Long-term efficacy of conditioning training program combined with feedback on kinetics and kinematics in male runners.

This study was aimed to compare the effects of 8-week conditioning training (CT) programs with and without feedback on lower limbs' biomechanics and injury incidence in free-injury male runners and assess their effectiveness across a 1-year observation. A total of 49 healthy male runners were randomly assigned to one of three groups of CT (n = 16), CT with feedback (n = 17), and placebo (n = 16) group. Kinematic and kinetic measurements were conducted at pre-intervention, 8 weeks post-intervention, and 1-year follow-up stage. Injury incidence was also measured at pre-intervention and follow-up stage. As a result, significant improvement was found in within-group differences in CT and CT with feedback groups. Moreover, significant difference in CT with feedback group was observed in the kinetic outcome improvement after 8 weeks as compared to CT group. On the other side, there were no significant differences between the CT and CT with feedback groups in kinematic outcomes. However, the percentage of changes in kinematic outcomes were higher in CT with feedback group than those in the CT group. No significant change was observed in the placebo group in all the variables. There was comparative between-group difference between CT with feedback group and the placebo one, favoring the former group. At 1-year follow-up, the injury incidence was reduced by 32% for CT group, 64.6% for CT with feedback group, and 15.5% for placebo. Thus, the CT with feedback was effective in improving biomechanics and reducing injury incidence. Improvements were generally maintained through 1 year, indicating potential for long-term changes. This study demonstrates the applicability of using feedback with CT to enhance safer movement patterns in runners and may subsequently help prevent or reduce injury risks.

The iliotibial tract: imaging, anatomy, injuries, and other pathology.

The iliotibial tract, also known as Maissiat's band or the iliotibial band, and its associated muscles function to extend, abduct, and laterally rotate the hip, as well as aid in the stabilization of the knee. A select group of associated injuries and pathologies of the iliotibial tract are seen as sequela of repetitive stress and direct trauma. This article intends to educate the radiologist, orthopedist, and other clinicians about iliotibial tract anatomy and function and the clinical presentation, pathophysiology, and imaging findings of associated pathologies. Specifically, this article will review proximal iliotibial band syndrome, Morel-Lavallée lesions, external snapping hip syndrome, iliotibial band syndrome and bursitis, traumatic tears, iliotibial insertional tendinosis and peritendonitis, avulsion fractures at Gerdy's tubercle, and Segond fractures. The clinical management of these pathologies will also be discussed in brief.

Morphological features of fascia lata in relation to fascia diseases.

Fascia lata is an important element of the fascial system, which forms the continuum of connective tissue throughout the body. This deep fascia envelops the entire thigh and hip area and its main function is to transmit mechanical forces generated by the musculoskeletal system of the lower extremities. Fascia lata is also known as a useful and easily harvested graft material. Despite its crucial role in lower extremity biomechanics and wide-ranging applications in plastic and reconstructive surgery, both the structure of fascia lata and particularly the cells populating this tissue are relatively unexplored and therefore poorly understood. The aim of this study was to characterize the main cell populations encountered within human fascia lata and to try to understand their role in health and diseases. Pathologically unchanged human fascia lata was obtained post mortem from adult males. The specimens were analyzed under light, electron, and confocal microscopy. On the basis of different visualization techniques, we were able to characterize in detail the cells populating human fascia lata. The main cells found were fibroblasts, fibrocytes, mast cells, cells showing myoid differentiation, nerve cells, and most interestingly, telocytes. Our results supplement the formerly inadequate information in the literature regarding the cellular components of deep fascial structure, may contribute to a better understanding of the pathogenesis of fascial disorders and improve fascia lata application as a graft material.

Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners: a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study.

BACKGROUND: Despite the numerous health benefits of distance running, it is also associated with the development of 'gradual onset running-related injuries' (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. OBJECTIVE: To identify risk factors associated with hITBS in distance runners. DESIGN: Descriptive cross-sectional study. SETTING: 21.1 km and 56 km Two Oceans Marathon races (2012-2015). PARTICIPANTS: 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. METHODS: Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). RESULTS: 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. CONCLUSION: Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.

Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?

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.

[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.

Stretching and Releasing of Iliotibial Band Complex in Patients with Iliotibial Band Syndrome: A Narrative Review.

Iliotibial band syndrome (ITBS) is one of the most common overuse syndromes causing knee pain; it is especially prevalent in runners and also common in cyclists, rowers, and field athletes, with occasional cases occurring in non-athletes too. ITBS symptoms can negatively affect not only knee function, but also mental and physical aspects of health-related quality of life. Although various conservative treatment options have been investigated and discussed, there is still no consensus on a standard of care for ITBS. Moreover, the literature on the etiology and risk factors of ITBS, which could help in selecting appropriate treatment methods, is conflicting and inconclusive. The role of individual treatment modalities such as stretching and releasing techniques has not been extensively studied and remains unclear. In this article, we will critically review the available evidence for the benefits of ITB stretching and "release" methods in the treatment of ITBS. In addition to the direct evidence (clinical studies examining the effects of ITB stretching and other methods that purportedly stretch or "release" the ITB), we present several additional lines of reasoning that discuss the rationale for ITB stretching/releasing in terms of the etiology of ITBS, the mechanical properties and behavior of the ITB, and the risk factors for ITBS development. We conclude that the current literature provides some evidence for the inclusion of stretching or other "release" methods in the early rehabilitation of ITBS. Long-term interventions typically include ITB stretching; however, it remains unclear to what extent stretching within a multimodal treatment actually contributes to resolving the symptoms. At the same time, there is no direct evidence to suggest that stretching and "release" methods have any negative effects.

PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results.

INTRODUCTION: Description of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS. METHODS: A prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented. RESULTS: A total of 14 patients were included, with a mean follow-up of 16 months (range 12-42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively). CONCLUSION: The PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.

Feasibility and reliability of various morphologic features on magnetic resonance imaging for iliotibial band friction syndrome.

Background: To evaluate the feasibility, inter-reader reliability, and intra-reader reliability for various morphological features reported to be related to iliotibial band friction syndrome (ITBFS) on knee magnetic resonance imaging (MRI). Methods: A total of 145 patients with a clinical diagnosis and knee MRI findings consistent with ITBFS were included in the "study group" and 232 patients without knee pathology on both physical examination and MRI were included in the "control group". Various morphologic features on knee MRI were assessed including the patella shape, patella height, lateral epicondyle anterior-posterior (AP) width, lateral epicondyle height, ITB diameter (ITB-d), and ITB area (ITB-a). Results: Patients in the study group had significantly higher lateral epicondyle height (13.9 mm vs. 12.92 mm, P = 0.003), ITB-d (2.9 mm vs. 2.0 mm, P = 0.022), and ITB-a (38.5 mm2 vs. 23.8 mm2, P < 0.001) than the control group. ITB-a showed higher area under the curve index (0.849 with 74.1% sensitivity and 72.4% specificity at a 30.3 mm2 cutoff) than ITB-d (0.710 with 70.8% sensitivity and 61.2% specificity at 2.4 mm cutoff) and lateral epicondyle height (0.776 with 72.4% sensitivity and 67.8% specificity at 13.4 mm cutoff). However, only the interreader agreement for ITB-a (intraclass correlation coefficient = 0.65) was moderate, while the agreements for other morphologic features were good or excellent. Conclusions: Lateral epicondyle height seems to be a reliable and feasible morphologic feature for diagnosis of ITBFS.

Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?

OBJECTIVE: Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB. METHODS: The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived. RESULTS: According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention. CONCLUSIONS: High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.

The immediate effects of Kinesio Taping on running biomechanics, muscle activity, and perceived changes in comfort, stability and running performance in healthy runners, and the implications to the management of Iliotibial band syndrome.

BACKGROUND: Kinesio Taping is frequently used in the management of lower limb injuries, and has been shown to improve pain, function, and running performance. However, little is known about the effects of Kinesio Taping on running biomechanics, muscle activity, and perceived benefits. RESEARCH QUESTION: This study aimed to explore the immediate effects of Kinesio Taping on lower limb kinematics, joint moments, and muscle activity, as well as perceived comfort, knee joint stability, and running performance in healthy runners. METHODS: Twenty healthy participants ran at a self-selected pace along a 20-metre runway under three conditions; no tape (NT), Kinesio Tape with tension (KTT), and Kinesio tape without tension (KTNT). Comparisons of peak hip, knee angles and moments, and EMG were analysed during the stance phase of running. RESULTS: KTT exhibited significant increases in peak hip flexion, peak hip abduction and hip external rotation compared to NT. Moreover, the KTT condition showed a trend towards a decrease in peak hip internal rotation and adduction angle compared to the NT condition. EMG results showed that Tensor Fascia Latae activity decreased with KTT compared with NT, and Gluteus Maximus activity reduced with KTNT when compared with NT. Ten of the 20 participants indicated important improvements in the comfort score, six participants in the knee stability score, and seven participants in the running performance score when using KTT. SIGNIFICANCE: These results suggest that changes in running biomechanics previously associated with ITBS can be improved with the application of kinesio tape, with the greatest effect seen with the application of kinesio tape with tension. Perceived improvements were seen in comfort, stability and running performance, however these benefits were only seen in half the participants. Further work is required to explore the biomechanical effects and perceived benefits in different patient groups.

Effect of Flat Running Shoes on Hip Kinematics in Male Recreational Runners.

Patellofemoral joint pain and iliotibial band syndrome are very common running-related injuries. Excessive contralateral pelvic drop, hip adduction, and hip internal rotation have been suggested to be associated with the two injuries. The purpose of this repeated measures and the cross-sectional study was to investigate the effect of flat running shoes on these kinematic variables compared with that of conventional running shoes with a 10 mm drop. Eighteen male recreational runners were recruited to run in flat shoes and conventional shoes with a 10 mm drop, in random order. Impact force data and lower extremity kinematics were synchronously obtained using two Kistler force plates and eight motion infrared cameras, whereas differences in the impact force and hip kinematics were compared using statistical parametric mapping. Regarding hip kinematics, the hip flexion (p = 0.004) and adduction angles (p = 0.004) decreased significantly at 30-70% and 62-85% of the stance phase, respectively, while wearing flat running shoes; the contralateral pelvic drop angle (p = 0.001) decreased significantly at 31-75% of the stance phase while wearing flat running shoes. The knee internal rotation angle (p = 0.035) decreased significantly at 8-17% of the stance phase while wearing flat running shoes compared with conventional running shoes. Given that these kinematic variables are associated with patellofemoral joint pain and iliotibial band syndrome, flat running shoes may have potential benefits for the prevention or treatment of knee injuries.

Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls.

BACKGROUND: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). METHODS: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. RESULTS: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). CONCLUSION: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner's knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner's knee.

Shockwave Therapy Versus Dry Needling for the Management of Iliotibial Band Syndrome: A Randomized Clinical Trial: SWT Vs. DN for the Treatment of ITBS.

BACKGROUND: Iliotibial band syndrome (ITBS) is a common leading cause of lateral knee pain. Despite varieties of medical and non-medical treatments proposed for the management of ITBS, the best therapeutic approach for its treatment remained a significant question. The current study aims to compare the outcomes of dry needling (DN) versus shockwave therapy (SWT) in the management of ITBS. MATERIALS AND METHODS: This randomized clinical trial was conducted on 40 patients diagnosed with ITBS. The patients were randomly divided into two treatment groups of DN (n=20) and SWT (n=20). Visual analog scale for the pain assessment, Lower Extremity Functional Scale (LEFS) for the function evaluation, and length of the iliotibial band were assessed at baseline, immediately after the cessation of the intervention, and within four weeks. RESULTS: The two groups were similar regarding demographic characteristics (P0.05). Both approaches could efficiently lead to improved pain (P0.001) and promoted function based on LEFS (P0.001); however, iliotibial band length (ITBL) did not alter remarkably (P0.05). The groups were similar in terms of pain score, LEFS, and ITBL at all of the assessment intervals (P0.05), but the pain score within four weeks following the interventions that were significantly better in DN (P=0.023). CONCLUSION: Based on our results, DN, as well as SWT, could remarkably lead to an improvement in pain and function among patients resenting from ITBS; however, none of the approaches was superior over the other.

Ultrasound-guided release for iliotibial band syndrome: A novel ultraminimally invasive surgical procedure.

BACKGROUND: Iliotibial band (ITB) syndrome is the most common cause of lateral knee pain in runners (affecting 7-14%) and in persons taking part in other sports. The aim of this study was to show how to perform a distal release of the ITB guided by ultrasound and present our initial results with this new technique. METHODS: The surgical technique - either Z-plasty or transverse section of the ITB - was first validated on 14 cadaver specimens and then applied in clinical practice. We operated on 32 patients (27 males and five females, 34 cases) from 2013 to 2018. Mean age was 40 years (25-60). The patients comprised 21 recreational middle- or long-distance runners (23 cases), five cyclists, two basketball players, two military personnel, one fireman, and one boxer. RESULTS: All patients were satisfied after 3 months and returned to their sporting activities without restrictions. The visual analog scale score for the practice of sports activities improved from 7 (6-9) before surgery to 0 (0-1) after. The average Lysholm score was 68 points before surgery and 97 (91-100) after, with five good results and 29 excellent results. No patients complained of instability or muscle weakness after 3 months. CONCLUSION: Ultrasound-guided release of the ITB is a novel minimally aggressive surgical approach that potentially enables faster recovery. It is relatively easy, quick, and painless, with a small incision, and can be performed under local anaesthesia in an outpatient setting. It does not require limb exsanguination or stitches, and complications are minimal.

A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment.

BACKGROUND: The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS). METHODS: We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group. RESULTS: In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively). CONCLUSIONS: This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.

Sex-Specific Hip Movement Is Correlated With Pelvis and Upper Body Rotation During Running.

There is a sex bias for common overuse running injuries that are associated with sex-specific hip kinematics. Gait retraining programs aimed at altering hip kinematics may be more efficient if they incorporated an understanding of how hip kinematics are correlated with the movement of the remaining body segments. We applied a principal component analysis to structure the whole-body running kinematics of 23 runners (12 ♀) into k = 12 principal movements (PMk), describing correlated patterns of upper and lower body movements. We compared the time-dependent movement amplitudes with respect to each PMk between males and females using a waveform analysis and interpreted our findings according to stick figure animations. The movement amplitudes of two PMs (PM6 and PM8) showed statistically significant effects of "sex," which were independent of running speed. According to PM8, females showed more hip adduction, which correlated with increased transverse rotation of the pelvis and upper body compared to men. We propose that increased hip adduction and upper body rotation in female runners may be a strategy to compensate for a less efficient arm and upper body swing compared to men. Gait interventions aimed at reducing hip adduction and running-related injuries in female runners should consider instructions for both upper and lower body to maximize training efficacy.

The role of the iliotibial band cross-sectional area as a morphological parameter of the iliotibial band friction syndrome: a retrospective pilot study.

BACKGROUND: Iliotibial band friction syndrome (ITBFS) is a common disorder of the lateral knee. Previous research has reported that the iliotibial band (ITB) thickness (ITBT) is correlated with ITBFS, and ITBT has been considered to be a key morphologic parameter of ITBFS. However, the thickness is different from inflammatory hypertrophy. Thus, we made the ITB cross-sectional area (ITBCSA) a new morphological parameter to assess ITBFS. METHODS: Forty-three patients with ITBFS group and from 43 normal group who underwent T1W magnetic resonance imaging were enrolled. The ITBCSA was measured as the cross-sectional area of the ITB that was most hypertrophied in the magnetic resonance axial images. The ITBT was measured as the thickest site of ITB. RESULTS: The mean ITBCSA was 25.24 ± 6.59 mm2 in the normal group and 38.75 ± 9.11 mm2 in the ITBFS group. The mean ITBT was 1.94 ± 0.41 mm in the normal group and 2.62 ± 0.46 mm in the ITBFS group. Patients in ITBFS group had significantly higher ITBCSA (P < 0.001) and ITBT (P < 0.001) than the normal group. A receiver operator characteristic curve analysis demonstrated that the best cut-off value of the ITBT was 2.29 mm, with 76.7% sensitivity, 79.1% specificity, and area under the curve (AUC) 0.88. The optimal cut-off score of the ITBCSA was 30.66 mm2, with 79.1% sensitivity, 79.1% specificity, and AUC 0.87. CONCLUSIONS: ITBCSA is a new and sensitive morphological parameter for diagnosing ITBFS, and may even be more accurate than ITBT.

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.

Stiffness of the iliotibial band and associated muscles in runner's knee: Assessing the effects of physiotherapy through ultrasound shear wave elastography.

OBJECTIVES: To test the hypothesis that Iliotibial Band Syndrome (ITBS) is caused by excessive iliotibial band (ITB) tension, promoted by hip abductor and external rotator weakness, and evaluate the influence of 6 weeks of physiotherapy on ITB stiffness. DESIGN: Interventional study with control group. SETTING: Clinical. PARTICIPANTS: 14 recreational runners with ITBS and 14 healthy controls of both sexes. MAIN OUTCOME MEASURES: Ultrasound shear wave elastography, hip muscle strength, visual analog scale pain, subjective lower extremity function. RESULTS: No statistical differences in ITB tension between legs as well as between patients suffering from ITBS and healthy controls were detected. Results showed significant strength deficits in hip abduction, adduction as well as external and internal rotation. Following six weeks of physiotherapy, hip muscle strength (all directions but abduction), pain and lower extremity function were significantly improved. ITB stiffness, however, was found to be increased compared to baseline measurements. CONCLUSION: Shear wave elastography data suggest that ITB tension is not increased in the affected legs of runners with ITBS compared to the healthy leg or a physical active control group, respectively. Current approaches to the conservative management of ITBS appear ineffective in lowering ITB tone.