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Eric Foch and Clare E. Milner

the most commonly injured anatomical site. 4 , 5 Female runners are more likely than male runners to develop the knee overuse injury iliotibial band syndrome (ITBS). 6 Furthermore, ITBS is one of the most common overuse running injuries. 6 The iliotibial band resists hip adduction and knee internal

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Ross H. Miller, Stacey A. Meardon, Timothy R. Derrick and Jason C. Gillette

Previous research has proposed that a lack of variability in lower extremity coupling during running is associated with pathology. The purpose of the study was to evaluate lower extremity coupling variability in runners with and without a history of iliotibial band syndrome (ITBS) during an exhaustive run. Sixteen runners ran to voluntary exhaustion on a motorized treadmill while a motion capture system recorded reflective marker locations. Eight runners had a history of ITBS. At the start and end of the run, continuous relative phase (CRP) angles and CRP variability between strides were calculated for key lower extremity kinematic couplings. The ITBS runners demonstrated less CRP variability than controls in several couplings between segments that have been associated with knee pain and ITBS symptoms, including tibia rotation–rearfoot motion and rearfoot motion–thigh ad/abduction, but more variability in knee flexion/extension–foot ad/abduction. The ITBS runners also demonstrated low variability at heel strike in coupling between rearfoot motion–tibia rotation. The results suggest that runners prone to ITBS use abnormal segmental coordination patterns, particular in couplings involving thigh ad/abduction and tibia internal/external rotation. Implications for variability in injury etiology are suggested.

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Eric Foch and Clare E. Milner

Proximal factors such as excessive frontal plane pelvis and trunk motion have been postulated to be biomechanical risk factors associated with iliotibial band syndrome. In addition, lateral core endurance deficiencies may be related to increased pelvis and trunk motion during running. The purpose of this cross-sectional investigation was to determine if differences in biomechanics during running, as well as lateral core endurance exist between female runners with previous iliotibial band syndrome and controls. Gait and lateral core endurance were assessed in 34 female runners (17 with previous iliotibial band syndrome). Multivariate analysis of variance was performed to assess between group difference in pelvis, trunk, hip, and knee variables of interest. Runners with previous iliotibial band syndrome exhibited similar peak trunk lateral flexion, peak contralateral pelvic drop, peak hip adduction, and peak external knee adduction moment compared with controls. In addition, trunk-pelvis coordination was similar between groups. Contrary to our hypotheses, both groups exhibited trunk ipsilateral flexion. Lateral core endurance was not different between groups. These findings provide the first frontal plane pelvis and trunk kinematic data set in female runners with previous iliotibial band syndrome. Frontal plane pelvis and trunk motion may not be associated with iliotibial band syndrome.

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Lindsay Hunter, Quinette Abigail Louw and Sjan-Mari van Niekerk

Context:

Iliotibial-band syndrome (ITBS) is a common overuse running injury. There is inconclusive evidence to support current management strategies, and few advances have been made in the past few years. New management approaches should thus be developed and evaluated.

Objective:

To assess the effects of a real-time running-retraining program on lower-extremity biomechanics, pain while running, and function.

Design:

Single-subject experimental study.

Setting:

University motion-analysis laboratory.

Participant:

Female recreational runner with ITBS.

Intervention:

Nine real-time running-retraining sessions were implemented based on the biomechanical alterations of the participant's symptomatic lower limb, including pelvic and knee movement in the transverse plane, as well as foot movement in the frontal plane. Real-time visual feedback of the pelvic-rotation angle was provided during the running-retraining sessions.

Main Outcome Measurements:

3-dimensional lower-extremity running kinematics, pain on a verbal analog scale while running on a treadmill, and the Lower Extremity Functional Scale (LEFS).

Results:

Pelvic external rotation decreased, although the aim was to increase pelvic external rotation and knee rotation. The foot-progression angle improved after the intervention and at 1-mo follow-up. There was a 12.5% improvement in running time, and the pain score while running improved by 50% postintervention; these improvements were maintained at 1-mo follow-up. The mean LEFS score, indicative of function, improved by 8.75% and by 10% at the end of the intervention and at 1-mo follow-up, respectively.

Conclusion:

The real-time running-retraining program improved pain while running, as well as function, and was effective in addressing the lower-limb biomechanical alterations of the knee and foot in a female runner with ITBS. The application, effectiveness, and feasibility of real-time training should be addressed in larger studies in the future.

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Janice K. Loudon and Marcie Swift

Clinical Question:

Is there evidence to suggest that runners with a history of ITBS demonstrate altered lower extremity kinematics compared with runners without a history of ITBS?

Clinical Bottom Line:

There is moderate evidence suggesting that hip kinematics differ between runners with a history of ITBS compared with healthy runners. Results are contradictory related to the plane of movement and direction of the kinematic change. In addition, assessing hip kinematics following an exhaustive run may be beneficial to detect change.

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Rodrigo de M. Baldon, Daniel F.M. Lobato, Leonardo Furlan and Fábio Serrão

The purpose of this study was to compare lower limb kinematics between genders during stair descent. Fifteen females and fifteen males who were healthy and active were included in this study. The lower limb kinematics (pelvis, femur and knee) in the coronal and transversal planes were assessed during stair descent at 30°, 40°, 50° and 60° of knee flexion. The study found that females showed greater knee medial rotation for all the knee flexion angles (P = .02−.001), greater femoral adduction (P = .01 for all variables), with exception for 30° (P = .13), and greater femoral lateral rotation at 60° (P = .04). Females also showed a trend to have greater knee valgus at all the knee flexion angles (P = .06−.11) as well as less contralateral pelvis elevation at 50° and 60° (P = .10 and .12, respectively). This study showed that females carry out the stair descent with a lower limb alignment that might predispose them to develop overuse knee injuries, such as the iliotibial band syndrome and patellofemoral pain syndrome. Further prospective investigations should be carried out to verify whether these variables are factors that could predict these knee injuries.

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Megan Q. Beard, Samantha A. Boland and Phillip A. Gribble

Implications The HHD is a reliable, cost-effective clinical tool to detect diminished hip strength seen in participants with many chronic overuse running-related musculoskeletal injuries, including patellofemoral pain 1 , 2 and iliotibial band syndrome. 16 Our study supports reliable measurement of HABD and

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James J. Hannigan, Louis R. Osternig and Li-Shan Chou

Weak hip strength, particularly in the hip abductors and external rotators, is considered a risk factor for several running-related injuries, including patellofemoral pain syndrome (PFPS) 1 – 6 and iliotibial band syndrome (ITBS). 7 In addition, females with PFPS have displayed greater hip

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Nicola Relph and Katie Small

, Deary C . The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners - A systematic review of the literature . Phys Ther Sport . 2014 ; 15 ( 1 ): 64 – 75 . PubMed ID: 23954385 doi:10.1016/j.ptsp.2013.07.002 23954385 10.1016/j.ptsp.2013.07.002 41. Carter

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Max R. Paquette and Daniel A. Melcher

running injuries . Med Sci Sports Exerc . 1988 ; 20 ( 5 ): 501 – 505 . PubMed doi: 10.1249/00005768-198810000-0001 3193867 10. Noehren B , Schmitz A , Hempel R , Westlake C , Black W . Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome . J