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Aderem J.1, Louw Q.1
1University of Stellenbosch, Department of Physiotherapy, Cape Town, South Africa
Background: Iliotibial band syndrome is the second most common running injury. A gradual increase in its occurrence has been noted over the past decade. This may be related to the increasing number of runners worldwide. Since the last systematic review, six additional papers have been published, providing an opportunity for this review to explore the previously identified proximal risk factors in more detail.
Purpose: To quantitatively explore the trunk, pelvic and lower limb biomechanical risk factors associated with Iliotibial band syndrome in runners and to provide an algorithm for future research and clinical guidance.
Methods: An electronic search was conducted of literature published up until April 2015. The critical appraisal tool for quantitative studies was used to evaluate methodological quality of eligible studies. Forest plots displayed biomechanical findings, mean differences and confidence intervals. Level of evidence and clinical impact were evaluated for each risk factor. A meta-analysis was conducted where possible.
Results: 13 studies were included (prospective (n=1), cross-sectional (n=12)). Overall the methodological score of the studies was moderate. Female shod runners who went onto developing Iliotibial band syndrome presented with increased peak hip adduction and increased peak knee internal rotation during stance. Female shod runners with Iliotibial band syndrome presented with increased: peak knee internal rotation and peak trunk ipsilateral during stance.
Conclusion(s): Findings indicate new quantitative evidence about the biomechanical risk factors associated with Iliotibial band syndrome in runners. Despite these findings, there are a number of limitations to this review including: the limited number of studies, small effect sizes and methodological shortcomings. This review has considered these shortcomings and has summarised the best available evidence to guide clinical decisions and plan future research on Iliotibial band syndrome aetiology and risk.
Implications: This review considered the clinical and research implications. At this stage we cannot make conclusive clinical recommendations, even for peak knee internal rotation and peak trunk ipsilateral flexion, due to the limited number of studies, small effect sizes and methodological shortcomings. The evidence for factors that may predispose runners to the development of ITBS remains limited to a single study. Despite these shortcomings, our review summarised the best available evidence to guide clinical decisions or plan future research. Clinicians performing gait analysis should consider the type of shoes the runner is wearing as well as if they run to fatigue as these this will also have an effect. Future studies should report data on males and females separately. The most important finding of our review is that we identified many methodological factors which should be addressed in future research. Our concise, quantitative presentation of the data presented in this review could assist future researchers with the data required to calculate sample sizes. Future studies should report reliability and measurement errors to understand the attributable role of potential risk factors associated with ITBS. They should consider published risk factors in order to compare across studies. A physiological plausible theory for selected risk factors is also lacking and this should be addressed in future.
Funding acknowledgements: No funding was required
Topic: Sport & sports injuries
Ethics approval: The study protocol was approved by the Health Research Ethics Committee of Stellenbosch University in Cape Town, South Africa.
All authors, affiliations and abstracts have been published as submitted.
