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Iliotibial band syndrome is the most common cause of lateral knee pain in runners, but needs further epidemiologic study to better understand differences among various types of runners.
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Contributing factors include strain and strain rate, kinematic deviations in the frontal and transverse plane, and weakness in the lateral and posterior hip musculature.
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The pathophysiology has 2 models, enthesopathy and compression versus impingement and friction.
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Neuromuscular coordination is a developing area of
Physical Medicine and Rehabilitation Clinics of North America
Iliotibial Band Syndrome in Runners: Biomechanical Implications and Exercise Interventions
Section snippets
Key points
Anatomy
The iliotibial band has been a long-standing fascination of evolutionary biologists and functional anatomists. Emanuel Kaplan described the iliotibial band as an “independent structure,” suggesting the description “anterolateral ligament of support.”8 The ligament was described as firmly attached to the lateral edge of the linea aspera of the femur and lateral femoral epicondyle, with distal course to the Gerdy tubercle. Fascial relationships were described among the iliotibial band, fascia
Kinematic and muscle performance factors
ITBS occurs in the deceleration phase of stance-phase running19, 21, 31 (Figs. 5 and 6). The preceding swing phase and muscle preactivation may have a role in the quality and performance of the deceleration phase.19, 32, 33 The sagittal plane has not been firmly established as a risk factor for injury except for the impingement zone at around 30° of flexion.21 Miller and colleagues34 analyzed kinematics in 8 runners during an exhaustive run (ie, self-selected pace at 20 minutes) and compared
Orientation to gait and kinematics in iliotibial band syndrome in comparison with patellofemoral pain syndrome
The interaction of the pelvis and trunk on knee moments is illustrated by Powers13 (Fig. 9). Using biomechanical theory, Powers suggested that varus torque on the knee through poor pelvic control may be a factor in ITBS; this might present as in Fig. 9B, illustrating the shift of center of mass away from the stance knee and the stance knee outside the foot, whereas the kinematics for patellofemoral pain may be as shown in Fig. 9C with a valgus knee position and shift in center of mass over the
Case example using running technique retraining
Physical therapist Darrell J. Allen63 reported an ITBS case study whereby he instructed the runner to increase the step rate by 5%. The patient had no prior treatment. Video analysis was performed with a single camera and analyzed in slow motion at 60 frames per second. Stride rate was calculated at 168 steps per minute. The heel strike occurred in front of the center of mass with the knee in 10° of flexion. No forward lean was observed during stance phase. Based on recommendations by
Summary
The biomechanical approach to ITBS includes improved force distribution into the iliotibial band insertion at the knee. Iliotibial band strain and strain rate are competing risk factors for ITBS. Researchers suggest further exploration of neuromuscular control at the hip. The hip control mechanism may be influenced by mechanoreceptors at the knee and coordination of the trunk and pelvis. Passive and active tension in the iliotibial band is a possible contributing factor. Researchers propose 3
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Cited by (36)
Epidemiology of iliotibial band syndrome in runners on Reunion Island: Prevalence, characteristics, risk factors and management
2024, Journal de Traumatologie du SportEffect of submaximal running in rocker shoes on gluteal muscle activation under different running conditions
2023, Science and SportsCitation Excerpt :Furthermore, increased hip adduction and internal rotation angle during running have been shown to increase strain on the ITB during the stance phase and promote ITBS [16]. Consequently, rehabilitation interventions mainly focus on resistance exercises for GMed and GMax, in combination with the usual care [11]. The type of running shoe used (sole material, thickness or hardness) may positively affect muscular activity, ground reaction force and soft tissue vibrations during running [17].
Knee Iliotibial Band Z-Plasty Lengthening and Bursectomy Technique
2022, Arthroscopy TechniquesConservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?
2022, Physical Therapy in SportCitation Excerpt :Hence, soft tissue techniques must be understood as a symptomatically effective first line of treatment that may reduce pain perception (Behm and Wilke, 2019) and, thus, prepare patients for subsequent treatments. Since some authors consider excessive hip adduction a risk factor in the development of ITBS in runners (Bramah et al., 2018; Ferber et al., 2010; Noehren et al., 2007), strengthening of the hip stabilizing muscles (especially the hip abductors) is usually recommended as integral component of the treatment of the syndrome (Baker & Fredericson, 2016; McKay, Maffulli, Aicale, & Taunton, 2020; Mellinger & Neurohr, 2019; Strauss, Kim, Calcei, & Park, 2011; Weckström & Söderström, 2016). Little interventional research testing the effectiveness of strength training in runners with ITBS has been conducted, and the level of evidence of studies published to date is mostly low.
Disclosure: No financial interests exist in the materials presented in this article. One illustration requires specific wording to credit JOSPT and Chris Powers as written under Fig. 9.