Iliotibial Band Syndrome (ITBS) is a leading source of knee pain in runners. Several factors have been linked to contributing to ITBS including running mechanics, shoewear, and hip strength just to name a small few. So the question runners and active individuals want to know is what’s most likely causing my knee pain and how do I address it?
Well a recent research report on ITBS from JOSPT exposed multiple overlapping factors including tighter ITB length, altered hip and knee kinematics with running (greater hip internal rotation and knee adduction during stance phase) and diminished hip strength (external rotation). In short, ITBS development is multifactorial in nature and unlikely due to a single factor.
In addition, research has been conflicting for ITBS and lateral knee pain. “For example , hip abductor weakness has been demonstrated in track athletes with ITBS. However, this is in contrast to more recent research, in which no difference in hip abductor strength in persons with ITBS were reported”. This conflicting research could be the result of different testing procedures or group demographics, or it could be due to the increasing complexity of lateral knee pain and the growing proof that lateral knee pain is multifactorial in nature.
Therefore, if ITBS and lateral knee pain is multifactorial in nature than single isolation tests are likely less reliable and thus a thorough movement assessment would be more applicable and useful, especially a movement assessment that targets neuromuscular deficits.
The researches of the recent JOSPT study recognized the potential for compensatory strategies and the need to utilize interventions that target motor control deficits (firing patterns, sequencing, and timing and control of functional movements). Their conclusion stated “ that other factors, such as neuromuscular control, may play a larger role in contributing to altered hip and knee kinematics in this population”.
On that account, a helpful tool to address ITBS is the Selective Functional Movement Assessment (SFMA). The SFMA allows the clinician to assess fundamental movement and its specific and directional motor control/stability limitations. When compensations are seen in these fundamental movements what do you think will be the consequence when the athlete goes to high level movement like running? Of course, they end up compensating! Compensations that lead to “tightness” and “weakness” seen in isolation, all originating from motor control deficits! Addressing the isolation will not fix the motor control compensations. but fixing the motor compensations will fix the problems seen in isolation! Do we want to cut the problem down branch by branch or at its root?!
The SFMA allows us to ‘cut through’ single factors,or symptoms, and address the fundamental neuromuscular cause seen with ITBS. Lets stop chasing the symptoms and be smart about how we address a complex issue. Further, the SFMA allows the clinician to still appraise several of the single factors like length tension thereby providing its own “clinical prediction rule” and thereby prioritizing our interventions. Utilizing the SFMA allows the clinician to properly address ITBS at its root cause(s) and improve the involved neuromuscular deficits found with the appropriate interventions.
