A study titled "Iliotibial band pathology: synthesizing the available evidence for clinical progress" by Geisler P (2020) aimed to explore the evidence regarding iliotibial band (ITB) syndrome.
The ITB is a strong, complex structure that cannot be stretched, and it provides stability for both the hip and knee joints. Loss of strength and control around the hip, especially weakness in hip abduction and external rotation, and increased hip adduction during loading, such as running, are thought to be key factors in the development of ITBS.
Training error is also thought to be a factor in over 60% of cases.
The author suggests a progressive, 3-level rehabilitation program to first calm symptoms and then address causative factors. The program includes low load, mostly open chain exercises, moderate load, closed chain exercises, and higher load exercises, including impact and sport preparation.
Although narrative reviews like this study can provide a useful overview of current thinking, there is a lack of high-quality clinical trials demonstrating the effectiveness of the recommended approaches such as massage and stretches.
Therefore physiotherapists should apply the principles of progressive rehab and address potential causes to suit individual needs. Psychosocial factors must also be considered, especially beliefs about the injury and pain, as well as unhelpful training beliefs.
Overall, this paper helps develop our understanding of pathology and treatment options for ITBS. Runners with excessive hip adduction during running or a very narrow stride width maybe more at risk of injury, and gait retraining with cues may be necessary, and a graded return to goal activities based on symptoms should be part of the treatment plan.
James McMurray
Sport and Exercise Health Sciences BSc
Physiotherapy BSc
References:
Geisler P. R. (2020). Iliotibial Band Pathology: Synthesizing the Available Evidence for Clinical Progress. Journal of athletic training, 10.4085/JAT0548-19. Advance online publication. https://doi.org/10.4085/JAT0548-19
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