IT Band References

Mentoring Minutes: IT Band References

IT Band Syndrome effects up to 12% in Runners and over 50% in cyclists. Learn more about how to treat this pattern with this Mentoring Minutes!

References & VIDEO NOTES:

Gait Posture. 2015 Feb;41(2):706-10. doi: 10.1016/j.gaitpost.2015.01.031. Epub 2015 Feb 7.

Associations between iliotibial band injury status and running biomechanics in women.

Foch E1, Reinbolt JA2, Zhang S3, Fitzhugh EC3, Milner CE3.

- 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.

- Twenty-seven female runners participated in the study.

- Participants were divided into three equal groups: current ITBS, previous ITBS, and controls.

- Over ground 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 greater trunk ipsilateral flexion less iliotibial band flexibility compared to runners with previous ITBS and controls. 

- Runners with current ITBS may lean their trunk more towards the stance limb which may be associated with decreased iliotibial band flexibility.


Int J Sports Phys Ther. 2017 Feb;12(1):16-24.


Wilhelm M1, Matthijs O2, Browne K1, Seeber G3, Matthijs A2, Sizer PS1, Brismée JM1, James CR1, Gilbert KK1.

- Iliotibial Band (ITB) syndrome is a troublesome condition with prevalence as high as 12% in runners. Stretching has been utilized as a conservative treatment. However, there is limited evidence supporting ITB elongation in response to a stretching force.

- The purpose of this study was to describe the iliotibial band tensor fascia lata complex (ITBTFLC) tissue elongation response to a simulated clinical stretch in-vitro.

-  The strain response of six un-embalmed ITBTFLCs to a simulated clinical stretch of 2.75% elongation was assessed. Four sets of array marks were placed along the length of the ITBTFLC. Tissue elongation was compared between proximal, middle, and distal ITBTFLC regions.

- Significant elongation was observed in the proximal, middle, and distal regions during the "stretched" versus the resting condition. The proximal region exhibited significantly greater elongation versus the middle and distal regions.


Arch Phys Med Rehabil. 2002 May;83(5):589-92.

Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches.

Fredericson M1, White JJMacmahon JMAndriacchi TP.

- a compare the relative effectiveness of 3 common standing stretches for the iliotibial band (ITB): arms at side, arms extending overhead, and arms reaching diagonally downward .

- biomechanics was captured as a 3-dimensional image by using a 4-camera gait acquisition system with a forceplate.

- For each stretch, change in ITB tissue length and the force generated within the stretched complex was measured. Data were then combined and analyzed by using kinetic values assessment.

- All 3 stretches created statistically significant changes in ITB length but stretch incorporating overhead arm extension, was consistently most effective both for average ITB length change and average adduction moments at the hip and knee.


BMC Musculoskelet Disord. 2015 Nov 16;16:356. doi: 10.1186/s12891-015-0808-7.

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

Aderem J1, Louw QA2.

- Iliotibial 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.

- Thirteen 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.


Sports Med. 2012 Nov 1;42(11):969-92. doi: 10.2165/11635400-000000000-00000.

Iliotibial band syndrome in runners: a systematic review.

van der Worp MP1, van der Horst Nde Wijer ABackx FJNijhuis-van der Sanden MW.

- incidence estimated to be between 5% and 14%.

- a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners.

- The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without

- While the articles were inconsistent regarding the treatment of ITBS, hip/knee coordination and running style appear to be key factors in the treatment of ITBS


J Orthop Sports Phys Ther. 2010 Feb;40(2):52-8. doi: 10.2519/jospt.2010.3028.

Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.

Ferber R1, Noehren BHamill JDavis IS.

- examine differences in running mechanics between runners who had previously sustained iliotibial band syndrome (ITBS) and runners with no knee-related running injuries.

- Because the iliotibial band has both femoral and tibial attachments, it is possible that atypical hip and foot mechanics could result in the development of ITBS.

- The running mechanics of 35 females who had previously sustained ITBS were compared to 35 healthy age-matched and running distance-matched healthy females. Comparisons of hip, knee, and ankle 3-dimensional kinematics and internal moments during the stance phase of running gait were measured.

-The ITBS group exhibited significantly greater peak rearfoot invertor moment, peak knee internal rotation angle, and peak hip adduction angle compared to controls.


Sports Med. 2011 Jun 1;41(6):463-76. doi: 10.2165/11588740-000000000-00000.

Effects of bicycle saddle height on knee injury risk and cycling performance.

Bini R1, Hume PACroft JL.

- Incorrect bicycle configuration may predispose athletes to injury and reduce their cycling performance. This review summarizes literature on methods for determining bicycle saddle height and the effects of bicycle saddle height on measures of cycling performance and lower limb injury risk.

- Increasing saddle height can cause increased shortening of the vastii muscle group, but no change in hamstring length. Length and velocity of contraction in the soleus seems to be more affected by saddle height than that in the gastrocnemius.

- The majority of evidence suggested that a 5% change in saddle height affected knee joint kinematics by 35% and moments by 16%.

- On the basis of the conflicting evidence on the effects of saddle height changes on performance and lower limb injury risk in cycling, we suggest the saddle height may be set using the knee flexion angle method (25-30°) to reduce the risk of knee injuries and to minimize oxygen uptake.


J Sci Med Sport. 2017 Apr;20(4):349-355. doi: 10.1016/j.jsams.2016.09.002. Epub 2016 Sep 20.

Hip abductor strength and lower extremity running related injury in distance runners: A systematic review.

Mucha MD1, Caldwell W1, Schlueter EL1, Walters C1, Hassen A2.

- Determine the association between hip abduction strength and lower extremity running related injury in distance runners.

- Prospective longitudinal and cross sectional studies that quantified hip abduction strength and provided diagnosis of running related injury in distance runners were included and assessed for quality.

- Of the 1841 articles returned in the initial search, 11 studies matched all inclusion criteria. Studies were grouped according to injury: iliotibial band syndrome, patellofemoral pain syndrome, medial tibial stress syndrome, tibial stress fracture, and Achilles tendinopathy, and examined for strength differences between injured and non-injured groups.

-Meaningful differences were found in the studies examining iliotibial band syndrome. Three of five iliotibial band syndrome articles found weakness in runners with iliotibial band syndrome; two were of strong methodological rigor and both of those found a relationship between weakness and injury.

- Hip abduction weakness evaluated by hand held dynamometer may be associated with iliotibial band syndrome in distance runners as suggested by several cross sectional studies

IT Band Syndrome - Patient's Guide To Relief

IT Band.jpeg

Do any of your patients struggle with lateral knee pain?  

Maybe from running, cycling, or another form of exercise?  

This week's patient education article is all about IT band syndrome.  How many of your referrals for IT Band Syndrome end up being lumbar radiculopathy?  Or patellofemoral pain?  Or Patellar Tendinopathy?   

Today's article will clear up some myths and also give your patient's some tried-and-true exercises that can offer them some real lasting relief...

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