THE IMMEDIATE EFFECTS OF FOAM ROLLING AND STRETCHING ON ILIOTIBIAL BAND STIFFNESS: A RANDOMIZED CONTROLLED TRIAL

T. Pepper¹, J.-M. Brismée¹, P.S. Sizer Jr.¹, J. Kapila¹, G.H. Seeber^2,1, C. Huggins^3,1, T.L. Hooper⁴

Background: Iliotibial Band Syndrome (ITBS) is a common clinical condition likely caused by abnormal compressive forces between the iliotibial band (ITB) and the lateral femoral condyle. Stretching interventions are common in ITBS treatment and may predominantly affect tensor fascia latae (TFL). Another ITBS treatment is foam rolling, which may more directly affect the ITB tissue. Shear wave ultrasound elastography (SWUE) measures real-time soft tissue stiffness, allowing tissue changes to be measured and compared.

Purpose: The purpose of this randomized controlled trial was to examine the effects of foam rolling and iliotibial complex stretching on ITB stiffness and hip adduction range of motion (ROM).

Methods: Data from 11 males (age = 30.5 ± 9.0 years, Body Mass Index (BMI) = 27.8 ± 4.0) and 19 females (age = 23.5 ± 4.9, BMI = 23.2 ± 2.1) were analyzed for this study. Subjects were randomly assigned to control, stretching, and foam rolling groups. Measurements included ITB Young’s modulus at the
(1) mid-thigh,
(2) distal femur and
(3) TFL muscle belly; hip adduction ROM; and mid-thigh ITB-to-femur depth. Multiple 3 (intervention) x 2 (time) mixed ANOVAs were used to analyze.
(1) ITB Young’s modulus at the patella and thigh and the TFL at 0˚ and 10˚ of hip adduction,
(2) ITB-to-femur depth at 0˚ and 10˚ of hip adduction, and
(3) hip adduction ROM. Pearson correlations assessed the relationships between hip adduction ROM and ITB Young’s modulus at the mid-thigh and the level of the superior patella to ITB-to-femur tissue depth before and immediately following the interventions.

Results: The ITB stiffness at the thigh and patella increased with 10° adduction, but TFL stiffness did not increase. No significant interactions or main effects were found for group or time differences in ITB Young’s modulus at the three measured locations. A main effect for adduction ROM was observed, where ROM increased 0.8˚ post-treatment (p = .02) Correlations between hip adduction ROM and ITB-to-femur depth to SWUE were fair to moderate. For ITB tissue depth, a significant interaction was found for Time by Group during 10° adduction, where the depth decreased 5 percent with 10° adduction following foam rolling.

Conclusion(s): A single episode of stretching and foam rolling does not affect short-term ITB stiffness, but foam rolling decreases ITB tissue depth. The lack of ITB stiffness changes may be from an inadequate intervention stimulus. Alternatively, tissue depth changes following foam rolling may relate to perceived foam rolling benefits.

Implications: This is the first study to examine ITB stiffness in vivo and confirm previous in vitro findings, which indicates that other factors are contributing to perceived clinical improvement with intervention such as ITB foam rolling or stretching. Since ITB stiffness does not change, but depth does other factors may affect the sub-ITB tissues. Research investigating the influence of sub-ITB tissue space and the mechanics of hip adduction motion is currently lacking, and the cause of such depth changes is unknown. Future research should be evaluated based on these findings.

Funding, acknowledgements: No funding has been received for this study.

Keywords: shear wave ultrasound elastography, Iliotibial band, foam rolling

Topic: Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Texas Tech University Health Sciences Center (TTUHSC)

Committee: TTUHSC Lubbock/Odessa IRB for Protection of Human Subjects

Ethics number: (# L19-076)