Iliotibial Band Origin Tendinopathy Is an Underrecognized Cause of Anterolateral Hip Pain: A Narrative Review and Clinical Commentary.

ABSTRACT: Hip pain is a common concern among athletes. With gluteal tendinopathy, femoroacetabular impingement, and osteoarthritis predominating sports medicine and musculoskeletal practices, less common etiologies may be overlooked. Complex pelvic anatomy and variable pain referral patterns may make identifying an accurate diagnosis challenging. Employing a systematic approach to evaluation and having a thorough understanding of hip region anatomy are essential. A potentially overlooked cause of anterolateral hip pain is iliotibial band origin tendinopathy. Patients often present with pain around the anterolateral hip and tenderness to palpation at the anterolateral iliac crest. While patients with iliotibial band origin tendinopathy usually respond to nonsurgical intervention, there is little literature to guide evaluation and treatment, highlighting a gap in the recognition of this condition. The purpose of this narrative review is to describe the anatomy of the proximal iliotibial band origin, outline the clinical diagnosis and imaging findings of ITBOT, and summarize current treatment options.

[Research progress of lower limb muscle strength training in the treatment of lliotibial band syndrome].

Iliotibial band syndrome (ITBS), as an overused injury of the lower extremities, has developed into a common cause of lateral knee pain. At present, the treatment of ITBS includes drug therapy, muscle strength training, physical therapy, and surgical treatment. Among these methods, physical therapy, drug therapy, and surgical treatment can only alleviate the symptoms of patients. As a safe and effective treatment, lower limb muscle strength training can improve patients' muscle strength, correct abnormal gait, and reduce the recurrence rate of the disease by paying attention to the dynamic changes of patients' recovery process. At present, the pathogenesis of ITBS remains unclear, and the treatment methods are not unified. It is necessary to further study the biomechanical factors related to the lower extremities and develop more scientific and comprehensive muscle strength training methods.

Síndrome de la banda iliotibial / Iliotibial band syndrome

Introducción: El dolor en la rodilla responde a múltiples causas. Entre ellas se encuentra el síndrome de la banda iliotibial que afecta, principalmente, a pacientes jóvenes que practican cierta actividad deportiva. Objetivo: Actualizar y ofrecer información sobre el síndrome de la banda iliotibial. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 92 días (01 de julio al 30 de septiembre de 2020). Se emplearon las siguientes palabras: iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. Se realizó una revisión bibliográfica de un total de 186 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 40 citas seleccionadas para realizar la revisión, 38 de los últimos cinco años. Desarrollo: Se mencionan las características anatómicas más importantes relacionadas con la banda iliotibial. Se refiere a las maniobras empleadas, así como los exámenes imagenológicos de mayor utilidad. Se exponen las principales entidades implicadas en el diagnóstico diferencial. Con relación al tratamiento se mencionan las modalidades conservadoras y quirúrgicas. Conclusiones: El síndrome de la banda iliotibial es una enfermedad que tiene como característica fundamental dolor lateral de la rodilla el cual aumenta con la actividad física. El tratamiento conservador constituye la primera línea y el quirúrgico está justificado a los seis meses de respuesta limitada a la primera modalidad del enfrentamiento terapéutico(AU)

Introduction: Knee pain responds to multiple causes such as the iliotibial band syndrome that mainly affects young patients who practice certain sports activities. Objective: To update and offer information on iliotibial band syndrome. Methods: The search and analysis of the information was carried out in a period of 92 days - from July 1 to September 30, 2020, with the words iliotibial band syndrome, iliotibial band friction syndrome AND lateral knee pain. A bibliographic review of 186 articles published in PubMed, Hinari, SciELO and Medline databases was carried out using the EndNote search manager and reference manager, Forty citations were selected to perform the review, 38 of them were from the last five years. Development: The most important anatomical characteristics related to the iliotibial band are mentioned. They refer to the maneuvers used, as well as the most useful imaging tests. The main entities involved in the differential diagnosis are presented. Regarding treatment, conservative and surgical modalities are mentioned. Conclusions: The iliotibial band syndrome is a disease, main characterized by lateral knee pain, which increases with physical activity. Conservative treatment constitutes the first option; in addition, surgical treatment is justified after six months of limited response to the first option of therapeutic management(AU)

Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study.

BACKGROUND: Iliotibial band syndrome (ITBS) carries marked morbidity in runners. Its management is not standardized and lacks evidence base. We evaluated the effectiveness of three different exercises programs in reducing ITBS symptoms. METHODS: Patients were divided into three equal treatment groups: ITB stretching (group A), conventional exercise (group B), and experimental hip strengthening exercise (group C). Numeric pain rating scale (NPRS; every week), lower extremity functional scale (LEFS; every 2 weeks), dynamometer (DN; weeks 0, 2, 4, 6, 8), single-limb mini squat (SLMS; week 0, 8), and Y-balance test™ (YBT), between and within group's differences were evaluated using ANOVA model. RESULTS: Twenty-four female runners (age 19-45 years) were included into one of three groups (A, B, and C). Statistical significance (p < 0.05) within group C was observed for composite YBT and DN for injured and non-injured leg, the YBT (injured leg for the posterior medial), LEFS, NPRS, and the SLMS. Statistical significance (p < 0.05) was found between group A and group C. The stretching group exhibited statistically significant (p < 0.05) YBT anterior reach for the injured/non-injured leg and the LEFS. CONCLUSION: There were no statistical differences between the three groups. The subjects who underwent experimental hip strengthening exercises consistently showed improvements in outcome measures, and never scored less than the other two groups. TRIAL REGISTRATION: ClinicalTrials.gov identifier (NCT number): NCT0229615.

Proximal Iliotibial Band Syndrome in a Runner: A Case Report.

Overuse injuries of the hip are frequent among runners and often present a diagnostic dilemma requiring imaging modalities beyond radiographs, delayed diagnosis, and prolonged time away from sport and activity. We report a case of a 38-year-old female recreational runner with progressive lateral hip pain and magnetic resonance imaging findings of edema along the gluteal aponeurotic fascia and origin of the tensor fascia lata muscle consistent with the diagnosis of enthesopathy of the proximal iliotibial band. LEVEL OF EVIDENCE: V.

[Clinical diagnosis and treatment for iliotibial band syndrome].

As an usually occurs in athletes, iliotibial band syndrome is payed more attention for people, the disease is diagnosed mainly by clinical symptoms, physical examination and MRI, but there is no uniform diagnostic criteria. The pathogenesis of iliotibial band syndrome is considered to be related to pressure and friction factors. As for the treatment, manipulation, muscle exercise, mainly drugs and physical therapy and so on both at home and abroad are recognized to use to achieve desired effect. For conservative failure, refractory iliotibial band syndrome patients, arthroscopy, or release of iliotibial band syndrome surgery are performed. While conservative local drug injection combined with muscle exercise could play a role in pain management besides, arthroscopic as operation method is more advanced, and applicable to all types of patients without absolute contraindication, so it is helpful for patients with early activity. At present, there is still a great deal of controversy about its pathogenesis, and there is no obvious limit for the specific indications of its various therapies in clinic, so it needs further specification.

Progression in Running Intensity or Running Volume and the Development of Specific Injuries in Recreational Runners: Run Clever, a Randomized Trial Using Competing Risks.

BACKGROUND: It has been proposed that training intensity and training volume are associated with specific running-related injuries. If such an association exists, secondary preventive measures could be initiated by clinicians, based on symptoms of a specific injury diagnosis. OBJECTIVES: To test the following hypotheses: (1) a running schedule focusing on running intensity (S-I) would increase the risk of sustaining Achilles tendinopathy, gastrocnemius injuries, and plantar fasciitis compared with hypothesized volume-related injuries; and (2) a running schedule focusing on running volume (S-V) would increase the risk of sustaining patellofemoral pain syndrome, iliotibial band syndrome, and patellar tendinopathy compared with hypothesized intensity-related injuries. METHODS: In this randomized clinical trial and etiology study, healthy recreational runners were included in a 24-week follow-up, divided into 8-week preconditioning and 16-week specific-focus training periods. Participants were randomized to 1 of 2 running schedules: S-I or S-V. The S-I group progressed the amount of high-intensity running (88% maximal oxygen consumption [VO2max] or greater) each week, and the S-V group progressed total weekly running volume. A global positioning system watch or smartphone collected data on running. Running-related injuries were diagnosed based on a clinical examination. Estimates were reported as risk difference and 95% confidence interval (CI). RESULTS: Of 447 runners, a total of 80 sustained an injury (S-I, n = 36; S-V, n = 44). Risk differences (95% CIs) of intensity injuries in the S-I group were -0.8% (-5.0%, 3.4%) at 2 weeks, -0.8% (-6.7%, 5.1%) at 4 weeks, -2.0% (-9.2%, 5.2%) at 8 weeks, and -5.1% (-16.5%, 6.3%) at 16 weeks. Risk differences (95% CIs) of volume injuries in the S-V group were -0.9% (-5.0%, 3.2%) at 2 weeks, -2.0% (-7.5%, 3.5%) at 4 weeks, -3.2% (-9.1%, 2.7%) at 8 weeks, and -3.4% (13.2%, 6.2%) at 16 weeks. CONCLUSION: No difference in risk of hypothesized intensity- and volume-specific running-related injuries exists between the 2 running schedules focused on progression in either running intensity or volume. LEVEL OF EVIDENCE: Etiology, level 1b. J Orthop Sports Phys Ther 2018;48(10):740-748. Epub 12 Jun 2018. doi:10.2519/jospt.2018.8062.

Differences in Knee and Hip Adduction and Hip Muscle Activation in Runners With and Without Iliotibial Band Syndrome.

BACKGROUND: Iliotibial band syndrome has been associated with altered hip and knee kinematics in runners. Previous 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. 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, 8 were male runners and 7 were female runners. Inclusion criteria for the injured group were pain within 2 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 iliotibial band syndrome. Convenience sampling was used based on referrals from local running clinics and orthopedic clinics. METHODS: Three-dimensional motion capture was performed with 10 high-speed cameras synchronized with wireless surface electromyography during a 30-minute run. The first data point was at 3 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 with control runners at 30 minutes (P = .002, control = -1.48°, injured = 3.74°). Tensor fasciae latae muscle activation in injured runners was increased compared with control runners at 3 minutes (P = .017, control = 7% maximal voluntary isometric contraction, injured = 11% maximal voluntary isometric contraction). 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 3 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 tensor fasciae latae activation, given the small differences of 4% in muscle activation. Increased knee adduction in runners at 30 minutes was over 5° and beyond the minimal detectable difference. Additional research is needed to confirm whether the degree of knee adduction changes earlier versus later in a run and whether fatigue is a clinically relevant factor. LEVEL OF EVIDENCE: III.

Dynamic Varus and the Development of Iliotibial Band Syndrome.

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 associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit. DESIGN: Prospective cohort study. SETTING: Biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS: Sixty-eight 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 ± 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 = .006) and occurred sooner during stance ( P = .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 = .02 and P = .002, respectively) and vertical stiffness was lower ( P = .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.

[Running and causes of running-related injuries].

Running is one of the most popular sports among the adult Danish population. Overuse injuries of the knee, such as runners knee, jumpers knee, patello-femoral pain syndrome and patello-femoral pre-arthrosis, are common and cause reduction of the health beneficial physical activity. Treatment should primarily focus on adjustment of training habits and physiotherapeutic guided rehabilitation. Other treatment options include changing landing pattern during running, corticosteroid injections, non-steroid anti-inflammatory drugs and ultimately surgery.

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

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.

Intra-articular fibroma of tendon sheath in a knee joint associated with iliotibial band friction syndrome.

Iliotibial band (ITB) friction syndrome is a common overuse injury typically seen in the active athlete population. A nodular lesion on the inner side of the ITB as an etiology or an accompanying lesion from friction syndrome has been rarely reported. A 45-year-old male presented with recurrent pain and a movable nodule at the lateral joint area, diagnosed as ITB friction syndrome. The nodule was confirmed as a rare intra-articular fibroma of the tendon sheath (FTS) on the basis of histopathologic findings. We describe the MRI findings, arthroscopic and pathologic features, in this case of intra-articular FTS presenting with ITB friction syndrome.

[MR manifestations and clinical significance of iliotibial band friction syndrome].

OBJECTIVE: To describe the MRI features of Iliotibial band friction syndrome (ITBFS), in order to improve the understanding and diagnosis of ITBFS. METHODS: The MR findings of 16 patients (18 knees )of clinically diagnosis ITBFS were reviewed retrospectively. RESULTS: The MRI features of ITBFS:(1)Ill- defined abnormal signal intensity extended to the lateral femoral epicondyle.(2) Poorly defined abnormal signal intensity presented deep to the ITB adjacent to the lateral femoral epicondyle. (3) Fluid collections medial to the ITB adjacent to the lateral femoral epicondyle. (4) The part of ITB over the lateral femoral epicondyle was thicker. (5) Joint effusion. (6)Other abnormal signs. CONCLUSION: MRI is a relatively good method for detection of ITBFS.

Imaging lesions of the lateral hip.

The lateral aspect of the hip is composed of a complex array of osseous and soft tissue structures. Both common and uncommon clinical entities are encountered in the lateral hip. This article briefly introduces fundamental imaging anatomy and the functional roles of different osseous and soft tissue structures in the lateral aspect of the hip, followed by a discussion of relevant imaging findings of lateral hip pathology. Greater trochanteric pain syndrome is frequently encountered in patients with lateral hip pain and encompasses a spectrum of soft tissue abnormalities including trochanteric and subgluteal bursitis, and tendinopathy or tears of the gluteal tendons. In addition, different types of injuries to the gluteal myotendinous unit and injuries to the indirect head of the rectus femoris, proximal iliotibial band, and the lateral joint capsular ligaments can present with lateral hip pain. Some of the less common soft tissue abnormalities of the lateral hip include Morel-Lavallée lesion and meralgia paresthetica.

Triathlon: running injuries.

The running portion of the triathlon represents the final leg of the competition and, by some reports, the most important part in determining a triathlete's overall success. Although most triathletes spend most of their training time on cycling, running injuries are the most common injuries encountered. Common causes of running injuries include overuse, lack of rest, and activities that aggravate biomechanical predisposers of specific injuries. We discuss the running-associated injuries in the hip, knee, lower leg, ankle, and foot of the triathlete, and the causes, presentation, evaluation, and treatment of each.

Iliotibial band syndrome in runners: a systematic review.

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.