Mechanics of iliotibial band syndrome

NewsBot · Dec 1, 2006

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Lower extremity mechanics of iliotibial band syndrome during an exhaustive run.
Gait Posture. 2006 Nov 27;
Miller RH, Lowry JL, Meardon SA, Gillette JC

Injury patterns in distance running may be related to kinematic adjustments induced by fatigue. The goal was to measure changes in lower extremity mechanics during an exhaustive run in individuals with and without a history of iliotibial band syndrome (ITBS). Sixteen recreational runners ran to voluntary exhaustion on a treadmill at a self-selected pace. Eight runners had a history of ITBS. Twenty-three reflective marker positions were recorded by an eight-camera 120Hz motion capture system. Joint angles during stance phase were exported to a musculoskeletal model (SIMM) with the iliotibial band (ITB) modeled as a passive structure to estimate strain in the ITB. For ITBS runners, at the end of the run: (1) knee flexion at heel-strike was higher than control (20.6 degrees versus 15.3 degrees , p=0.01); (2) the number of knees with predicted ITB impingment upon the lateral femoral epicondyle increased from 6 to 11. Strain in the ITB was higher in the ITBS runners throughout all of stance. Maximum foot adduction in the ITBS runners was higher versus control at the start of the run (p=0.003). Maximum foot inversion (p=0.03) and maximum knee internal rotation velocity (p=0.02) were higher versus control at the end of the run. In conclusion, ITB mechanics appear to be related to changes in knee flexion at heel-strike and internal rotation of the leg. These observations may suggest kinematic discriminators for clinical assessment.
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Admin2 · Dec 1, 2006

Related thread:
Iliotibial band syndrome

NewsBot · Apr 7, 2007

Opinion piece
Is iliotibial band syndrome really a friction syndrome?
John Fairclough, Koji Hayashi, Hechmi Toumi, Kathleen Lyons, Graeme Bydder, Nicola Phillips, Thomas M. Best and Mike Benjamin
Journal of Science and Medicine in Sport
Volume 10, Issue 2 , April 2007, Pages 74-76

Iliotibial band (ITB) syndrome is regarded as an overuse injury, common in runners and cyclists. It is believed to be associated with excessive friction between the tract and the lateral femoral epicondyle-friction which ‘inflames’ the tract or a bursa. This article highlights evidence which challenges these views. Basic anatomical principles of the ITB have been overlooked: (a) it is not a discrete structure, but a thickened part of the fascia lata which envelops the thigh, (b) it is connected to the linea aspera by an intermuscular septum and to the supracondylar region of the femur (including the epicondyle) by coarse, fibrous bands (which are not pathological adhesions) that are clearly visible by dissection or MRI and (c) a bursa is rarely present—but may be mistaken for the lateral recess of the knee. We would thus suggest that the ITB cannot create frictional forces by moving forwards and backwards over the epicondyle during flexion and extension of the knee. The perception of movement of the ITB across the epicondyle is an illusion because of changing tension in its anterior and posterior fibres. Nevertheless, slight medial–lateral movement is possible and we propose that ITB syndrome is caused by increased compression of a highly vascularised and innervated layer of fat and loose connective tissue that separates the ITB from the epicondyle. Our view is that ITB syndrome is related to impaired function of the hip musculature and that its resolution can only be properly achieved when the biomechanics of hip muscle function are properly addressed.
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NewsBot · Aug 31, 2007

ASB Clinical Biomechanics Award Winner 2006:
Prospective study of the biomechanical factors associated with iliotibial band syndrome.
Noehren B, Davis I, Hamill J.
Clin Biomech (Bristol, Avon). 2007 Aug 27; [Epub ahead of print]

BACKGROUND: Iliotibial band syndrome is the leading cause of lateral knee pain in runners. Despite its high prevalence, little is known about the biomechanics that lead to this syndrome. The purpose of this study was to prospectively compare lower extremity kinematics and kinetics between a group of female runners who develop iliotibial band syndrome compared to healthy controls. It was hypothesized that runners who develop iliotibial band syndrome will exhibit greater peak hip adduction, knee internal rotation, rearfoot eversion and no difference in knee flexion at heel strike. Additionally, the iliotibial band syndrome group were expected to have greater hip abduction, knee external rotation, and rearfoot inversion moments.

METHODS: A group of healthy female recreational runners underwent an instrumented gait analysis and were then followed for two years. Eighteen runners developed iliotibial band syndrome. Their initial running mechanics were compared to a group of age and mileage matched controls with no history of knee or hip pain. Comparisons of peak hip, knee, rearfoot angles and moments were made during the stance phase of running. Variables of interest were averaged over the five running trials, and then averaged across groups.

FINDINGS: The iliotibial band syndrome group exhibited significantly greater hip adduction and knee internal rotation. However, rearfoot eversion and knee flexion were similar between groups. There were no differences in moments between groups.

INTERPRETATION: The development of iliotibial band syndrome appears to be related to increased peak hip adduction and knee internal rotation. These combined motions may increase iliotibial band strain causing it to compress against the lateral femoral condyle. These data suggest that treatment interventions should focus on controlling these secondary plane movements through strengthening, stretching and neuromuscular re-education.
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NewsBot · Nov 1, 2007

From latest Dynamic Chiropractic:
Tensor Fascia Latae and Iliotibial Band
Functional Evaluation

The tensor fascia latae (TFL) acts through the iliotibial tract by pulling it superiorly and anteriorly. It assists in flexing, medial rotation and abduction of the hip and extension of the knee joint. The TFL arises from the anterior part of the outer lip of the iliac crest, the lateral aspect of the anterior superior iliac spine and the upper part of the anterior border of the iliac wing. Keep in mind that in addition to arising from the iliac crest, the iliotibial band (ITB) attaches into the posterior gluteus maximus muscle in the back. When the TFL and gluteal muscles contract, they increase tension on the band. Often, one muscle dominates the movement pattern causing an imbalance to occur, which may lead to injury. When a muscle imbalance exists, some muscles are short (overactive) and others are long (underactive)
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Full article

NewsBot · Jun 26, 2008

A prospective study of iliotibial band strain in runners
Joseph Hamill, Ross Miller, Brian Noehren, Irene Davis
Clinical Biomechanics (Articles in Press)

Background
Iliotibial band syndrome is the leading cause of lateral knee pain in runners. It is thought that pain develops from strain on the iliotibial band due to friction of the iliotibial band sliding over the lateral femoral epicondyle. The purpose of this study was to investigate mechanical strain in the iliotibial band as a possible causative factor in the development of iliotibial band syndrome.

Methods
From a large prospective study, female runners who incurred iliotibial band syndrome during the study were compared to a control group who incurred no injuries. Strain, strain rate and duration of impingement were determined from a musculoskeletal model of the lower extremity.

Findings
The results indicated that the iliotibial band syndrome subjects exhibited greater strain throughout the support period, but particularly at midsupport compared to the control group. Strain rate was significantly greater in the iliotibial band syndrome group compared to the control group and was greater in the involved limb of the iliotibial band syndrome group compared to their contralateral limb. However, there were no differences in the duration of impingement between the groups.

Interpretation
This study indicates that a major factor in the development of iliotibial band syndrome is strain rate. Therefore, we suggest that strain rate, rather than the magnitude of strain, may be a causative factor in developing iliotibial band syndrome. The effect size (>0.5) indicated that strain rate may be biologically significant in the etiology of iliotibial band syndrome.
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NewsBot · Oct 10, 2008

Continuous relative phase variability during an exhaustive run in runners with a history of iliotibial band syndrome.
Miller RH, Meardon SA, Derrick TR, Gillette JC.
J Appl Biomech. 2008 Aug;24(3):262-70.

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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NewsBot · Mar 4, 2009

The influence of matching populations on kinematic and kinetic variables in runners with iliotibial band syndrome.
Grau S, Maiwald C, Krauss I, Axmann D, Horstmann T.
Res Q Exerc Sport. 2008 Dec;79(4):450-7.

The purpose of this study was to assess how participant matching influences biomechanical variables when comparing healthy runners and runners with iliotibial band syndrome (ITBS). We examined 52 healthy runners (CO) and 18 with ITBS, using three-dimensional kinematics and pressure distribution. The study population was matched in three ways and compared with the biomechanical findings: ITBS versus CO I (unmatched), ITBS versus CO II (matched to gender) and ITBS versus CO III (matched to gender height, and weight). The final number of participants in each group was n = 18. The kinematic variables showed a dependency on the matching process. The largest statistically significant differences (after Bonferroni adjustment) in the frontal and transverse planes were between ITBS and CO III (p = .008). Pressure measurements were also dependent on the matching process, with decreasing and nonsignificant differences (p = .006) between ITBS and CO after refining the process (ITBS vs. CO III). The results of this study and the necessity of matching seem to be plausible (lever arms, different running styles). Data matching is important for understanding overuse injuries in running.
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NewsBot · Jun 1, 2009

Iliotibial band tension affects patellofemoral and tibiofemoral kinematics
Azhar M. Mericanab, Andrew A. Amisac
Journal of Biomechanics

The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100° to 0° flexion. This was repeated after the following ITB loads: 30, 60 and 90N. There was no change with 30N load for patellar translation. On average, at 60 and 90N, the patella translated laterally by 0.8 and 1.4mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7°, 1.2° and 1.5° for 30, 60 and 90N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60° and 75° flexion. The increase was 5.2°, 9.5° and 13° in this range for 30, 60 and 90N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known.
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NewsBot · Feb 2, 2010

Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.
Ferber R, Noehren B, Hamill J, Davis IS.
J Orthop Sports Phys Ther. 2010 Feb;40(2):52-8.

STUDY DESIGN: Cross-sectional experimental laboratory study.

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

BACKGROUND: ITBS is the second leading cause of knee pain in runners and the most common cause of lateral knee pain. Despite its prevalence, few biomechanical studies have been conducted to better understand its aetiology. 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.

METHODS: 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.

RESULTS: The ITBS group exhibited significantly greater peak rearfoot invertor moment, peak knee internal rotation angle, and peak hip adduction angle compared to controls. No significant differences in peak rearfoot eversion angle, peak knee flexion angle, peak knee external rotator moment, or peak hip abductor moments were observed between groups.

CONCLUSION: Females with a previous history of ITBS demonstrate a kinematic profile that is suggestive of increased stress on the iliotibial band. These results were generally similar to those reported for a prospective study conducted within the same laboratory environment
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NewsBot · Oct 4, 2011

Using the variability of continuous relative phase as a measure to discriminate between healthy and injured runners.
Hein T, Schmeltzpfenning T, Krauss I, Maiwald C, Horstmann T, Grau S.
Hum Mov Sci. 2011 Sep 28. [Epub ahead of print]

Several studies have used variability of continuous relative phase (CRP) to investigate overuse injuries, since low variability is thought to be related to running injuries. This study investigates whether the analysis of CRP variability leads to additional information about possible differences or similarities between healthy and injured runners. Further, a decision about future applications of CRP variability should be based on the ability to implement and interpret data. 18 healthy female runners (CO) and 18 female runners who suffered from iliotibial band syndrome (ITBS) were evaluated by calculating CRP variability for 4 coupling pairs. Besides analyzing continuous variability of CRP, we also averaged it for the whole stance phase and for four predefined stance phase intervals. Confidence intervals were displayed and independent t-tests for comparing the two groups were conducted. During initial and terminal stance phase as well as after heel-off an increase in CRP variability was detected for both groups of runners. In contrast, the foot flat period was characterized by stable joint coordination and a decrease in variability. This paper presents possible interpretations of CRP variability but no statistically significant differences in CRP variability were found between the two groups of runners. Despite the missing statistical significance, a relationship between high CRP variability and injury seems to be conceivable, since the injured runners demonstrated an increased variability for all couplings in the first half of the stance phase. Further application of CRP variability in biomechanical research is essential to determine whether a relationship exists between injury and coordination variability.
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NewsBot · Sep 22, 2012

Iliotibial Band Syndrome in Runners: A Systematic Review.
van der Worp MP, van der Horst N, de Wijer A, Backx FJ, Nijhuis-van der Sanden MW.
Sports Med. 2012 Sep 20

Background: The popularity of running is still growing and, as participation increases, the incidence of running-related injuries will also rise. Iliotibial band syndrome (ITBS) is the most common injury of the lateral side of the knee in runners, with an incidence estimated to be between 5% and 14%. In order to facilitate the evidence-based management of ITBS in runners, more needs to be learned about the aetiology, diagnosis and treatment of this injury.

Objective: This article provides a systematic review of the literature on the aetiology, diagnosis and treatment of ITBS in runners. Search strategy: The Cochrane Library, MEDLINE, EMBASE, CINAHL, Web of Science, and reference lists were searched for relevant articles. Selection criteria: Systematic reviews, clinical trials or observational studies involving adult runners (>18 years) that focused on the aetiology, diagnosis and/or treatment of ITBS were included and articles not written in English, French, German or Dutch were excluded.

Data collection and analysis: Two reviewers independently screened search results, assessed methodological quality and extracted data. The sum of all positive ratings divided by the maximum score was the percentage quality score (QS). Only studies with a QS higher than 60% were included in the analysis. The following data were extracted: study design; number and characteristics of participants; diagnostic criteria for ITBS; exposure/treatment characteristics; analyses/outcome variables of the study; and setting and theoretical perspective on ITBS.

Main results: The studies of the aetiology of ITBS in runners provide limited or conflicting evidence and it is not clear whether hip abductor weakness has a major role in ITBS. The kinetics and kinematics of the hip, knee and/or ankle/foot appear to be considerably different in runners with ITBS to those without. The biomechanical studies involved small samples, and data seem to have been influenced by sex, height and weight of participants. Although most studies monitored the management of ITBS using clinical tests, these tests have not been validated for this patient group. 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. Runners might also benefit from mobilization, exercises to strengthen the hip, and advice about running shoes and running surface.

Conclusion: The methodological quality of research into the management of ITBS in runners is poor and the results are highly conflicting. Therefore, the study designs should be improved to prevent selection bias and to increase the generalizability of findings.
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Admin2 · May 23, 2013

Frontal Plane Running Biomechanics in Female Runners with Previous Iliotibial Band Syndrome.
Foch E, Milner CE
Journal of Applied Biomechanics [2013]

Proximal factors such as excessive frontal plane pelvis and trunk motion have been postulated to be biomechanical risk factors associated with iliotibial band syndrome. Additionally, 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, contralateral pelvic drop, hip adduction, and external knee adduction moment compared to controls. Additionally, 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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NewsBot · May 30, 2013

Hip Strength and Core Endurance in Runners With and Without Iliotibial Band Syndrome
Megan Hyatt, John-Paul Hezel, M.D., Michael Jones, Karrie Hamstra-Wright, PhD
Journal of Kinesiology and Nutrition Student Research

Iliotibial Band Syndrome (ITBS) is one of the main causes of lateral knee pain in runners. One etiological variable associated with ITBS is ipsilateral hip abductor weakness. Poor trunk control also contributes to pelvic drop and hip adduction, which may contribute to ITBS.

The purposes of this study were to compare hip abductor and adductor strength and back extensor endurance, as a measure of trunk control, between runners with and without ITBS. Fifteen runners who averaged ³12 mi/week participated (ITBS: 4 females, 1 male; Controls: 6 females, 4 males).

Hip abduction and adduction strength (N) was measured using a handheld dynamometer (HHD). Subjects were positioned in a supine position with the HHD on the distal lower leg. Each subject performed a 5s isometric hip abduction and adduction contraction. Subjects completed one practice trial and 3-4 maximal contraction trials. The three trials that fell within 10% of each other were averaged and normalized using body weight. Back extensor endurance (s) was measured with the subjects prone and the upper body unsupported. Subjects held their trunk parallel to the floor for one isometric contraction until failure. A 1-way MANOVA was used to examine differences in abduction and adduction strength between groups. A 1-way ANOVA was used to measure back extensor endurance between groups.

No differences existed in hip abduction (ITBS: 3.28±0.97N, Control: 2.81±.40N, P=0.23) or adduction (ITBS: 3.15±0.98N, Control: 3.01±.97N, P=0.80) strength. Back extensor endurance did not differ between groups (ITBS: 103.6±41.4s, Control: 137.7±43.6s, P=0.18). We did not find group differences in hip strength or back extensor endurance. However, an average endurance difference of 34s between groups may be clinically important. Further research with a greater sample is needed to better understand hip strength and back extensor endurance in this population.
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NewsBot · Jun 30, 2013

Effect of Increased Iliotibial Band Load on Tibiofemoral Kinematics and Force Distributions: A Direct Measurement in Cadaveric Knees
Hemanth R. Gadikota, Shinsuke Kikuta, Wei Qi, David Nolan, Thomas J. Gill, Guoan Li
J Orthop Sports Phys Ther 2013;43(7):478-485.

STUDY DESIGN: Controlled laboratory study using cadaveric knee specimens and a repeated-measures design.

OBJECTIVES: To investigate the effect of increased iliotibial band load (assumed to represent increased tensor fascia latae and gluteus maximus strength) on tibiofemoral kinematics and force distribution on the tibiofemoral articulation.

BACKGROUND: Owing to the difficulty in measuring in vivo joint loading, there is limited evidence on the direct relationship between increased iliotibial band load and force distribution in the tibiofemoral articulation.

METHODS: Eight fresh-frozen cadaveric knee specimens were used in this study. A robotic testing system assessed tibiofemoral kinematics under 3 simulated loading conditions: (1) 300-N quadriceps load, 100-N hamstrings load, 0-N iliotibial band load; (2) 300-N quadriceps load, 100-N hamstrings load, 50-N iliotibial band load; and (3) 300-N quadriceps load, 100-N hamstrings load, 100-N iliotibial band load. The load distribution in the medial and lateral tibiofemoral articulation was also measured under these loading conditions by using piezoelectric pressure sensors. Data were collected and analyzed at full extension and at 5°, 10°, 15°, 20°, 25°, and 30° of knee flexion.

RESULTS: The loads transmitted through the medial tibiofemoral articulation significantly decreased when the load on the iliotibial band was increased, with a concomitant significant increase in lateral tibiofemoral articulation load. Greater iliotibial band load also increased anterior tibial translation and valgus tibial rotation, and decreased the amount of internal tibial rotation and medial tibial translation.

CONCLUSION: The present study demonstrated that an increase in iliotibial band load, when tested in a non–weight-bearing condition in a cadaveric model, can significantly decrease the loads transmitted through the medial tibiofemoral articulation.
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NewsBot · Aug 20, 2013

The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners – A systematic review of the literature
Maryke Louw & Clare Deary
Physical Therapy in Sport; Available online 16 August 2013

The aim of this literature review was to identify the biomechanical variables involved in the aetiology of iliotibial band syndrome (ITBS) in distance runners. An electronic search was conducted using the terms “iliotibial band” and “iliotibial tract”.

The results showed that runners with a history of ITBS appear to display decreased rear foot eversion, tibial internal rotation and hip adduction angles at heel strike while having greater maximum internal rotation angles at the knee and decreased total abduction and adduction range of motion at the hip during stance phase. They further appear to experience greater invertor moments at their feet, decreased abduction and flexion velocities at their hips and to reach maximum hip flexion angles earlier than healthy controls. Maximum normalised braking forces seem to be decreased in these athletes. The literature is inconclusive with regards to muscle strength deficits in runners with a history of ITBS. Prospective research suggested that greater internal rotation at the knee joint and increased adduction angles of the hip may play a role in the aetiology of ITBS and that the strain rate in the iliotibial bands of these runners may be increased compared to healthy controls.

A clear biomechanical cause for ITBS could not be devised due to the lack of prospective research.
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NewsBot · Oct 22, 2013

The Influence of Iliotibial Band Syndrome History on Running Biomechanics Examined via Principal Components Analysis
Eric Foch, Clare E. Milner
Journal of Biomechanics; Available online 19 October 2013

Iliotibial band syndrome (ITBS) is a common knee overuse injury among female runners. Atypical discrete trunk and lower-extremity biomechanics during running may be associated with the etiology of ITBS. Examining discrete data points limits the interpretation of a waveform to a single value. Characterizing entire kinematic and kinetic waveforms may provide additional insight into biomechanical factors associated with ITBS. Therefore, the purpose of this cross-sectional investigation was to determine whether female runners with previous ITBS exhibited differences in kinematics and kinetics compared to controls using a principal components analysis (PCA) approach. Forty participants comprised two groups: previous ITBS and controls. Principal component scores were retained for the first three principal components and were analyzed using independent t-tests. The retained principal components accounted for 93%-99% of the total variance within each waveform. Runners with previous ITBS exhibited low principal component one scores for frontal plane hip angle. Principal component one accounted for the overall magnitude in hip adduction which indicated runners with previous ITBS assumed less hip adduction throughout stance. No differences in the remaining retained principal component scores for the waveforms were detected among groups. A smaller hip adduction angle throughout the stance phase of running may be a compensatory strategy to limit iliotibial band strain. This running strategy may have persisted after ITBS symptoms subsided.
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NewsBot · Jan 28, 2014

Assessment of Strength, Flexibility, and Running Mechanics in Males With Iliotibial Band Syndrome
Brian Noehren, PT, PhD, Anne Schmitz, PhD, Ross Hempel, BS, Carolyn Westlake, MS, William Black, MD
J Orthop Sports Phys Ther, Epub 22 January 2014. doi:10.2519/jospt.2014.4991J Orthop Sports Phys Ther, Epub 22 January 2014. doi:10.2519/jospt.2014.4991

Study Design Cross-sectional laboratory study.

Objectives To assess differences in hip strength, iliotibial band length, and hip and knee mechanics during running between male runners with iliotibial band syndrome and healthy controls.

Background Flexibility, strength, and running mechanics are commonly assessed in patients with iliotibial band syndrome (ITBS). However, these variables have not been evaluated concurrently in this population.

Methods Thirty-four males participated (17 healthy, 17 ITBS). Hip strength was measured with a hand held dynamometer and iliotibial band flexibility was assessed using an inclinometer while performing the Ober’s test. Kinetic and three-dimensional kinematic data were obtained during running. Kinematic variables of interest included frontal and transverse plane hip and knee joint angles during early stance. Independent sample t-tests as well as effect sizes were used to assess group differences.

Results Compared to the control group, persons with ITBS had a significantly lower Ober’s measurement (1.2°), weaker hip external rotators (1.2 Nm/kg), greater hip internal rotation (3.7°), and greater knee adduction (3.6°). However, only hip internal rotation and knee adduction exceeded the minimal detectable difference value.

Conclusions Our results suggest that intervention strategies that target neuromuscular control of the hip and knee may be indicated for males with iliotibial band syndrome.
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NewsBot · Feb 3, 2014

Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?
Jelsing EJ, Finnoff JT, Cheville AL, Levy BA, Smith J.
J Ultrasound Med. 2013 Jul;32(7):1199-206. doi: 10.7863/ultra.32.7.1199.

OBJECTIVES:
The purpose of this study was to determine whether the iliotibial band (ITB) moves relative to the lateral femoral epicondyle (LFE) as a function of knee flexion in both non-weight-bearing and weight-bearing positions in asymptomatic recreational runners.
METHODS:
Five male and 15 female asymptomatic recreational runners (10-30 miles/wk) aged 18 to 40 years were examined with sonography to assess the distance between the anterior fibers of the ITB and the LFE in full extension, 30° of knee flexion, and 45° of knee flexion. Measurements were obtained on both knees in the supine (non-weight-bearing) and standing (weight-bearing) positions.
RESULTS:
The distance between the anterior fibers of the ITB and the LFE decreased significantly from full extension to 45° of knee flexion in both supine (0.38-cm average decrease; P < .001) and standing (0.71-cm average decrease; P < .001) positions. These changes reflect posterior translation of the ITB during the 0° to 45° flexion arc of motion in both the supine and standing positions.
CONCLUSIONS:
Sonographic evaluation of the ITB in our study population clearly revealed anteroposterior motion of the ITB relative to the LFE during knee flexion-extension. Our results indicate that the ITB does in fact move relative to the femur during the functional ranges of knee motion. Future investigations examining ITB motion in symptomatic populations may provide further insight into the pathophysiologic mechanisms of ITB syndrome and facilitate the development of more effective treatment strategies.
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NewsBot · May 10, 2014

Frontal Plane Running Biomechanics in Female Runners with Previous Iliotibial Band Syndrome
Eric Foch, Clare E. Milner
JAB Volume 30, Issue 1, February 2014, 30, 58 – 65

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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NewsBot · Dec 12, 2014

The effect of angle and moment of the hip and knee joint on iliotibial band hardness
Hiroshige Tateuchicorrespondence, Sakiko Shiratori, Noriaki Ichihashi
Gait and Posture; Articles in Press

Highlights
•We aimed to clarify the factors contributing to increase in ITB hardness.
•ITB hardness was measured using shear wave elastography.
•Excessive hip and knee adduction moment and hip adduction angle leads to increased ITB hardness.
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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 5 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.
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NewsBot · Jan 26, 2015

Gender differences in gait kinematics in runners with iliotibial band syndrome
A. Phinyomark, S. Osis, B. A. Hettinga, R. Leigh and R. Ferber
Scandinavian Journal of Medicine & Science in Sports; Early View

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.
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NewsBot · Feb 8, 2015

Associations between Iliotibial Band Injury Status and Running Biomechanics in Women
Eric Foch, Jeffrey A. Reinbolt, Songning Zhang, Eugene C. Fitzhugh, Clare E. Milner
Gait and Posture; Article in Press

Highlights
•Increased trunk ipsilateral flexion may be a consequence of ITBS.
•Iliotibial band flexibility should be targeted during rehabilitation for ITBS.
•Strengthening hip abductors may benefit both current and previously injured runners.
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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
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NewsBot · Aug 21, 2015

From LER:
Iliotibial band syndrome and running mechanics

NewsBot · Aug 28, 2015

Understanding the IT band

?We found that the human IT band has the capacity to store 15 to 20 times more elastic energy per body mass than its much-less-developed precursor structure in a chimp,? Eng said. ?We looked at the IT band?s capacity to store energy during running, and we found its energy-storage capacity is substantially greater during running than walking, and that?s partly because running is a much springier gait. We don?t know whether the IT band evolved for running or walking; it could have evolved for walking and later evolved to play a larger role in running.?
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NewsBot · Nov 18, 2015

Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review
Jodi Aderem and Quinette A. Louw
BMC Musculoskeletal Disorders 2015, 16:356 doi:10.1186/s12891-015-0808-7

Background
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.

Methods
An 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.

Result
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.

Conclusion
Findings 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.
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NewsBot · Apr 2, 2016

Biomechanical Features of Running Gait Data Associated with Iliotibial Band Syndrome: Discrete Variables Versus Principal Component Analysis
Angkoon Phinyomark , Sean T. Osis, Dylan Kobsar, Blayne A. Hettinga, Ryan Leigh, Reed Ferber
XIV Mediterranean Conference on Medical and Biological Engineering and Computing 2016
Volume 57 of the series IFMBE Proceedings pp 574-579

The features associated with temporal gait biomechanical data are complex and multivariate and it is therefore necessary to identify methods that reduce the difficulty underlying the interpretation and identification of differences between groups of interest. Discrete variables and principal component analysis (PCA) are feature extraction methods that have been widely used. However, a comprehensive understanding of the relationship between discrete variables and PCA features has never been completed. The objectives of this study were to (1) determine the relationships between the two feature methods and (2) compare the performance of each for the identification and discrimination of between-group differences for injured and non-injured subjects. Running gait kinematic data of 48 patients experiencing iliotibial band syndrome (ITBS) were compared to a group of 48 asymptomatic control subjects for transverse plane hip and ankle joint and frontal plane hip joint waveform data. Twenty-two discrete variables and three to four PCA features were extracted from each waveform and divided into three subgroups: magnitude features, difference operator features, and phase shift features. The following key results were obtained: (1) strong correlations were found between discrete variables; (2) the first PCA feature captured the magnitude information and thus showed strong correlation with the discrete variables in the magnitude group; (3) there was no consistent result that showed all discrete variables were found in the first few principal components; (4) the performance of the PCA features in identifying between-group differences decreased (reduced the effect size) as compared to using the discrete variables, but this does not necessarily result in a decrease in the performance of the PCA features to discriminate between ITBS and controls using a support vector machine classifier. These results suggest care must be taken when selecting features of gait waveforms for both identification and discrimination of between-group differences for injured and non-injured runners.
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NewsBot · Apr 30, 2016

The effect of three-dimensional postural change on shear elastic modulus of the iliotibial band
Hiroshige Tateuchi et al
Journal of Electromyography and Kinesiology; 26 April 2016

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.
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NewsBot · Jun 7, 2016

Knee External Rotation Kinematics and Prevalence of ITBS in Dominant Limbs of Female Runners
Olivia Perozzi, Dony Maiguel, Mike Jones, DPT, Burcu Aydemir, Karrie Hamstra-Wright, PhD
Journal of Kinesiology and Nutrition Student Research;

Context: Iliotibial Band Syndrome (ITBS) is an overuse injury that is thought to be related to irregular hip, knee, or foot mechanics during running. Increased transverse plane motion at the knee is strongly supported as a factor in running injuries at the knee. It has also been suggested that the dominant limb is more susceptible to injury, but this has not been investigated in runners with ITBS.
Objective: To investigate knee external rotation angles and the prevalence of ITBS in the dominant limbs of female runners. Design: Retrospective cross-sectional study.
Setting: University research laboratory.
Participants: Twenty-five females (31.3?10.5 years) who ran ≥ 12mi/wk participated. Interventions: Three groups were formed based on the presence of ITBS: ITBS injured leg (ITBS-inj; n=13), ITBS non-injured leg (ITBS-non; n=13) and control dominant leg (CON; n=12). Stance phase kinematic data was captured using a three-camera VICON Bonita motion analysis system while subjects ran on a treadmill at a self-selected pace. Limb dominance was determined subjectively. Main Outcome Measures: Knee external rotation (KER) angles were normalized to 100 data points and differences were determined by Cohen's d analysis. The three time points with the largest Cohen's d were used to determine significance by one-way ANOVAs. Prevalence of ITBS in the dominant limbs was analyzed using a Fischer’s exact test.
Results: A comparison of KER angles between ITBS-inj and ITBS-non showed a small, non-signficant difference (d=0.41, P=0.52). Comparison between ITBS-inj and CON showed a medium, non-signficant difference (d=0.70, P= 0.10). There was no significant correlation between prevalence of injury and dominant limbs (Right: 50%, Left: 37.5%, P=0.23).
Conclusion: In contrast to currentliterature, increased KER was not found in the affected limbs of runners with ITBS. Limb dominance also does not appear to correlate with prevalence of this injury.
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NewsBot · Jun 7, 2016

Discrete Frontal Plane Hip Strength And Ratio Differences In Female Runners With ITBS
Katarzyna smirnow, Dony Maiguel, Olivia Perozzi, Mike Jones, DPT, Burcu Aydemir, Karrie Hamstra-Wright, PhD
Journal of Kinesiology and Nutrition Student Research

Context: Iliotibial Band Syndrome (ITBS) is an overuse knee injury, which has been linked to frontal plane hip strength imbalances in females. Due to methodological inconsistencies, a consensus on the presence of hip weakness in runners with ITBS has not been reached.
Objective: The purpose of our study was to investigate discrete and ratio differences in frontal plane hip strength between female runners with ITBS and healthy controls.
Design: Retrospective cross-sectional study.
Setting: University research laboratory.
Participants: Thirty-one female runners (31.9?10.1 yrs) who ran ≥12 mi/wk, participated. Interventions: Two groups were formed based on presence of ITBS: ITBS injured leg (ITBS; n=16) and control dominant leg (CON; n=15). Hip abduction (ABD) and adduction (ADD) were measured bilaterally using a hand-held dynamometer (HHD). Three repeated peak isometric strength trials were taken with a fourth trial if the variance was >10%. Main Outcome Measures: ABD and ADD (Kg) were calculated as the mean of 3 trials with the lowest variance. Mean discrete and ratio values were normalized to body weight and expressed as a percentage (%BW). Discrete values were ABD strength, and the ratio was ABD:ADD. A T-test was used to analyze group differences (ITBS and CON) for discrete ABD strength and the ABD:ADD ratio.
Results: No significant effect was found for discrete ABD strength (ITBS: 19.2 ? 1.94 %BW, CON: 22.9 ? 1.83 %BW, P = 0.18) or strength as a ratio of ABD to ADD (ITBS: 0.99, CON: 1.01, P = 0.81).
Conclusions: Female runners with ITBS displayed no frontal plane hip strength asymmetry when tested in the supine position with belt fixation. The results of this study are in contrast to research which used a side-lying position for strength testing
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NewsBot · Oct 1, 2016

The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome
Allison M. Brown, Rebecca A. Zifchock, Howard J. Hillstrom, Jinsup Song, Carole A. Tucker
Clinical Biomechanics; in press

Highlights
•Injured runners decrease stance phase hip adduction angles after a fatiguing run.
•Stance phase hip internal rotation was not affected by a fatiguing run in injured runners.
•Fatigue did not affect hip joint coupling values differently in injured runners.
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Background
Altered hip and knee kinematics and joint coupling have been documented in runners with iliotibial band syndrome. Symptoms often present themselves after several minutes of running, yet the effect of fatigue warrants further exploration. The purpose of this study was to determine the effect of a run to fatigue in runners with iliotibial band syndrome, as compared to healthy controls.

Methods
Twenty uninjured and 12 female runners with iliotibial band syndrome performed a treadmill run to fatigue. Prior-to and following a run to fatigue, overground running data were collected. Variables of interest included stance phase: peak hip adduction and internal rotation, peak hip abductor and external rotator joint moments and frontal-sagittal plane hip and knee joint coupling.

Findings
Fatigue resulted in decreased peak hip adduction angles in injured runners. Fatigue did not affect injured runners differently than controls with respect to the remaining variables. Coupling differences did not exist between healthy and injured runners with respect to the loading or propulsive phases of stance.

Interpretation
While clinicians often strengthen hip abductor muscles and provide gait re-training to decrease stance phase hip adduction, our results suggest that, when exerted, female runners with iliotibial band syndrome independently modify their running gait to decrease hip adduction, potentially as a result of pain. Fatigue did not have an effect on the remaining study variables. It is possible that reducing the length of the iliotibial band through minimizing hip adduction reduces pain, but the other variables examined are not sensitive to this phenomenon
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NewsBot · Jun 13, 2017

Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome
Jocelyn F. Hafer et al
Clinical Biomechanics; Article in Press

Highlights
•Coordination variability was similar between uninjured and injured runners.
•Exertion had minimal impact on coordination variability in all runners.
•Presence or absence of pain did not appear to alter coordination variability.
•Runners with iliotibial band syndrome had variable responses to the run to exertion.
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Abstract
Background
Iliotibial band syndrome is a common overuse running injury which results in altered mechanics. While injuries alter discrete mechanics, they may also cause a change in coordination variability, the stride-to-stride organization of runners' movement patterns. Uninjured and injured runners may experience a change in coordination variability during a run to exertion due to fatigue, pain, or a combination of these factors. The aim of the current study was to determine if runners with iliotibial band syndrome and uninjured runners display different segment coordination variability across the course of a run to exertion.

Methods
3D kinematics were collected as 13 uninjured runners and 12 runners with iliotibial band syndrome ran on a treadmill. A modified vector coding technique was used to calculate coordination variability during stance for segment couples of interest. Coordination variability was compared between uninjured and injured runners at the beginning and end of the run. The influence of pain on coordination variability was also examined.

Findings
There were no differences in coordination variability at the beginning or end of the run between uninjured runners and those with iliotibial band syndrome. The change in coordination variability due to the run was not different between uninjured runners, injured runners who experienced no change in pain, and injured runners who did experience a change in pain.

Interpretation
Runners do not constrain the patterns of segment motion they use in response to exertion nor does it appear that occurrence of pain during running results in a differential change in coordination variability.
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NewsBot · Jan 30, 2018

Dynamic Varus and the Development of Iliotibial Band
Syndrome
Christopher D. Stickley et al
Journal of Athletic Training 2018;53(1):000–000

Context: Although the risk of osteoarthritis development
after acute knee injury has been widely studied, the long-term
consequences of knee overuse injury are not well understood.
Objective: To identify the relationship between gait-related
risk factors osteoarthritis and the development of iliotibial band
syndrome (ITBS) in members of a single University Army
Reserve Officers’ Training Corps (ROTC) unit.
Design: Prospective cohort study.
Setting: Biomechanics laboratory.
Patients or Other Participants: Sixty-eight ROTC cadets
undergoing standardized physical fitness training.
Intervention(s): Three-dimensional lower extremity kinematics
(240 Hz) and kinetics (960 Hz) were collected for 3
bilateral trials during shod running at 4.0 m/s 6 10%. Injury
tracking was conducted for 7 months of training.
Main Outcome Measure(s): Biomechanical variables, including
varus thrust and knee-adduction moment, were compared
between the injured and control groups.
Results: Twenty-six cadets with no history of overuse injury
served as the control group, whereas 6 cadets (7 limbs) who
developed ITBS that required them to modify their training
program or seek medical care (or both) served as the injured
group. Maximum varus velocity was higher (P ¼ .006) and
occurred sooner during stance (P¼.04) in the injured group than
in the control group, indicating greater varus thrust. Maximum
knee-varus angle and maximum knee-adduction moment were
higher (P ¼ .02 and P ¼ .002, respectively) and vertical stiffness
was lower (P ¼ .03) in the injured group.
Conclusions: Measures of dynamic varus stability appeared
to be altered in individuals who developed ITBS.
Biomechanical knee variables previously identified as increasing
the risk for knee osteoarthritis were also associated with the
development of ITBS in healthy adults.
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NewsBot · Apr 27, 2018

Differences in knee and hip adduction and hip muscle activation in runners with and without iliotibial band syndrome
Robert L. Baker, PT, PhD, Richard B. Souza, PT, PhD, Mitchell J. Rauh, PhD, Michael Fredericson, MD, Michael D. Rosenthal, PT, DSc
PM&R; Article in Press

Background
Iliotibial Band Syndrome has been associated with altered hip and knee kinematics in runners. Prior studies have recommended further research on neuromuscular factors at the hip. The frontal plane hip muscles have been a strong focus in strength comparison, but not for electromyography investigation.

Objective
To compare hip surface electromyography, and frontal plane hip and knee kinematics, in runners with and without iliotibial band syndrome.

Design
Observational cross sectional study, 30 participants were tested for motion capture at the hip and knee and muscle activation in the lateral and posterior hip.

Setting
Biomechanics research laboratory within a university.

Participants
Thirty subjects were recruited consisting of 15 injured runners with iliotibial band syndrome and 15 gender, age and body mass index matched controls. In each group, eight were male runners and seven were female runners. Inclusion criteria for the injured group were pain within two months related to iliotibial band syndrome and a positive Noble compression test. Participants were excluded if they reported other lower extremity diagnoses within the last year or active lower extremity or low back pain not related to iliotibial band syndrome. Controls were excluded if they reported a history of ITBS. Convenience sampling was used based on referrals from local running clinics and orthopedic clinics.

Methods
Three-dimensional motion capture was performed using ten high speed cameras synchronized with wireless surface electromyography during a 30 minute run. The first data point was at three minutes using a constant speed of 2.74 meters per second. A second data point was at 30 minutes using a self-selected pace by the participant to allow for a challenging run until completion at 30 minutes.

Main Outcome Measurements
Motion capture was reported as peak kinematic values from heel strike to peak knee flexion for hip adduction and knee adduction. Surface electromyography was reported as a percentage of maximal voluntary contraction for the gluteus maximus, gluteus medius and tensor fascia latae muscles.

Results
Injured runners demonstrated increased knee adduction compared to control runners at 30 minutes (p=.002, control = -1.48°, injured = 3.74°). Tensor fasciae latae muscle activation in injured runners was increased compared to control runners at three minutes (p=.017, control = 7% MVIC, Injured = 11% MVIC).

Conclusion
The results of this study suggest that lateral knee pain in runners localized to the distal iliotibial band is associated with increased knee adduction at 30 minutes. Increased Tensor Fasciae Latae muscle activation at three minutes is noted but more investigation is needed to better understand the clinical meaning. These findings are consistent with but not conclusive evidence supporting the theory that neuromuscular factors of the hip muscles may contribute to increased knee adduction in runners with iliotibial band syndrome. We advise caution using these findings to support treatments intended to modify TFL activation given the small differences of four percent in muscle activation. Increased knee adduction in runners at 30 minutes was over five degrees and beyond the minimal detectable difference. Additional research is needed to confirm if the degree of knee adduction changes earlier versus later in a run, and whether or not fatigue is a clinically relevant factor.
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NewsBot · Sep 22, 2018

Extensions of lower end of iliotibial tract and its clinical significance
Rupa Chhaparwal, Poonam Gaur,Nidhi Chhaparwal
Indian Journal of Basic and Applied Medical Research; March 2018: Vol.-7, Issue- 2, P. 208-213
208

Introduction: Iliotibial tract (ITT) is a combination of fascia, muscles and ligament. It is present only in human beings, it
stabilizes the knee both in extension and in partial flexion; and is, therefore, used constantly during walking and running.
Aims & Objectives:Iliotibial Band Syndrome is a common thighinjury, associated with running. Clinical studies have
emphasized the role of the ITT on knee mechanics. Anatomical and morphological study of the lower end of ITT may help
in understanding its role to stabilize the knee joint during flexion and extension.
Looking to the applied significance of ITT in general and its lower end in particular; and added to this the fact that no such
data is available for central Indian population. This work was undertaken to study the morphology and morphometry of the
lower end of ITT and its various extensions.
Material & Methods:Thirty-four lower limbs (17right & 17 Left) for this study were obtained from the department of
anatomy. ITT was identified on anterolateral aspect of thigh. Its distal attachments were dissected on to patella, tibia, fibula.
Observations & results: The width (2.7cm) and thickness (2.25 mm) of ITT were measured at the level of upper border of
patella. We also measured width of the slips going towards patella (1.7cm) and Gerdy’s tubercle (1.25 cm).
Conclusion: The findings of the present work, besides, enhancing anatomical knowledge of the region may be of help to
orthopedicians and physiotherapists in the diagnosis and management of lateral knee pain.
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Stanley · Oct 22, 2018

I first suffered from Iliotibial band syndrome in 1975 or 1976. At the time it was addressed as lateral knee pain. It responded in my case with a heel lift on the ipsilateral side. When I was at the Cleveland Foot Clinic in the Sports Medicine department, I would supervise the treatment of 40 runners per day. In most of the cases of IT Band syndrome responded to a 1/4" heel lift on the ipsilateral side. There are really two conditions that occur there which is a friction syndrome and a tension syndrome. The cases that did not respond had an extreme amount of tightness of the Tensor fascia lata.

mike weber · Oct 23, 2018

There is no Friction. One of the big myths. There is compression of a fat and nerve bundle

NewsBot · Nov 28, 2018

Sex difference on strain of iliotibial band
Dayoon Kim et al
JPFSM

[Aims] Approximately 12% of runners suffers from iliotibial band
syndrome (ITBS) annually, and it is reported that women sustain
the ITBS by twice than men. Abnormal increase in the compression
forces between the iliotibial band (ITB) and lateral femoral epicondyle
causes irritation and inflammation in the tissue deep to the
ITB, and an increase of the strain of ITB suggested developing factors
of ITBS. However, the relationship between sex and the strain
of ITB was uncleared. Thus, the aim of this study was to determine
the difference in the strain of ITB of sex. [Methods] Twelve healthy
recreational athletes (6 men, 6 women) volunteered in this study.
We measured the strain of distal ITB using Shear wave elastography
with non-weight bearing (NWB) and ITB strain with weight bearing
(WB). Two-way repeated ANOVA followed with post-hoc Bonferroni’s
test was performed for the comparison of the strain of ITB
in 2 postures between 2 groups. [Results] On WB posture, women
group showed greater strain than men group (p < 0.05), however,
men group showed greater strain on NWB posture (p < 0.05). Both
men and women groups have a significant difference in the strain of
ITB between WB and NWB postures. [Conclusion] Women showed
greater strain during weight bearing in this study, it is suggested that
the increased strain of ITB are related to the occurrence of ITBS.
It could be considered that sex differences in alignment of lower
extremities during weight bearing could influence on the strain of
ITB. Further study is required to examine the contributing factors to
increased ITB strain such as muscle activity or joint angles
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NewsBot · Dec 2, 2018

EFFECTS OF RUNNING BIOMECHANICS ON THE OCCURRENCE OF ILIOTIBIAL
SYNDROME IN MALE RUNNERS — A PROSPECTIVE STUDY
Peixin Shen et al
36th Conference of the International Society of Biomechanics in Sports, Auckland, New Zealand, September 10-1

This study aimed to determine the gait characteristics that easily induce ITBS and
explore the gait changes after the occurrence of ITBS. 30 healthy male runners
participated in our study, 15 in ITBS and control group respectively. All participants
underwent two gait trials, namely, before the first day of their routine running and
after 8 weeks. After 8 weeks of running, the ITBS group exhibited greater peak
anterior pelvic tilt and hip flexion angle than the control group. The ITBS group
showed increased peak trunk inclination angle, whereas the control group
demonstrated lower peak hip flexion and peak hip adduction than those at the
beginning of running. Decreased peak hip flexion and peak hip adduction angle
was a gait adjustment strategy that could be used to avoid ITBS occurrence.
Excessive trunk posture and pelvic activity during running are also ITBS risk
factors.
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NewsBot · Feb 11, 2019

Hip muscle response to a fatiguing run in females with iliotibial band syndrome
Allison M.BrownabRebecca A.ZifchockcMarkLenhoffbJinsupSongdHoward Hillstromb
Human Movement Science; Volume 64, April 2019, Pages 181-190

Highlights
•The gluteus medius muscle may be less resistant to fatigue in females with ITBS.
•Gluteus medius strength was not different between females with and without ITBS.
•Gluteus medius strength didn’t respond differently to fatigue in females with ITBS.
•TFL and gluteus medius onset is not affected by fatigue in females with ITBS.
Click to expand...

Impaired hip muscle function has often been cited as a contributing factor to the development of iliotibial band syndrome (ITBS), yet our full understanding of this relationship is not well established. The objective of this study was to examine the effect of fatigue on hip abductor muscle function in females with ITBS. Female runners, 20 healthy and 12 with a current diagnosis of ITBS, performed a treadmill run to fatigue. Prior-to and following the run to fatigue, gluteus medius strength and median frequency values (an indicator of fatigue resistance) were measured. Additionally, onset activation timing of the gluteus medius and tensor fascia latae was measured during overground running. Both healthy and injured runners demonstrated decreased gluteus medius strength following the run to fatigue (p = 0.01), but there was no interaction between groups (p = 0.78). EMG onset activation timing did not differ between groups for the gluteus medius (P = 0.19) and tensor fascia latae muscles (P = 0.52). Injured runners demonstrated decreased gluteus medius initial median frequency values suggestive of fatigue (P = 0.01). These findings suggest that the gluteus medius muscle of female runners with ITBS does not demonstrate gross strength impairments but does demonstrate less resistance to fatigue. Clinicians should consider implementation of a gluteus medius endurance training regimen into a runner’s rehabilitation program.
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