Dissertations / Theses on the topic 'Iliotibial band syndrome'

One of the most common running related injuries and leading cause of lateral knee pain in recreational runners is iliotibial band syndrome (ITBS). The popularity of recreational running and rate of running related injuries are increasing. This study’s goals were to evaluate the effects of three different exercises programs in reducing ITBS symptoms and determine if the experimental exercise group program provides a new progressive rehab intervention for ITBS management. This study consisted of volunteer female distance runners age 19-45 with ITBS—with a 10-mile per week average running distance during a three-month period. After recording age, gender, injured leg, pain, body weight, and height the participants were split into three treatment groups: i) an experimental exercise group, ii) a conventional exercise group, and iii) a stretching group. Outcomes measured were the Y Balance test (YBT), single leg mini squats (SLMS), dynamometer readings (DN), lower extremity functional scale (LEFS), and numeric pain rating scale (NPRS). The YBT, SLMS and LEFS were taken at weeks 0 and 8, hip strength DN measurements were taken biweekly and the NPRS was taken weekly for 8-weeks. Hypothetically the experimental exercise group should exhibit similar or greater improvements in ITBS symptoms compared to current researched programs for hip strength and stretching. A two-way factorial, repeated measures, analysis of variance (ANOVA) model examined the effects each exercise program had on the outcome measures for between and within group’s differences. Statistical significance within the experimental group was determined for the composite YBT and DN measurements for injured and non-injured leg, injured leg for the posterior medial reach for the YBT, LEFS questionnaire, NPRS during running activity and the SLMS. Statistical significance was determined between the stretching and experimental exercise groups. The stretching group exhibited statistically significant YBT anterior reach for the injured/non-injured leg and the LEFS questionnaire. Although there were no statistical differences found for the experimental exercises group, it consistently showed improvements in outcome measures and never scored less than the other two groups.
Kinesiology, School of
Graduate

Purpose: To determine the relationship between iliotibial band (ITB) length and the presence of patellofemoral pain syndrome (PFPS), compare the difference in ITB length between the painful knee and the non-painful knee in subjects with unilateral PFPS, determine the test-retest reliability, standard error of measurement, and minimal detectable change (MDC) of the Ober test and modified Thomas test, and explore the relationship between the Ober test and the modified Thomas test in measuring ITB length. Subjects: Forty-eight subjects were recruited (PFPS group n=24, control group n=24) from three different outpatient physical therapy clinics. Methods: The Ober test and modified Thomas test was conducted on both legs of each subject to determine ITB length with the use of a digital inclinometer. Examiners were blinded to group assignment and an independent observer recorded all the results. Results: The mean values for hip adduction during the Ober test was 7.2 degrees in the control group and 2.3 degrees in the PFPS group. One way ANOVA revealed a significant difference between groups (p= .011). There were no differences in ITB length comparing the painful knee to the non-painful knee for both the Ober test and modified Thomas test. The ICC values calculated for the test-retest reliability were .95 for the Ober test and .86 for the modified Thomas test. Pearson correlational analysis revealed a weak negative correlation (r=-.40, p=.005) between the Ober test and modified Thomas test on the left side and no correlation on the right side. Discussion and Conclusion: The Ober test is better at distinguishing between a PFPS group and a control group than the modified Thomas test supporting the clinical utility of the Ober test. The use of a digital inclinometer for both the Ober test and modified Thomas test appears to be a reliable method for the measurement of ITB length. However, given the lack of relationship found between the two tests, the two examination procedures should not be used interchangeably for the measurement of ITB length.

Physical Therapy
Ph.D.
The etiology of iliotibial band syndrome (ITBS) is not fully understood, however, dysfunction at the hip and decreased resistance to fatigue have been suggested to contribute to development of the syndrome. The objective of this study was to investigate differences in hip abductor strength and fatigue resistance, hip muscle activation timing and hip joint kinematic, kinetic and joint coupling patterns in female runners with and without ITBS. In addition, this study examined the effects of a run to exertion on these variables. Twelve female runners with ITBS and 20 healthy female runners participated in this study. Gluteus medius strength and electromyographic (EMG) data were collected during isometric testing. In addition, EMG data from the gluteus medius and tensor fascia latae muscles as well as 3-dimensional kinematic, kinetic and joint coupling data were collected during overground running. All data were collected prior-to and following a run to exertion. Prior to the run to exertion, with runners in a "fresh" state, there were no differences in hip abductor strength, kinematic joint coupling and terminal swing phase muscle activation timing between runners with ITBS and healthy runners. In a "fresh" state, ITBS runners demonstrated less resistance to fatigue at their gluteus medius muscle than did the healthy runners. As a result of exertion, runners with ITBS demonstrated decreased peak hip adduction angles during the stance phase of running gait. There were no group-by-exertion interactions for peak hip internal rotation angles, hip abductor and external rotator moments, kinematic joint coupling or hip abductor strength. There was a main effect of exertion for hip abductor moments, hip external rotator moments and hip abductor strength whereby both healthy and injured runners demonstrated 3.8, 4.2 and 7.3% decreases respectively following the run to exertion. In addition, there was a main effect of exertion on hip frontal/knee transverse plane kinematic joint coupling during the first half of loading where runners demonstrated a 7.3% increase in joint coupling values following the run to exertion. Our data did not detect group-by-exertion interactions or main effects of group or exertion with respect to terminal swing muscle activation timing. There was a significant group-by-exertion interaction when examining fatigue resistance. In a fresh-state, runners with ITBS demonstrated less resistance to fatigue than their healthy counterparts. Following the run to exertion, these differences did not exist. The results of this study suggest that currently symptomatic runners with ITBS demonstrate a potentially compensatory pattern of decreased stance phase hip adduction as compared with healthy runners. Hip internal rotation, abductor moments, external rotator moments or kinematic joint coupling do not appear to discriminate between the two groups. The results of this study also suggest that hip abductor strength may not be as large of a factor in the development of ITBS as previously thought. Instead, this muscle's endurance, or its ability to resist fatigue may play a larger role.
Temple University--Theses

Thesis (MScPhysio)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Introduction: Iliotibial band syndrome (ITBS), an overuse injury, is the second most common running injury and the main cause of lateral knee pain in runners. Due to the increasing number of runners worldwide there has been an increase in its occurrence. Runners with ITBS typically experience symptoms just after heel strike at approximately 20°-30° of knee flexion (impingement zone) during the stance phase of running. A variety of intrinsic and extrinsic risk factors may be responsible for why some runners are more prone to developing symptoms during the impingement zone as opposed to others. Abnormalities in running biomechanics is an intrinsic risk factor which has been most extensively described in literature but little is known about its exact relationship to ITBS. Objectives: The purpose of this systematic review was to provide an up to date evidence synthesis of the biomechanical risk factors associated with ITBS. These risk factors may need to be considered in the prevention or management of ITBS in runners. A clinical algorithm is also presented. Methods: A systematic review with meta-analysis was conducted. An electronic search was performed in PubMed, PEDro, SPORTSDisc and Scopus of literature published up-until May 2014. Cross-sectional and cohort studies were eligible for inclusion if they evaluated the lower limb biomechanics of runners with ITBS or those who went onto developing it. All studies included in the review were methodologically appraised. Evidence was graded according to the level of evidence, consistency of evidence and the clinical impact. Data was described narratively using tables or narrative summaries where appropriate. A meta-analysis was conducted for biomechanical risk factors which were reported in at least two studies, provided that homogeneity in the outcomes and samples were present. Results: A total of 11 studies were included (1 prospective and 10 cross-sectional). Overall the methodological score of the studies was moderate. Increased peak hip adduction and knee internal rotation during the stance phase may predict the development of ITBS in female runners. These biomechanical risk factors may need to be screened for ITBS prevention, despite the evidence base being limited to a single study. Currently there is no conclusive evidence that any of the biomechanical parameters need to be considered when managing runners with ITBS. Stellenbosch University https://scholar.sun.ac.za iii Conclusion: Biomechanical differences may exist between runners with ITBS and those who may develop ITBS compared to healthy runners. Although a large variety of biomechanical risk factors were evaluated, the evidence base for screening or managing these risk factors for runners with ITBS is limited. This is due to a small evidence base, small clinical effect and heterogeneity between study outcomes and findings. Further prospective and cross-sectional research is required to ascertain if abnormalities in running biomechanics may be related to why runners develop ITBS or to ascertain which risk factors may be involved when managing these runners.
AFRIKAANSE OPSOMMING: Inleiding: Iliotibiale-band-sindroom (ITBS), ’n besering vanweë oormatige gebruik, is die tweede algemeenste hardloopbesering en die hoofoorsaak van laterale kniepyn by hardlopers. Namate die getal hardlopers wêreldwyd toeneem, neem die voorkoms van hierdie toestand ook toe. Hardlopers met ITBS ervaar tipies simptome ná die hakslag met die knie ongeveer 20-30° gebuig (die wrywingsone of “impingement zone”) gedurende die staanfase van hardloop. Verskeie intrinsieke en ekstrinsieke risikofaktore kan ’n rol speel in waarom sommige hardlopers meer geneig is as ander om gedurende die wrywingsone simptome te ervaar. Abnormaliteite in hardloopbiomeganika is ’n intrinsieke risikofaktor wat reeds omvattend in die literatuur beskryf is. Tog is weinig bekend oor presies hoe dit met ITBS verband hou. Oogmerke: Die doel van hierdie stelselmatige ondersoek was om ’n sintese te bied van die jongste bewyse van die biomeganiese risikofaktore van ITBS. Hierdie risikofaktore kan dalk oorweeg word om ITBS by hardlopers te voorkom of te bestuur. ’n Kliniese algoritme word ook aangebied. Metodes: ’n Stelselmatige ondersoek is met behulp van meta-ontleding onderneem. PubMed, PEDro, SPORTSDisc en Scopus is elektronies deurgesoek vir literatuur wat tot en met Mei 2014 verskyn het. Deursnee en kohortstudies is ingesluit indien dit gehandel het oor die biomeganika in die onderste ledemate van hardlopers wat ITBS het of later ontwikkel het. Alle studies wat deel was van die ondersoek is metodologies geëvalueer. Bewyse is aan die hand van bewysvlak, bewyskonsekwentheid en kliniese impak beoordeel. Data is narratief beskryf met behulp van tabelle of narratiewe opsommings waar dit toepaslik was. ’n Meta-ontleding is onderneem waar biomeganiese risikofaktore in minstens twee studies aangemeld is, mits daar homogeniteit in die uitkomste sowel as die steekproewe was. Resultate: Altesaam 11 studies is ingesluit (een prospektief en tien deursnee). Die metodologiese telling van die studies was oorwegend gemiddeld. Verhoogde spitsheupadduksie en interne knierotasie gedurende die staanfase kan op die ontwikkeling van ITBS by vrouehardlopers dui. Hierdie biomeganiese risikofaktore kan dalk nagegaan word vir ITBS-voorkoming, al was die bewysbasis beperk tot ’n enkele studie. Daar is tans geen afdoende bewys dat enige van die biomeganiese parameters oorweeg behoort te word in die bestuur van langafstandatlete met ITBS nie. Gevolgtrekking: Daar bestaan dalk biomeganiese verskille tussen hardlopers wat ITBS het of kan ontwikkel en gesonde hardlopers. Hoewel ’n groot verskeidenheid biomeganiese risikofaktore beoordeel is, is die bewysbasis vir die toets of bestuur daarvan by atlete met ITBS beperk. Dít is vanweë die klein hoeveelheid bewyse, die klein kliniese impak, en heterogeniteit tussen studie-uitkomste en bevindinge. Verdere prospektiewe en deursneenavorsing word vereis om te bepaal of abnormaliteite in hardloopbiomeganika ’n rol kan speel in waarom langafstandhardlopers ITBS ontwikkel, of om vas te stel watter risikofaktore ter sprake kan wees in die bestuur van hierdie hardlopers.

La performance sportive et la prévention des blessures en cyclisme sont étroitement liées à l'amélioration des capacités physiques, de la technique gestuelle ainsi qu'à l'optimisation du matériel utilisé.Dans ce contexte, nous avons étudié l'influence du recul de selle sur l'efficacité du mouvement de pédalage ainsi que sur les efforts internes au niveau du genou. Une approche de modélisation musculo-squelettique a été développée afin de quantifier indirectement les forces musculaires et articulaires exercées à partir de mesures externes cinématiques et dynamiques. Un intérêt tout particulier a été porté sur l'adéquation entre les mesures des efforts extérieurs, le modèle anthropométrique et les mesures cinématiques afin de diminuer les incohérences dynamiques associées à un système surdéterminé.A partir de ces mesures, les effets du recul de la selle sur la performance ont été évalués à travers l'indice d'efficacité de la force produite à la pédale et un nouvel indice, basé sur le travail mécanique externe. Les résultats ont montré qu'un positionnement de la selle plus reculé augmente l'efficacité du mouvement de pédalage.Concernant la prévention des blessures, notre analyse s'est portée sur l'effet du recul de selle sur deux troubles musculo-squelettiques (TMS) fréquents en cyclisme : le syndrome fémoro-patellaire et le syndrome de la bandelette ilio-tibiale. Nos résultats ont montré que le recul de selle ne modifie pas les forces fémoro-patellaires communément incriminées dans la survenue de ce syndrome. Par ailleurs, une position plus reculée augmente les forces fémoro-tibiales de compression par le biais notamment de la contraction excentrique des muscles ischio-jambiers. Bien que le syndrome de la bandelette ilia-tibiale soit classiquement décrit comme un syndrome de friction (syndrome de l'essuie-glace), le calcul de la force d'interaction entre la bandelette iliotibiale et l'épicondyle fémoral a montré que la compression est le facteur discriminant dans le pathoméchanisme. L'approche méthodologique de simulation développée dans ce cadre possède par ailleurs un fort potentiel afin de corriger les défauts techniques, d'optimiser les réglages matériels et améliorer la prise en charge thérapeutique des TMS.Plus généralement, les développements méthodologiques et implications cliniques issus de ces travaux trouvent des applications directes dans le milieu du cyclisme mais aussi dans l'étude de nombreuses activités sportives (notamment sur ergomètre) du point de vue de la performance, de la prévention des blessures et de la rééducation
Performance and prevention of injuries in cycling are closely linked to the optimisation of individual's physical capacity and technique as weil as sport equipment.In this context, we have studied the influence of saddle setback on the effectiveness of pedalling and on knee joint loads. A musculoskeletal modelling was developed to estimate muscle and joint forces from experimental kinematic and dynamic measurements. We first focused on the adequacy between sensors data, anthropometrie model and kinematic measurements to obtain dynamically consistent input data.Then, the effect of sadd le setback on perforn1ance was evaluated through the index of pedal force effectiveness and a new index based on extemal mechanical work. Results have showed that a more backward sadd le position increases the effectiveness of pedalling.As regards to in jury prevention, our analysis focused on the effect of the saddle setback on two knee injuries commonly observed in cycling: the patellofemoral syndrome and iliotibial band syndrome. Our results showed that saddle setback do not influence patellofemoral joint forces that are usually linked to this syndrome. Moreover, a more backward saddle position increases tibiofemoral compression forces due to increasing eccentric contraction of the hamstrings.Commonly described as a friction syndrome, the computation of interaction force between iliotibial band and lateral femoral epicondyle have showed that the compression was the discriminating factor in the occurrence of the syndrome. The simulation approach developed here could be used as an additional tool to help correct potentially hartnful sport techniques, optimise equipment setup/design and improve the treatment of injuries.More generally, this thesis brings new methodological improvements and clinical implications that have broader applications on sport perfortnance, injury prevention and rehabilitation

La pronation et les pieds plats ont longtemps été considérés conjointement, notamment dans leur relation avec la blessure. Or, cette relation, au regard des résultats divergents de la littérature, a été remise en question. Récemment, la dissociation entre la typologie et la fonctionnalité du pied a permis de mettre en évidence une possible association entre la pronation et la lombalgie. L’étude de la locomotion de sujets pronateurs identifiés par des tests fonctionnels pourrait exposer les facteurs de risques biomécaniques associés à la lombalgie. L’objectif général était d’identifier et d’étudier l’impact cinématique et baropodométrique de la pronation à la marche. Puis d’évaluer l’effet de traitements préventifs visant à limiter la biomécanique à risque dans un but de prévention primaire. Trois études ont été menées. Une étude de concordance entre différents tests d’identification de la pronation a été réalisée, dans des conditions différentes, afin de sélectionner un test approprié à l’étude de la marche. La cinématique et la baropodométrie de la marche de 159 sapeurs-pompiers professionnels, pronateurs vs non-pronateurs, ont été comparées. Deux protocoles d’un mois visant à réduire la pronation (renforcement musculaire du pied ou port de semelles) ont été proposés chez les sujets pronateurs. La concordance des différents tests de fonctionnalité a été jugée faible. Une combinaison de tests fonctionnels a été utilisée pour affiner le diagnostic de pronation. Les sujets pronateurs ont exposé des différences baropodométriques et cinématiques de l’avant et de l’arrière-pied, du genou et du bassin à la marche. Cette cinématique pourrait constituer un facteur de risque de lombalgie. La pronation a été réduite par les deux protocoles préventifs et accompagnée de modifications cinématiques du pied et de la hanche. Bien que nos protocoles préventifs ne témoignent pas d’une incidence sur le bassin, ils exposent une modification cinématique du membre inférieur, qui pourrait modifier la biomécanique du bassin et constituer un moyen de prévention des lombalgies
Pronation and flat feet have, for a long time, been associated, particularly in their relationship to injury. However, this relationship has been questioned in view of the divergent results in writings. Recently, the dissociation between foot-type and foot-function has highlighted a possible link between pronation and low back pain. The study of pronator subjects' way of moving, identified by foot function tests, could highlight the biomechanical risk factors associated with low back pain. The general objective was to identify and study the kinematic and plantar pressure impact of pronation while walking. Then to evaluate the effect of preventive treatments aimed aimed to limit the biomechanics at risk while keeping primary prevention in mind. Three studies were conducted. A concordance study between different pronation identification tests, under different conditions, was carried out in order to select an appropriate test for the study of gait. Gait kinematic and baropodometric analyses of 159 pronator vs non-pronator professional firefighters were then compared. Then, the effects of two one-month protocols aimed at reducing pronation (foot muscle strengthening or wearing insoles) were suggested to pronator subjects. Agreement between the different tests of foot-function identification was found to be low. A combination of functional tests was used to refine the identification of pronation. Pronator subjects showed plantar pressure and kinematic differences in the forefoot, hindfoot, knee and pelvis. These kinematic effects may reflect a risk factor for low back pain. Pronation was reduced by both preventive protocols wich were accompanied by kinematic changes in the foot and hip. Although our preventive protocols do not show an impact on the pelvis, they do show a kinematic change in the lower limb that could modify the biomechanics of the pelvis and provide a mean of preventing low back pain

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 117 leaves of pages : ill.
The purpose of this pre-post crossover clinical trial was to investigate the relative effectiveness of the combination of stretching followed by strengthening, versus the combination of strengthening followed by stretching, of the gluteus medius and iliotibial band (ITB), in the rehabilitation of chronic Iliotibial Band Syndrome (ITBS) in long distance runners. The results were based upon subjective and objective clinical findings, as well as effect on running performance.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science. Johannesburg, 2001
Long distance running is characterised by a high injury rate (van Mechelen, 1995; Lysholm and Wiklander, 1987). It is an ever-growing sport, being tried by increasing numbers of people with varying degrees of athletic ability. Injuries are detrimental to training, increase the risk of sustaining another injury, and are expensive to treat placing demands on our already strained health care system. Runners are healthy people who would require less health care than most people if they could avoid injuries. Iliotibial band friction syndrome (ITBFS), is one of the most common running injuries experienced. Buttock and/or posterior thigh pain (BAOPTP) is another common condition, which is also resistant to treatment. It tends to become chronic and to result in ongoing morbidity.
IT2018

Mini-dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010.
Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is a prevalent condition and is the most common cause of lateral knee pain in long distance runners and cyclists. There are a significant number of aetiological factors related to ITBFS. As a result of this the general chiropractic approach to the treatment of ITBFS is multimodal and include interventions such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the available literature suggests that to determine its efficacy, it should be performed in isolation. The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are thought to co-exist and perpetuate one another. It is recommended that chiropractors include pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature showing its effectiveness in the treatment of this condition. There appears to be a need for further research in the form of randomized controlled clinical trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the sacroiliac joint manipulation and dry needling in the treatment of ITBFS. Objectives The study aimed to determine the comparative effectiveness of dry needling alone versus manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS. Methods This study was a randomised, open label trial. 47 participants with ITBFS were divided into three groups, each group receiving a different intervention i.e.: group one received dry needling of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac joint manipulation, group three received a combination of the two interventions. Subjective measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test as well as digital inclinometer readings of Modified Obers test, were utilised to determine the effects of the respective interventions. These measurements were recorded twice, once prior to commencing the treatment programme. These values were then evaluated to compare the efficacy of the different treatment interventions. Each participant received four treatments over a two week period. Results There were no statistically significant differences between the three treatment groups as they all seemed to parallel one another with regards to overall improvement in subjective and objective measurements (P<0.5). However on closer examination subtle differences between the groups were noted. An interesting endpoint is that the combination group did not fair the best throughout the study, which was contrary to the original hypothesis. The groups receiving only the single intervention appeared to fair marginally better over the combination group. A secondary endpoint that became evident during the study and on analysis of the data, was that hip joint instability must also be considered when treating ITBFS when there is concomitant sacroiliac joint dysfunction. Conclusion A decision needs to be made with regard to which intervention best suits the individual at the time. A combination therapy, which originally was thought to be the best treatment option, should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling should be decided upon. In totality, all intervention proved to be effective in the treatment of ITBFS.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2013.
Background : It has become practically impossible for practitioners to remain current with clinical developments. Additionally the demand from patients and third party payors for quality evidence is increasing. A systematic review is one manner in which information can be graded, summarised and presented in a succinct format for use by practitioners, patients and third party payors. Objectives : To identify the current knowledge available on the conservative management of iliotibial band syndrome (ITBS) and to evaluate the scientific and methodological rigor of that knowledge. The systematic review of these studies identified the level and type of evidence that currently exists in the support of conservative management of ITBS and the specific interventions and combinations of interventions currently employed. Method : A systematic review of ITBS studies was conducted. ITBS studies were identified using key indexing terms (iliotibial band syndrome, treatment, conservative and intervention) on several databases (EBSCOhost, Google Scholar, Metalib, Pubmed, Science Direct and Springerlink), all studies were included up until the date of ethics approval (21st May 2012) . The gathered studies were screened for compliance with the inclusion criteria, and then reviewed by blinded independent reviewers (reviewer criteria included qualification, clinical experience, academic experience, research experience and discipline). Data collection and analysis : The reviewers rated the methodological rigour of the ITBS studies utilising an appropriate scale (e.g. PEDro Scale). Feedback was collated and analysed for discordance. Studies were then analysed, ranked and followed by a discussion in the context of their clinical outcomes, thus formulating a structured summary of the known clinical data with regards to the clinical management of ITBS. Results: The identified citations (4130) were screened and sorted by study type. This resulted in 167 citations that were reviewed by abstract for compliance with the inclusion criteria. A final total of 23 studies meet eligibility criteria. Eight articles reported on a combination of interventions, four discussed biomechanical and causative factors, and the remaining eleven articles investigated individual interventions in the treatment of ITBS. After review and analysis, combination interventions were supported by the strongest level of evidence, thus advocating the use of a combination of interventions in the management of ITBS in providing better clinical outcomes. Moderate evidence favoured the use of customised orthoses, injectable corticosteroids, phonophoresis and addressing biomechanical and causative factors. However, there was moderate evidence against the use of deep tissue frictions, as no improvement was found. This outcome suggests a need for further evidence to advocate the appropriateness of these interventions in clinical care of ITBS. Hip abductor strengthening and stretch therapy were found to have limited evidence. However, no evidence was found to support the application of active release technique, corrective neuromuscular approach, custom dry floatation cushions and talar joint manipulation in the management of ITBS. This latter outcome indicated a need for studies to investigate their appropriateness or inappropriateness in clinical care. Conclusion : The systematic review of ITBS studies revealed that use of a combination of conservative therapies was found to have the strongest level of evidence, which may indicate its appropriateness in the management of patients suffering from ITBS. Specific combinations of conservative therapies and the use of individual therapies require future research in order to better delineate their contribution to the management of ITBS. Randomised controlled trials are the gold standard for research, as they have the greatest level of methodological quality, and should be used where possible when investigating the efficiency of interventions in the treatment of ITBS. Studies, which were not randomised controlled trials, but adopted the principles of a randomised controlled trial structure, contributed positively towards the methodological rigor of these studies.

A dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Technikon Natal, 1997.
Iliotibial Band Friction Syndrome is a common problem for patients as well as physicians. Many treatments have been devised for Iliotibial Band Friction Syndrome, but there is very little research to substantiate which of these treatments is most effective. Myofascial trigger points are a frequently overlooked and misunderstood phenomenon in the medical curriculae, yet with correct diagnosis and appropriate treatment the prognosis of these trogger points is usually excellent. The aim of this placebo-controlled study was to justify the hypotheses which stated that myofascial trigger point therapy would be effective in the treatment of Iliotibial Band Friction Syndrome (IBFS), as compared to detuned ultrasound as a form of treatment.
M

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016.
Background: Iliotibial band friction syndrome is a common dysfunction seen in athletes. Athletes develop biomechanical changes yet still continue with their sport. However, this syndrome limits their ability to participate at peak performance. This study determined which participants benefitted in terms of biomechanical and clinical outcomes in one of four groups: ankle joint, superior tibio-fibular joint, sacroiliac joint or a combination manipulation group (which contained any two of the three joint restrictions). Methods: This Durban University of Technology Institutional Research and Ethics Committee approved prospective clinical trial, utilised stratified sampling, with 48 participants across four groups: ankle (14); superior tibio-fibular (11), sacroiliac (12) and combination (11). The participants underwent six treatments in three weeks. Data collection occurred before consultations one, three, five and seven. The data included primary measures of the knee score questionnaire (KSQ), the algometer, the visual analogue scale (VAS) and the secondary measures of the Feiss line, the heel leg alignment, bilateral leg length, Q angle and tibio-femoral angle. All data was computed utilising the ANOVA testing, with a p-value <0.05 being significant and a 95% confidence interval. Pearson’s correlations were completed for intragroup associations between primary and secondary outcome measures. Results: The intragroup analysis revealed that all groups had significant changes in the KSQ and VAS, with the exception of the sacroiliac joint manipulation group (KSQ outcome not significant). Intergroup analysis revealed no differences between the groups with the exception of the combination group, which showed a significant increase in the tibio-femoral angle. Most commonly, the Pearson’s correlation revealed that changes in leg length were related to differences in primary outcome measures, irrespective of the group being tested. Conclusion: The outcomes of this study indicated that manipulation of the distal kinematic chain improved alignment and clinical outcomes to a greater degree than manipulating proximal restrictions. It is suggested with caution (due to limited sample size) that patients should first have their distal kinematic chain manipulated before more proximal joints are manipulated to achieve better outcomes.
M

The Gluteus Medius and the Tensor Fascia Lata are two of the main muscles involved in the action of hip abduction. This action is important for both dynamic movements in athletic pursuits and in every day ambulation. Weakness in these muscles has been connected to multiple injuries in the lower limb, but the question of the casual relationship between gait change, hip abductor weakness, and lower limb injury is still up for debate. As presented by the current research, younger populations tend to have overuse injuries with females having a greater susceptibility for injuries connected to hip abductor weakness, and older populations tend to have injures related to atrophy and degeneration of either the hip abductor muscles or the joint surrounding the hip. Research in this field has increasingly focused on sub-sets of the populations, such as just females or just males, trying to pinpoint the role that hip abductor weakness plays in these injuries. By trying to minimize or even eliminate the confounding variables that have previously made it difficult to determine the role hip abductor weakness plays in these gait changes and injuries, these studies have been able to make more clear conclusions at the expense of making a broader generalization. Similarities and differences between how the sub-groups present with hip abductor weakness are discussed, as well as discrepancies observed within the research done on similar cohorts. Future directions for research in this field are discussed, as well as implications for clinical implementation of targeted rehabilitation programs to ensure the best possible outcomes.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic at Durban Institute of Technology, 2004.
The purpose of this study was to investigate the association between the role of Myofascial Trigger Points of the lower extremity to the clinical presentation of lIiotibialband Friction syndrome
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