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
Eric Foch and Clare E. Milner
Paul R. Geisler and Todd Lazenby
Clinical practice in sports medicine is often guided by axioms or paradigms of practice, some of which have persisted over time despite a lack of objective evidence to support their validity. Evidence-based practice compels practicing clinicians to not only seek out and produce evidence that informs their decision-making, but also to challenge existing paradigms of thought and practice, especially when favorable treatment outcomes remain elusive. Insidious, load induced lateral knee pain around the iliotibial band in runners, cyclists, military personnel, rowers, and other athletes has for decades now been conceptualized as iliotibial band friction syndrome, a biomechanically based and unsubstantiated paradigm based on Renne’s 1975 theory that the iliotibial band slips back and forth over the lateral femoral epicondyle during flexion and extension movements of the knee, primarily irritating the underlying bursa and even the iliotibial band itself. Newer evidence about the anatomy and biomechanics of the iliotibial band, the physiology of the condition, and interventional outcomes is now available to challenge that long-held paradigm of thought for iliotibial band related pathology. Given this plethora of new information available for clinical scientists, iliotibial band impingement syndrome is proposed here as a new, evidence-informed paradigm for evaluating and treating this problematic overuse syndrome.
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.
Elizabeth A. Racioppi and Dawn T. Gulick
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.
Lindsay Hunter, Quinette Abigail Louw and Sjan-Mari van Niekerk
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.
To assess the effects of a real-time running-retraining program on lower-extremity biomechanics, pain while running, and function.
Single-subject experimental study.
University motion-analysis laboratory.
Female recreational runner with ITBS.
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).
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.
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.
Pablo Fanlo-Mazas, Elena Bueno-Gracia, Alazne Ruiz de Escudero-Zapico, José Miguel Tricás-Moreno and María Orosia Lucha-López
lack of flexibility of several muscles of the thigh has been documented as a possible factor contributing to PFP, 4 – 6 and it is a common finding in patients with PFPS. 7 – 9 A tight iliotibial band (ITB) can lead to laterally located patella and an abnormal patellar tracking pattern. 4 , 6 This
Isabel Mayer, Matthias W. Hoppe, Jürgen Freiwald, Rafael Heiss, Martin Engelhardt, Casper Grim, Christoph Lutter, Moritz Huettel, Raimund Forst and Thilo Hotfiel
The implementation of ARFI imaging in the context of FR is capable to gain valuable information about FR-induced changes in tissue characteristics according to the FR experience, which are not yet elucidated. 2 Data of the iliotibial band (ITB) and superficial and deep lateral thigh muscles (vastus
Mikiko Nakajima and Mallori Tittle
Nathaly Gaudreault, Alex Fuentes, Neila Mezghani, Virginie O. Gauthier and Katia Turcot
Decreased flexibility in muscles and joints of lower extremities is commonly observed in runners. Understanding the effect of decreased flexibility on knee walking kinematics in runners is important because, over time, altered gait patterns can make runners vulnerable to overuse injuries or degenerative pathologies.
To compare hamstring and iliotibial-band (ITB) flexibility and knee kinematics in runners and nonrunners.
A descriptive, comparative laboratory study.
Hamstring and ITB flexibility were measured with the active knee-extension test and the modified Ober test, respectively, in both groups of participants. Three-dimensional (3D) walking kinematic data were then recorded at the knee using a motiontracking system.
18 runners and 16 nonrunners.
Main Outcome Measures:
Knee-extension angle (hamstring flexibility) and hip-adduction angle (ITB flexibility). Knee kinematic parameters of interest included knee angle at initial contact, peak knee angles, and knee-angle range in all planes of movement.
The runners had a significantly less flexible ITB than the nonrunners (hip adduction [−] and adduction [+] angles, 3.1° ± 5.6° vs −6.4° ± 4.5°; P < .001). The runners demonstrated a greater mean tibial external-rotation angle at initial contact (7.3° ± 5.8° vs 2.0° ± 4.0°; P = .01) and a smaller mean peak tibial internal-rotation angle (−1.6° ± 3.0° vs −4.2° ± 3.2°; P = .04) than the nonrunners.
This study provides new insight into the relationship between muscle flexibility and 3D knee kinematics in runners. This supports the premise that there is an association between muscle flexibility and transverse-plane knee kinematics in this population.