Figure - uploaded by Maryke Louw
Content may be subject to copyright.

Source publication
Article
Full-text available
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 ever...

Similar publications

Article
Full-text available
[Purpose] The purpose of this study was to examine the correlation between weight-bearing (WB) and non-WB ankle dorsiflexion (DF) range of motion (ROM) and ankle movement during gait, including heel-rise time and ankle DF at heel-rise. [Subjects and Methods] Thirty healthy male subjects were recruited for this study. Ankle DF ROM of both feet was m...

Citations

... It is the first systematic review that focuses on BRFs for the most prevalent ROIs while using the same inclusion and exclusion criteria for all considered injuries. Previous reviews either did not report overuse injuries for specific types of injuries [18] or focused on a single overuse injury [15,[86][87][88][89][90][91][92][93][94]. Further, some reviews focused only on prospective studies [18]. ...
Article
Full-text available
Background Running overuse injuries (ROIs) occur within a complex, partly injury-specific interplay between training loads and extrinsic and intrinsic risk factors. Biomechanical risk factors (BRFs) are related to the individual running style. While BRFs have been reviewed regarding general ROI risk, no systematic review has addressed BRFs for specific ROIs using a standardized methodology. Objective To identify and evaluate the evidence for the most relevant BRFs for ROIs determined during running and to suggest future research directions. Design Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236,832). Data Sources PubMed. Connected Papers. The search was performed in February 2021. Eligibility Criteria English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic BRF. A BRF needed to be identified in at least one prospective or two independent retrospective studies. BRFs needed to be determined during running. Results Sixty-six articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some BRFs appeared for several ROIs, most BRFs were specific for a particular ROI. Most BRFs derived from lower-extremity joint kinematics and kinetics were located in the frontal and transverse planes of motion. Further, plantar pressure, vertical ground reaction force loading rate and free moment-related parameters were identified as kinetic BRFs. Conclusion This study offers a comprehensive overview of BRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. We identified limited evidence for most ROI-specific risk factors, highlighting the need for performing further high-quality studies in the future. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
... 10 Importantly, several of these measures have been shown to be related to ACL injury 25 as well as other lower extremity injuries and conditions, including chronic ankle instability 32 and iliotibial band syndrome. 33 Nonetheless, the results from the present investigation, when using an injury definition that included all lower extremity injuries irrespective of mechanism in a population of female collegiate athletes across multiple sports, suggest that the total LESS score may not be associated with an increased odds of injury. As previously stated, it is reasonable to propose that the methodological heterogeneity across studies may be the reason for the conflicting findings supporting LESS's predictive value for injury. ...
Article
Full-text available
Background: The Landing Error Scoring System (LESS) is a standardized tool used to identify aberrant biomechanical movement patterns during a jump-landing task. Prior authors have examined the value of the LESS in identifying ACL injury risk in athletic populations. Yet, no study has evaluated the association between LESS performance and incidence of any type of lower extremity injury in female collegiate athletes across multiple sports. Purpose: The purpose of this study was to examine the association between LESS performance as measured with a markerless motion-capture system and lower extremity injury in female collegiate athletes. Study design: Prospective cohort study. Methods: One hundred and ten DI female collegiate athletes (basketball, n=12; field hockey, n=17; gymnastics, n=14; lacrosse, n=27; softball, n=23; volleyball, n=17) completed a jump-landing test prior to the start of their sport seasons. The LESS was automatically scored using a Microsoft Kinect sensor and Athletic Movement Assessment software (PhysiMax®). Participants were tracked throughout one competitive season for incidence of time-loss lower extremity injury. A Receiver Operating Characteristic curve determined the optimal cutpoint for the total LESS score for predicting injury. Pearson's Chi squared statistics examined the association between injury and LESS total scores >5. The Fisher exact test evaluated group differences for the frequency of receiving an error on individual LESS test items. Results: Female collegiate athletes with LESS scores >5 were not more likely to be injured than those with scores ≤5 (χ2=2.53, p=0.111). The relative risk of injury to this group was 1.78 (95% CI=0.86, 3.68) while the odds ratio was 2.10 (95% CI=0.83, 5.27). The uninjured group was more likely to receive an error on lateral trunk flexion at initial contact than the injured group (p=0.023). Conclusion: The LESS total score was not associated with an increased odds of lower extremity injury in this cohort of female collegiate athletes. Future studies to examine the association between individual LESS item scores and injury are warranted. Level of evidence: 1b.
... A systemic literature review study aimed at identifying the biomechanical variables involved in the etiology of ITBS [32]. The authors demonstrated that runners with a history of ITBS appear to exhibit decreased hip adduction angles at heel strike while exhibiting decreased total abduction/adduction ROM at the hip during stance phase. ...
... This might imply that a single difference at one level, unilaterally, might be insignificant, however, it may become significant if the sum of all deviations in all joints, in more than one plane of motion, leads to a significant total change in the lower limb alignment, reflected by the GPS. This may explain the conflicting findings of several researchers who found no correlation between single kinematic deviations and injuries [32,38]. Ceyssens et al. in their systematic review, found no conclusive biomechanical mechanism to explain the development of running related injuries [38] and concluded that current prospective evidence relating biomechanical variables to running-related injury risk is scarce and inconsistent, with findings largely dependent on the population and injuries being studied. ...
... Ceyssens et al. in their systematic review, found no conclusive biomechanical mechanism to explain the development of running related injuries [38] and concluded that current prospective evidence relating biomechanical variables to running-related injury risk is scarce and inconsistent, with findings largely dependent on the population and injuries being studied. Furthermore, Louw and Deary [32] reported that it is unlikely that abnormal biomechanics of the foot or tibia are responsible for increasing tension in the ITB; there was most likely a more proximal cause. They stated that their review had very limited prospective evidence, and therefore, the results should be interpreted with caution [32]. ...
Article
Full-text available
Objective: The goal of this study was to utilize Gait Profile Score (GPS) and Gait Deviation Index (GDI), to assess its capability of differentiating between injured and non-injured runners. Design: In total, 45 long-distance runners (15 non-injured, 30 injured), diagnosed with one of the following running related injuries, patella femoral pain syndrome, iliotibial pain syndrome, and medial tibial stress syndrome, were recruited. Methods: Data were obtained from a running analysis gait laboratory equipped with eight infrared motion-capturing cameras and a conventional treadmill. Running kinematics were recorded according to the Plug-In Gait model, measuring running deviations of the pelvis and lower extremities at a sampling rate of 200 Hz. GPS and GDI were calculated integrating pelvis and lower limb kinematics. Movement Analysis Profile results were compared between injured and non-injured runners. The non-parametric two-sample Wilcoxson test determined whether significant kinematic differences were observed. Results: Total GPS score significantly differed between the injured and non-injured runners. Not all running kinematics expressed by GDI differed between groups. Conclusions: GPS score was capable of discriminating between the injured and non-injured runners’ groups. This new running assessment method makes it possible to identify running injuries using a single numerical value and evaluate movements in individual joints.
... As in patellofemoral pain syndrome, the proximal hipabductor and external-rotator muscles need to be properly recruited and activated appropriately over time to eccentrically stabilize the femur (and, thus, the tibiofemoral joint) in the impingement zone (208-308 of knee flexion) of 1-legged stance during walking and running. 2,27,30,32,35,39 Quite simply, the deltoid of the lower extremity, or the proximal muscles that fuse into the ITB, along with the gluteus medius and minimus and piriformis muscles, need to work constantly to avert problematic degrees of femoral adduction and internal rotation to prevent ITB fat pad impingement from occurring every time the foot hits the ground. ...
Article
Full-text available
The current paradigm of insidious lateral knee pain involving the iliotibial band (ITB) in repetitive knee-flexion activities has been termed ITB friction syndrome since 1975. The original model for ITB pain was based on a limited or incorrect understanding of the relevant anatomy, biomechanics, and tissue science, which gradually led to a plethora of frustrating and ineffective interventional strategies. Mounting evidence from arthroscopic, cadaveric, and biomechanical studies, as well as from diagnostic imaging and histologic reports, has helped deconstruct this long-held paradigm for ITB-related pathology and treatment. By outlining the historical paradigm for our understanding of ITB pain and gathering newer evidence through extensive research, I will synthesize the available data in this clinical update to present an updated, more informed model for understanding insidious-onset ITB-related pathology and treating patients. The result is called ITB impingement syndrome.
... It is the first systematic review that focuses on RRRFs for the most prevalent ROIs while using the same inclusion and exclusion criteria for all considered injuries. Previous reviews either did not report overuse injuries for specific types of injuries [18] or focus on a single overuse injury [15, [80][81][82][83][84][85][86][87][88]. Further, some reviews did only focus on prospective studies [18]. ...
Preprint
Objective To identify and evaluate the evidence of the most relevant running-related risk factors (RRRFs) for running-related overuse injuries (ROIs) and to suggest future research directions. Design Systematic review considering prospective and retrospective studies. (PROSPERO_ID: 236832) Data sources Pubmed. Connected Papers. The search was performed in February 2021. Eligibility criteria English language. Studies on participants whose primary sport is running addressing the risk for the seven most common ROIs and at least one kinematic, kinetic (including pressure measurements), or electromyographic RRRF. An RRRF needed to be identified in at least one prospective or two retrospective studies. Results Sixty-two articles fulfilled our eligibility criteria. Levels of evidence for specific ROIs ranged from conflicting to moderate evidence. Running populations and methods applied varied considerably between studies. While some RRRFs appeared for several ROIs, most RRRFs were specific for a particular ROI. The biomechanical measurements performed in many studies would have allowed for consideration of many more RRRFs than have been reported, highlighting a potential for more effective data usage in the future. Conclusion This study offers a comprehensive overview of RRRFs for the most common ROIs, which might serve as a starting point to develop ROI-specific risk profiles of individual runners. Future work should use macroscopic (big data) approaches involving long-term data collections in the real world and microscopic approaches involving precise stress calculations using recent developments in biomechanical modelling. However, consensus on data collection standards (including the quantification of workload and stress tolerance variables and the reporting of injuries) is warranted.
... 10,11 The exact underlying causes of ITBS have been debated. 3,7,[12][13][14][15][16][17][18] Investigators concluded that the syndrome's etiology may be multifactorial in nature. Selected authors have suggested an anterior-posterior ITB friction over the lateral femoral epicondyle producing inflammation of either the ITB tissue itself or highly-innervated tissues located deep to the ITB. ...
Presentation
iii. Background-Clinical stretching is frequently recommended for iliotibial band syndrome management. Current literature lacks conclusive findings regarding isolated iliotibial band tissue elongation and stiffness behaviors. Applying clinical-grade stretching force results to iliotibial band tissue behavior is thus challenging. iv. Purpose-The purpose of this descriptive in vitro laboratory study is to determine isolated iliotibial band tissue tensile behaviors during tension-to-failure testing and to relate the results to previously reported iliotibial band stretch findings. v. Methods-Ten isolated un-embalmed iliotibial band specimens were exposed to tension-to-failure testing using a 10kN material testing system. Peak load, load at yield point, and ultimate failure load were measured in Newtons. Corresponding absolute (mm) and relative (%) tissue deformation was recorded. Load-deformation curves were established to calculate iliotibial band stiffness (N/mm). vi. Results-A mean peak load of 872.8 ± 285.9N and resulting 9.0 ± 3.9% tissue deformation from initial length was recorded. An 805.5 ± 249.7N mean load at yield point and resulting 7.0 ± 1.9% tissue deformation was observed. A 727.6 ± 258.4N mean load was recorded directly prior to ultimate tissue failure. Mean tissue deformation at ultimate failure was 11.3 ± 4.2%. Mean iliotibial band system stiffness was 27.2 ± 4.5N/mm. vii. Conclusion-The iliotibial band can withstand substantial tensile forces. Clinical stretching forces likely fall within the load-deformation curve elastic region and may not result in permanent iliotibial band tissue deformation. Sustained elongation resulting from stretching the ITB may require substantial patient compliance. Future studies should investigate potential underlying factors related to positive symptom relief from iliotibial band stretching that include immunological responses, fluid accumulation, altered proprioception, and pain perception. viii. Implications-Although few earlier studies suggest that short-term clinical stretching unlikely results in appreciable iliotibial band tissue adaptation, stretching exercises to the iliotibial band are still the most frequently recommended management strategy to improve clinical symptoms, hip range of motion and subsequent lower extremity sensorimotor control during dynamic movements. It becomes clear on the basis of our study that the underlying mechanism of symptom improvement in ITBS after stretching is unlikely due to appreciable tissue adaptation but must be due to some other, yet unknown factor. Future investigations are necessary to understand the underlying mechanism behind this effect in order to treat patients with ITBS purposefully and thus avoid long standing impairments and/or recurrence of symptoms.
... As in patellofemoral pain syndrome, the proximal hipabductor and external-rotator muscles need to be properly recruited and activated appropriately over time to eccentrically stabilize the femur (and, thus, the tibiofemoral joint) in the impingement zone (208-308 of knee flexion) of 1-legged stance during walking and running. 2,27,30,32,35,39 Quite simply, the deltoid of the lower extremity, or the proximal muscles that fuse into the ITB, along with the gluteus medius and minimus and piriformis muscles, need to work constantly to avert problematic degrees of femoral adduction and internal rotation to prevent ITB fat pad impingement from occurring every time the foot hits the ground. ...
Article
Full-text available
The current paradigm of practice concerning insidious lateral knee pain involving the iliotibial band in repetitive knee flexion activities has been presented as iliotibial band friction syndrome since 1974. Renne's original model for ITB pain was based on a limited or incorrect understanding of the relevant anatomy, biomechanics, and tissue science, which gradually led to a plethora of frustrating and ineffective interventional strategies. Mounting evidence from arthroscopic, cadaveric and biomechanical studies, as well as from diagnostic imaging and histology reports helps deconstruct this long-held paradigm for ITB related pathology and treatment. Using an archeological approach to gather relevant evidence, this clinical update synthesizes the available data in order to present an updated, more informed model for understanding and treating insidious onset related ITB related pathology. The result is a new, more informed paradigm called Iliotibial Band Impingement Syndrome.
... 7 Numerous studies including several literature reviews have been conducted on ITBS etiology which is commonly acknowledged as "multifactorial". [8][9][10][11] Since Renne's study it has been widely believed that friction resulting from the ITB sliding over the lateral femoral epicondyle (LFE) of the femur during repetitive knee flexion-extension is the major cause of pain. 12 On the contrary, anatomical observations indicate that the ITB is securely anchored onto the distal femur in a way that the ITB cannot create frictional forces by moving forward and backward over the LFE. ...
Article
Background: Despite abundant literature, the treatment of iliotibial band syndrome (ITBS) in cyclists remains complicated as it lacks evidence-based recommendations. Purpose: The aim of this study was to develop a musculoskeletal modelling approach that investigates three potential biomechanical determinants of ITBS (strain, strain rate and compression force) and to use this approach to investigate the effect of saddle setback. Design: Cross-sectional. Methods: An existing 3D lower-body musculoskeletal model was adapted to cycling and to the computation of three putative pathomechanisms responsible for ITBS: ITB strain, ITB strain rate, and compression force between ITB and the lateral femoral epicondyle (LFE). Lower limb kinematics recorded from ten well-trained healthy cyclists served as input data of the model. Cyclists pedalled at a steady state (90rpm and 200W) on an ergometer, and three different saddle setback conditions were tested. The theoretical combined influence of hip and knee joint angles on ITBS was investigated and analysed through the lens of individual pedalling technique. Results: ITB-LFE compression force was the only parameter significantly affected by saddle setback and supports the hypothesis that compression force is likely to be a determinant factor in ITBS etiology. Furthermore, results showed that ITB-LFE compression force increases in individuals whose pedalling technique exacerbates hip extension-adduction and/or knee extension-internal rotation. Conclusion: This approach has the potential to be advantageously implemented as an additional tool to help diagnose/correct potentially harmful sport techniques and optimize equipment setup/design. Level of evidence: 3b.
... This indicates the possibility that differences may exist in other axes of movement, different to those concerning flexion-extension and the movement patterns of other joints 14 . Excessive hip adduction 12,[15][16][17][18][19][20] and knee internal rotation 7,11,12,18,20 have been cited as risk factors for suffering ITBS. In exchange, no differences have been found in hip adduction or in knee internal rotation in runners with current symptoms [21][22][23][24][25] . ...
... This indicates the possibility that differences may exist in other axes of movement, different to those concerning flexion-extension and the movement patterns of other joints 14 . Excessive hip adduction 12,[15][16][17][18][19][20] and knee internal rotation 7,11,12,18,20 have been cited as risk factors for suffering ITBS. In exchange, no differences have been found in hip adduction or in knee internal rotation in runners with current symptoms [21][22][23][24][25] . ...
Article
A study was performed to examine differences in hip and thigh muscle activation in male and female runners with and without iliotibial band syndrome (ITBS). The muscle activation of 21 runners (14 with ITBS and 7 healthy) was recorded during a run. No significant differences were observed in mean muscle activation between injured male and female runners. In contrast, in female runners with ITBS, there were differences in activation between the vastus lateralis and the tensor fascia lata (p<0.05), and between the vastus lateralis and the biceps femoris (p<0.05). With regard to male runners with ITBS, differences in activation were observed between the gluteus maximus and the 2 tensor fascia lata, and between the gluteus maximus and the biceps femoris (p<0.05). These findings contribute to a better understanding of iliotibial band syndrome and may be useful for designing of targeted treatments for the ITBS. KEY WORDS: electromyography, knee, iliotibial band syndrome. RESUMEN Esta investigación examinó las diferencias en la activación muscular en los músculos de la cadera y muslo en corredores y corredoras con y sin el síndrome de la banda iliotibial (SFBI). Se registró la actividad neuromuscular en 21 corredores durante la carrera (14 SFBI y 7 sanos). No se han encontrado diferencias significativas en la actividad muscular media entre los corredores y corredoras lesionados. Sin embargo, en el caso de las corredoras lesionadas, se han encontrado diferencias entre el vasto lateral y el tensor fascia lata, y entre el vasto lateral y el bíceps femoral (p<0,05 en ambos casos). En el caso de los corredores hombres lesionados, se han encontrado diferencias entre el glúteo mayor y el tensor fascia lata, y entre el glúteo mayor y el bíceps femoral (p<0,05 en ambos casos). Estos hallazgos proporcionan un mayor entendimiento de la lesión y ayudarían a un tratamiento más específico. PALABRAS CLAVE: electromiografía, rodilla, síndrome de la banda iliotibial.
... 10,11 The exact underlying causes of ITBS have been debated. 3,7,[12][13][14][15][16][17][18] Investigators concluded that the syndrome's etiology may be multifactorial in nature. Selected authors have suggested an anterior-posterior ITB friction over the lateral femoral epicondyle producing inflammation of either the ITB tissue itself or highly-innervated tissues located deep to the ITB. ...
Article
Background: Clinical stretching is frequently recommended for iliotibial band syndrome management. Current literature lacks conclusive findings regarding isolated human iliotibial band tissue elongation and stiffness behaviors. Applying clinical-grade stretching force results to iliotibial band tissue behavior is thus challenging. Purpose: This study's objectives were to determine isolated iliotibial band tissue tensile behaviors during tension-to-failure testing and to relate the results to previously reported iliotibial band stretch findings. Study design: Descriptive in vitro laboratory study. Methods: Ten isolated un-embalmed iliotibial band specimens were exposed to tension-to-failure testing using a 10kN material testing system. Peak load, load at yield point, and ultimate failure load were measured in Newtons. Corresponding absolute (mm) and relative (%) tissue deformation was recorded. Load-deformation curves were established to calculate iliotibial band stiffness (N/mm). Results: A mean peak load of 872.8 ± 285.9N and resulting 9.0 ± 3.9% tissue deformation from initial length was recorded. An 805.5 ± 249.7N mean load at yield point and resulting 7.0 ± 1.9% tissue deformation was observed. A 727.6 ± 258.4N mean load was recorded directly prior to ultimate tissue failure. Mean tissue deformation at ultimate failure was 11.3 ± 4.2%. Mean iliotibial band system stiffness was 27.2 ± 4.5N/mm. Conclusion: The iliotibial band can withstand substantial tensile forces. Clinical stretching forces likely fall within the load-deformation curve elastic region and may not result in permanent iliotibial band tissue deformation. Sustained elongation resulting from stretching the ITB may require substantial patient compliance. Future studies should investigate potential underlying factors related to positive symptom relief from iliotibial band stretching that include immunological responses, fluid accumulation, altered proprioception, and pain perception. Level of evidence: 3.