Association between Iliotibial Band Syndrome Status and Running Biomechanics in Women

Iliotibial band syndrome (ITBS) is common knee overuse injury that is twice as likely to afflict women compared to men. Etiological factors associated with ITBS include atypical biomechanics during running, as well as iliotibial band flexibility and hip abductor muscle weakness. This dissertation implemented a combination of discrete and continuous analyses to identify lower-extremity and trunk movement patterns that may be associated with ITBS injury status in female runners with current ITBS, previous ITBS, and controls. Three studies were conducted. Study 1 examined discrete joint and segment biomechanics during running, iliotibial band mechanics via musculoskeletal modeling and dynamic simulation, and hip physiological measures. Study 2 examined lower-extremity, as well as trunk – pelvis inter-segmental coupling variability using a vector coding technique. Study 3 characterized entire kinematic and kinetic waveforms using a principal components analysis approach. The findings of these studies can be summarized as follows: 1) runners with current ITBS lean their trunk more towards the stance limb than runners with previous ITBS and controls; 2) runners with previous ITBS exhibit less isometric hip abductor strength compared to controls; 3) runners with previous ITBS were more variable in frontal plane pelvis motion relative to the trunk and thigh compared to runners with current ITBS and controls; 4) a more complex movement pattern exists within pelvis and hip motion during running that cannot be explained in the first three principal components. Collectively, this information can be used by clinicians to address hip abductor muscle weakness and atypical pelvis/hip motion during running in female runners with current ITBS and previous ITBS

Biomechanics associated with tibial stress fracture in runners: A systematic review and meta-analysis

Background Tibial stress fracture (TSF) is an overuse running injury with a long recovery period. While many running studies refer to biomechanical risk factors for TSF, only a few have compared biomechanics in runners with TSF to controls. The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls. Methods Electronic databases PubMed, Web of Science, SPORTDiscus, Scopus, Cochrane, and CINAHL were searched. Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies. Results The search retrieved 359 unique records, but only the 14 that compared runners with TSF to controls were included in the review. Most studies were retrospective, 2 were prospective, and most had a small sample size (5–30 per group). Many variables were not significantly different between groups. Meta-analysis of peak impact, active, and braking ground reaction forces found no significant differences between groups. Individual studies found larger tibial peak anterior tensile stress, peak posterior compressive stress, peak axial acceleration, peak rearfoot eversion and hip adduction in the TSF group. Conclusion Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls. In individual included studies, many biomechanical variables were not statistically significantly different between groups. However, many were reported by only a single study, and sample sizes were small. We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings

Influence of Previous Iliotibial Band Syndrome on Coordination Patterns and Coordination Variability in Female Runners

It is unknown if female runners who have sustained multiple iliotibial band syndrome occurrences run differently compared with runners who developed the injury once or controls. Therefore, the purpose of this study was to determine if differences existed in coordination patterns and coordination variability among female runners with recurrent iliotibial band syndrome, 1 iliotibial band syndrome occurrence, and controls. Overground running trials were collected for 36 female runners (n = 18 controls). Lower extremity coordination patterns were examined during running via a vector coding analysis. Coordination variability was calculated via the ellipse area method. Separate 1-way (group) Kruskal–Wallis tests were performed to compare each coordination pattern and coordination variability. Lower extremity coordination between frontal plane hip–transverse plane hip, frontal plane pelvis–frontal plane thigh, and frontal plane thigh–transverse plane shank was similar among groups and so may not be related to the risk of iliotibial band syndrome. Runners with 1 iliotibial band syndrome occurrence demonstrated greater coordination variability for 2 of 3 couplings compared with both controls and runners with recurrent iliotibial band syndrome. Thus, the number of previous injury episodes may influence coordination variability in female runners with a history of iliotibial band syndrome

Relationship between iliotibial band syndrome and hip neuromechanics in women runners

Background Atypical frontal plane hip kinematics are associated with iliotibial band syndrome in women runners. Gluteus medius is the primary muscle controlling the hip adduction angle during the loading response of stance. It is unclear if differences exist in gluteus medius activity magnitude and activity duration between runners with previous iliotibial band syndrome and controls. Furthermore, hip neuromechanics may change after a prolonged run. Research Question Do differences exist in the hip adduction angle and gluteus medius activity between women with previous iliotibial band syndrome and controls at the beginning and end of a 30-minute moderate paced treadmill run? Methods Thirty women participated (n = 15 controls). Lower extremity kinematics and gluteus medius activity were recorded at the start and end of a 30-minute treadmill run at participants’ self-selected pace. Hip kinematics and gluteus medius activity were analyzed via separate two-way (group x time) mixed-model analysis of variance with time as the repeated measure. Results Hip neuromechanics were similar at the start and end of a 30-minute treadmill run in women with previous iliotibial band syndrome and controls. However, hip adduction excursion was less in women with previous iliotibial band syndrome compared to controls. Average gluteus medius activity magnitude and activity duration were not significantly different between groups. Significance These findings support the growing body of literature that smaller hip adduction motion is related to previous iliotibial band syndrome in women. Regardless of injury history, gluteus medius activity was similar between groups during the loading phase of stance

Not all single leg squates are equal: A biomechanical comparison of three variations

Background The single leg squat (SLS) is a functional task used by practitioners to evaluate and treat multiple pathologies of the lower extremity. Variations of the SLS may have different neuromuscular and biomechanical demands. The effect of altering the non-stance leg position during the SLS on trunk, pelvic, and lower extremity mechanics has not been reported. Purpose The purpose of this study was to compare trunk, pelvic, hip, knee, and ankle kinematics and hip, knee, and ankle kinetics of three variations of the SLS using different non-stance leg positions: SLS-Front, SLS-Middle, and SLS-Back. Methods Sixteen healthy women performed the three SLS tasks while data were collected using a motion capture system and force plates. Joint mechanics in the sagittal, frontal, and transverse planes were compared for the SLS tasks using a separate repeated-measures analysis of variance (ANOVA) for each variable at two analysis points: peak knee flexion (PKF) and 60 ° of knee flexion (60KF). Results Different non-stance leg positions during the SLS resulted in distinct movement patterns and moments at the trunk, pelvis, and lower extremity. At PKF, SLS-Back exhibited the greatest kinematic differences (p \u3c 0.05) from SLS-Front and SLS-Middle with greater ipsilateral trunk flexion, pelvic anterior tilt and drop, hip flexion and adduction, and external rotation as well as less knee flexion and abduction. SLS-Back also showed the greatest kinetic differences (p \u3c 0.05) from SLS-Front and SLS-Middle with greater hip external rotator moment and knee extensor moment as well as less hip extensor moment and knee adductor moment at PKF. At 60KF, the findings were similar except at the knee. Conclusion The mechanics of the trunk, pelvis, and lower extremity during the SLS were affected by the position of the non-stance leg in healthy females. Practitioners can use these findings to distinguish between SLS variations and to select the appropriate SLS for assessment and rehabilitation

Lower extremity kinematics during running and hip abductor strength in iliotibial band syndrome: A systematic review and meta-analysis

Background Iliotibial band syndrome is a common overuse injury that is twice as likely to affect female runners compared to male runners. It is unclear if there is a consistent running pattern and strength profile exhibited by female and male runners with iliotibial band syndrome. Research question The purpose of this systematic review and meta-analysis was to determine if any differences existed in lower-extremity kinematics and hip strength between runners who retrospectively, currently, or prospectively had iliotibial band syndrome. Methods Papers included must have reported three-dimensional kinematic running data and/or hip strength data that were statistically analyzed between runners that never developed iliotibial band syndrome and runners with iliotibial band syndrome. Meta-analysis was performed for each kinematic or strength variable reported in at least three studies. Female and male runners were analyzed separately and grouped into three cohorts (retrospective, current, prospective). Results Seventeen articles were included in this systematic review. Data from 10 cross-sectional studies were included for meta-analysis. Female runners with current iliotibial band syndrome exhibited smaller peak hip internal rotation angles and lower isometric hip abductor strength compared to controls. Significance Although limited biomechanical evidence exists, risk factors for ITBS are different between female and male runners and may vary according to injury status. Specifically, transverse plane hip motion and hip abductor strength weakness may be biomechanical risk factors in female runners with current iliotibial band syndrome only

Associations between iliotibial band injury status and running biomechanics in women

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

Differences in Lower Extremity and Trunk Kinematics between Single Leg Squat and Step Down Tasks.

The single leg squat and single leg step down are two commonly used functional tasks to assess movement patterns. It is unknown how kinematics compare between these tasks. The purpose of this study was to identify kinematic differences in the lower extremity, pelvis and trunk between the single leg squat and the step down. Fourteen healthy individuals participated in this research and performed the functional tasks while kinematic data were collected for the trunk, pelvis, and lower extremities using a motion capture system. For the single leg squat task, the participant was instructed to squat as low as possible. For the step down task, the participant was instructed to stand on top of a box, slowly lower him/herself until the non-stance heel touched the ground, and return to standing. This was done from two different heights (16 cm and 24 cm). The kinematics were evaluated at peak knee flexion as well as at 60° of knee flexion. Pearson correlation coefficients (r) between the angles at those two time points were also calculated to better understand the relationship between each task. The tasks resulted in kinematics differences at the knee, hip, pelvis, and trunk at both time points. The single leg squat was performed with less hip adduction (p ≤ 0.003), but more hip external rotation and knee abduction (p ≤ 0.030), than the step down tasks at 60° of knee flexion. These differences were maintained at peak knee flexion except hip external rotation was only significant in the 24 cm step down task (p ≤ 0.029). While there were multiple differences between the two step heights at peak knee flexion, the only difference at 60° of knee flexion was in trunk flexion (p < 0.001). Angles at the knee and hip had a moderate to excellent correlation (r = 0.51-0.98), but less consistently so at the pelvis and trunk (r = 0.21-0.96). The differences in movement patterns between the single leg squat and the step down should be considered when selecting a single leg task for evaluation or treatment. The high correlation of knee and hip angles between the three tasks indicates that similar information about knee and hip kinematics was gained from each of these tasks, while pelvis and trunk angles were less well predicted

Pearson correlation coefficients (r) for each variable for each comparison at the two time points are presented with bold text indicating significance.

<p>Pearson correlation coefficients (r) for each variable for each comparison at the two time points are presented with bold text indicating significance.</p

Average knee, hip, pelvis and trunk angles from a representative participant performing each of the three tasks.

<p>As the task durations were not equal, data were normalized to maintain the time differences between tasks for presentation purposes only.</p