasciae latae elongation during stretching in vivo using ultrasonic shear wave elastography. MethodsTwenty healthy men participated in this study. The shear elastic modulus of the tensor fasciae latae was calculated using ultrasonic shear wave elastography. Stretching was performed at maximal hip adduction and maximal hip extension in 12 different positions with three hip rotation conditions (neutral, internal, and external rotations) and four knee angles (0°, 45°, 90°, and 135°). FindingsTwo-way analysis of variance showed a significant main effect for knee angle, but not for hip rotation. The post-hoc test for knee angle indicated that the shear elastic modulus at 90° and 135° were significantly greater than those at 0° and 45°. InterpretationOur results suggest that adding hip rotation to the stretching position with hip adduction and extension may have less effect on tensor fasciae latae elongation, and that stretching at >90° of knee flexion may effectively elongate the tensor fasciae latae.

Musculoskeletal injuries in British Army recruits: a prospective study of diagnosis-specific incidence and rehabilitation times

BackgroundMusculoskeletal injuries during initial military training are a significant medical problem facing military organisations globally. In order to develop an injury management programme, this study aims to quantify the incidence and rehabilitation times for injury specific diagnoses.MethodsThis was a prospective follow-up study of musculoskeletal injuries in 6608 British Army recruits during a 26-week initial military training programme over a 2-year period. Incidence and rehabilitation times for injury specific diagnoses were recorded and analysed.ResultsDuring the study period the overall incidence of musculoskeletal injuries was 48.6%, and the most common diagnosis was iliotibial band syndrome (6.2%). A significant proportion of the injuries occurred during the first 11 weeks of the programme. The longest rehabilitation times were for stress fractures of the femur, calcaneus and tibia (116 ± 17 days, 92 ± 12 days, and 85 ± 11 days, respectively). The combination of high incidence and lengthy rehabilitation indicates that medial tibial stress syndrome had the greatest impact on training, accounting for almost 20% of all days spent in rehabilitation.ConclusionWhen setting prevention priorities consideration should be given to both the incidence of specific injury diagnoses and their associated time to recovery.

Comparison Of Running Mechanics In Healthy Versus Injured Runners With Patellar Tendonitis

Recent studies focused on running biomechanics and correcting its flaws to treat common running injuries such as iliotibial band syndrome, anterior knee pain, and patellofemoral pain syndrome. However, there have been no studies identifying specific biomechanical measures that may predispose athletes to patellar tendonitis (PT). PURPOSE: To compare running biomechanics between healthy and injured runners with PT. STUDY DESIGN: Case-control study. METHODS: Running video images of healthy and injured runners were taken between January 1, 2010 and October 31, 2013, and a total of 40 treadmill running videos (14 males and 26 females) were extracted. A group of 20 runners with PT (7 males and 13 females) was compared with gender, age, and BMI matched healthy control runners. The video image sequences were randomized and analyzed by a single examiner using software ImageJ, and the examiner was blinded from the randomization process and statistical analysis. Extracted biomechanical data include foot strike pattern, overstride angle, trunk posture angle, hip drop angle at mid-stance, knee position (varus, valgus), knee angle at mid-stance, and mid-stance foot position (pronate, supinate, neutral). Those variables were compared between runners with PT and healthy control runners. An independent t-test was performed to compare a statistical significance between the two groups. Alpha level was set at 0.05 priori. RESULTS: Healthy control runners demonstrated a 2.3° greater hip drop angle (6.0° ± 2.6°) on ipsilateral hip during the mid-stance of treadmill running compared to runners with PT (3.7° ± 2.4°, p=0.01). Also, the runners with PT showed 2.3° increased knee valgus angle (-0.7° ± 4.0°) compared to healthy control runners (1.6° ± 4.1°, p=0.04). There were no significant differences in other mechanical variables between the two groups. Additionally, the runners with PT were collectively significantly taller (172.3 cm ± 9.8) than the healthy control runners (164.0 ± 8.5 cm, p=0.01). CONCLUSIONS: There is a significant difference between knee angle and hip drop angles at mid-stance during treadmill running as well as average height between healthy control runners and runners with PT.

The Dilemma of Knee Osteoarthritis and Iliotibial Band Syndrome

In the majority of cases, acute exacerbation of lateral knee pains is associated with medial joint collapse and varus deformity in the absence of any joint effusion. In the elderly, this is usually associated with difficulty in walking and performing activities of daily living. However, in younger age-groups and athletes, this is usually as a result of extra-articular manifestations. This is primarily due to tight iliotibial band syndrome associated with chronic muscular spasm due to magnesium deficiency and long standing pains. Treatment of the underlying cause (primarily iliotibial band syndrome) of the lateral and posterior knee pain would result in improvement in pain. For these patients, this would also result in improved walking ability. This paper argues that a considerable volume of patients are receiving inappropriate and unnecessary treatment due to inadequate history taking and examination. We argue that healthcare providers must be vigilant in patients with clinical and radiological signs of severe osteoarthritis.

Lateral knee pain requires a thorough assessment and adequate, best-practice intervention.

Dear Editor: The article “Treatment of Lateral Knee Pain Using Soft Tissue Mobilization in Four Female Triathletes” by Winslow in the September 2014 edition of IJTMB,(1) is a good example of a clinical report. As a physiotherapist and clinical researcher, I am interested in the clinical reasoning and interventions used by colleagues. The clinical study involved four triathletes who had lateral knee pain for more than seven months, and who had undergone prior conservative treatment by other health care professionals. Although the physical assessment and intervention were described and the results for all athletes were positive at completion, I think it is important to discuss the methodology and approach described in this clinical report. Although the author stresses the importance of “an accurate diagnosis, ruling out other common causes for lateral knee pain” (p.29), the presented information suggests the diagnostic screening was not comprehensive and inconclusive. Physical assessment comprised merely of single tests of knee ligaments, menisci, and hamstring and iliotibial band flexibility. Apart from the flexibility tests, no test results were presented. In the report (p.25, p.29) it reads that the athletes’ “lateral knee pain” was different from iliotibial band syndrome (ITBS). However, the location and severity of the pain experienced during treadmill running was similar to the pain typical for ITBS. Also, the soft tissue mobilization was largely targeted at the ITB. ITBS has a specific clinical presentation, and is often diagnosed by ruling out other pathologies, history taking, and a specific test,(2) such as Noble’s compression test.(3) However, no specific ITBS test was performed, or its results are lacking. Therefore, this report remains unclear with regard to the diagnosis at the time of initiating treatment. Functional assessment included “squatting and jumping” (p.27), but no results were presented. Treadmill running was performed to assess pain severity only. An extended value would be to evaluate ITBS-related factors such as running technique(4,5) and hip abductor weakness.(6) That a more thorough assessment (of both body structures and active functioning) for accurate diagnosis is preferred, is highlighted by the finding that one patient was left undiagnosed from meniscal problems for more than four weeks (p.29). The intervention consisted of instruction “to abstain from all physical activity” and “soft tissue mobilization only” (p.28). This intervention seems not an evidence-based or best-practice approach.(2,7–9) To instruct triathletes to abstain from all physical activity for four weeks is not reflective of best-practice. Cardiovascular fitness and other athletic ability will reduce significantly, and other sports including swimming (with no pushing off the wall with the affected leg) might be possible while recovering from lateral knee pain problems. Soft tissue mobilization I do support when required, but it might be limited as a sole intervention. Soft tissue techniques for ITBS are supported by evidence as part of the intervention,(2,7) but pain control, technique of and biomechanical factors in running and cycling, and involvement of the athlete in their recovery process by using adequate self-management strategies (for example, stretching, foam roller, muscle strengthening) should also be considered.(2,7) In responding to this clinical report, I hope to open discussion on the importance and usefulness of a comprehensive assessment to deduce the cause of the athlete’s problem and good clinical, reasoned interventions to treat athletes with lateral knee pain for a speedy, long-lasting return to their full training program.

Associations between iliotibial band injury status and running biomechanics in women

Iliotibial band syndrome (ITBS) is a common overuse knee injury that is twice as likely to afflict women compared to men. Lower extremity and trunk biomechanics during running, as well as hip abductor strength and iliotibial band flexibility, are factors believed to be associated with ITBS. The purpose of this cross-sectional study was to determine if differences in lower extremity and trunk biomechanics during running exist among runners with current ITBS, previous ITBS, and controls. Additionally, we sought to determine if isometric hip abductor strength and iliotibial band flexibility were different among groups. Twenty-seven female runners participated in the study. Participants were divided into three equal groups: current ITBS, previous ITBS, and controls. Overground running trials, isometric hip abductor strength, and iliotibial band flexibility were recorded for all participants. Discrete joint and segment biomechanics, as well as hip strength and flexibility measures were analyzed using a one-way analysis of variance. Runners with current ITBS exhibited 1.8 (1.5)° greater trunk ipsilateral flexion and 7 (6)° less iliotibial band flexibility compared to runners with previous ITBS and controls. Runners with previous ITBS exhibited 2.2 (2.9) ° less hip adduction compared to runners with current ITBS and controls. Hip abductor strength 3.3 (2.6) %BM×h was less in runners with previous ITBS but not current ITBS compared to controls. Runners with current ITBS may lean their trunk more towards the stance limb which may be associated with decreased iliotibial band flexibility.

Gender differences in gait kinematics in runners with iliotibial band syndrome.

Atypical running gait biomechanics are considered a primary factor in the etiology of iliotibial band syndrome (ITBS). However, a general consensus on the underpinning kinematic differences between runners with and without ITBS is yet to be reached. This lack of consensus may be due in part to three issues: gender differences in gait mechanics, the preselection of discrete biomechanical variables, and/or relatively small sample sizes. Therefore, this study was designed to address two purposes: (a) examining differences in gait kinematics for male and female runners experiencing ITBS at the time of testing and (b) assessing differences in gait kinematics between healthy gender- and age-matched runners as compared with their ITBS counterparts using waveform analysis. Ninety-six runners participated in this study: 48 ITBS and 48 healthy runners. The results show that female ITBS runners exhibited significantly greater hip external rotation compared with male ITBS and female healthy runners. On the contrary, male ITBS runners exhibited significantly greater ankle internal rotation compared with healthy males. These results suggest that care should be taken to account for gender when investigating the biomechanical etiology of ITBS.

Greater Trochanteric Pain Syndrome: An Update on Diagnosis and Management

Greater trochanteric pain syndrome (GTPS) is a common cause of extra-articular lateral hip pain. The underlying etiology of GTPS ranges from gluteus medius and minimus tendinopathy or tears, to external coxa saltans or iliotibial band syndrome. Historically, this source of lateral hip pain was typically diagnosed as trochanteric bursitis as it was believed to be due to inflammation of the subgluteus maximus bursa. However, recent imaging and histopathological studies have shown that most cases are instead due to underlying gluteus medius or minimus tendon disorders. Identifying the specific pain generator in GTPS is important as the treatment differs depending on the cause. Strengthening should be prescribed in cases of gluteal tendinopathy; corticosteroid injections and NSAIDs may be helpful in cases of primary bursitis; and surgery may be indicated in functionally limiting gluteal tendon tears unresponsive to conservative treatment.

The effect of angle and moment of the hip and knee joint on iliotibial band hardness

Although several studies have described kinematic deviations such as excessive hip adduction in patients with iliotibial band (ITB) syndrome, the factors contributing to increased ITB hardness remains undetermined, owing to lack of direct in vivo measurement. The purpose of this study was to clarify the factors contributing to an increase in ITB hardness by comparing the ITB hardness between the conditions in which the angle, moment, and muscle activity of the hip and knee joint are changed. Sixteen healthy individuals performed the one-leg standing under five conditions in which the pelvic and trunk inclination were changed in the frontal plane. The shear elastic modulus in the ITB was measured as an indicator of the ITB hardness using shear wave elastography. The three-dimensional joint angle and external joint moment in the hip and knee joints, and muscle activities of the gluteus maximus, gluteus medius, tensor fasciae latae, and vastus lateralis, which anatomically connect to the ITB, were also measured. ITB hardness was significantly increased in the posture with pelvic and trunk inclination toward the contralateral side of the standing leg compared with that in all other conditions (increase of approximately 32% compared with that during normal one-leg standing). This posture increased both the hip adduction angle and external adduction moment at the hip and knee joint, although muscle activities were not increased. Our findings suggest that coexistence of an increased adduction moment at the hip and knee joints with an excessive hip adduction angle lead to an increase in ITB hardness.

Running: how to safely increase your mileage.

Running: how to safely increase your mileage.

Greater Trochanteric Pain Syndrome: Frequency and Associated Factors in Patients with Stroke

Background: Greater trochanteric pain syndrome (GTPS) is a common cause of lower extremity pain and is estimated to affect between 10% and 25% of the population. Despite all the research, there are no data in the literature about GTPS in the stroke population. Objective: The aim of the study was to determine frequency and related factors of GTPS in patients with stroke. Methods: Eighty-six patients with stroke were recruited from an inpatient rehabilitation department. Presence or absence of lateral thigh or hip pain was recorded. All patients with stroke (with or without self-reported pain) were examined using clinical criteria for the diagnosis of GTPS. Results: Lateral thigh or hip pain was reported on initial interviews by 29 of 86 patients. GTPS was diagnosed by means of structured physical examination maneuvers in 17 patients with stroke and self-reported pain and 11 patients with stroke without self-reported pain. Twenty-eight patients (32.6%) had GTPS. The following factors were significantly associated with GTPS: lower extremity spasticity, depression, and iliotibial band syndrome. No correlation was found between GTPS and age, sex, lesion localization, motor status, neglect, sensory loss, time since stroke, low back pain, knee and hip osteoarthritis, or health-related quality of life. Conclusion: In this study, we showed that patients with stroke have a high percentage of GTPS. Early diagnosis and treatment of pain from GTPS are important in this population, because GTPS may limit applicability of motor training and affect rehabilitation outcomes.

Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury.

An explorative, 1-year prospective cohort study. Objective To examine whether an association between a sudden change in weekly running distance and running-related injury varies according to injury type. It is widely accepted that a sudden increase in running distance is strongly related to injury in runners. But the scientific knowledge supporting this assumption is limited. A volunteer sample of 874 healthy novice runners who started a self-structured running regimen were provided a global-positioning-system watch. After each running session during the study period, participants were categorized into 1 of the following exposure groups, based on the progression of their weekly running distance: less than 10% or regression, 10% to 30%, or more than 30%. The primary outcome was running-related injury. A total of 202 runners sustained a running-related injury. Using Cox regression analysis, no statistically significant differences in injury rates were found across the 3 exposure groups. An increased rate of distance-related injuries (patellofemoral pain, iliotibial band syndrome, medial tibial stress syndrome, gluteus medius injury, greater trochanteric bursitis, injury to the tensor fascia latae, and patellar tendinopathy) existed in those who progressed their weekly running distance by more than 30% compared with those who progressed less than 10% (hazard ratio = 1.59; 95% confidence interval: 0.96, 2.66; P = .07). Novice runners who progressed their running distance by more than 30% over a 2-week period seem to be more vulnerable to distance-related injuries than runners who increase their running distance by less than 10%. Owing to the exploratory nature of the present study, randomized controlled trials are needed to verify these results, and more experimental studies are needed to validate the assumptions. Still, novice runners may be well advised to progress their weekly distances by less than 30% per week over a 2-week period.

English

Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners. Runners typically complain of persistent lateral knee pain not associated with swelling, usually it occurs due to one to two miles of running and further worsening of the pain during running on the downhill. The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also increase. The Iliotibial track (ITT) or the band is an anatomical structure of the lateral upper leg that recently has been highly published as an overused structure during sports. A friction syndrome has been attributed to excessive distance running, inappropriate running regimens and worn footwear (1) . Hence we have taken up this study to study

Changes in Health-Related Quality of Life and Knee Function After Knee Injury in Young Female Athletes.

Background:Recent literature has called for greater attention to evidence-based practice in sports medicine with the documentation of overall status and impairments following injury. The prospective documentation of impairments associated with knee injuries in female athletes regarding their health-related quality of life (HRQoL) and knee function (KF) of high school and collegiate athletes is limited. Assessing the effect knee injuries have on young female athletes may allow clinicians to better understand the perspectives of the athletes who sustain these injuries.Purpose:To document the changes over 12 months in self-reported HRQoL and KF in young females who have sustained a knee injury.Study Design:Case series; Level of evidence, 4.Methods:A convenience sample of 242 females (mean age, 17.4 ± 2.4 years) who injured their knee participating in sport or recreational activities was utilized. Injuries were categorized as anterior cruciate ligament tears (ACL), anterior knee pain (AKP), patellar instability (PAT), meniscus tear (MNT), iliotibial band syndrome (ITB), collateral ligament sprain (COL), and other (OTH). HRQoL was assessed with the Short Form–12 v 2.0 survey (SF-12) physical component summary (PCS) and mental component summary (MCS). KF was assessed with the 2000 International Knee Documentation Committee survey (IKDC). Dependent variables included the paired differences in the 2000 IKDC as well as SF-12 composite scores from preinjury through 12 months postdiagnosis. Paired differences were assessed with repeated-measures analyses of variance (P ≤ .05).Results:IKDC scores were lower through 12 months for ACL, AKP, and PAT; through 6 months for MNT; and through 3 months for COL and OTH. HRQoL PCS and MCS scores were lower through 3 to 12 months depending on the type of injury classification.Conclusion:Knee injuries can negatively affect KF and HRQoL for up to 12 months in young females. Sports medicine providers need to be aware of these impacts as they work to effectively treat individuals with these injuries.