Stiffness of the iliotibial band and associated muscles in runner's knee: Assessing the effects of physiotherapy through ultrasound shear wave elastography

Phys Ther Sport. 2020 Sep;45:126-134. doi: 10.1016/j.ptsp.2020.06.015. Epub 2020 Jul 25.


Objectives: To test the hypothesis that Iliotibial Band Syndrome (ITBS) is caused by excessive iliotibial band (ITB) tension, promoted by hip abductor and external rotator weakness, and evaluate the influence of 6 weeks of physiotherapy on ITB stiffness.

Design: Interventional study with control group.

Setting: Clinical.

Participants: 14 recreational runners with ITBS and 14 healthy controls of both sexes.

Main outcome measures: Ultrasound shear wave elastography, hip muscle strength, visual analog scale pain, subjective lower extremity function.

Results: No statistical differences in ITB tension between legs as well as between patients suffering from ITBS and healthy controls were detected. Results showed significant strength deficits in hip abduction, adduction as well as external and internal rotation. Following six weeks of physiotherapy, hip muscle strength (all directions but abduction), pain and lower extremity function were significantly improved. ITB stiffness, however, was found to be increased compared to baseline measurements.

Conclusion: Shear wave elastography data suggest that ITB tension is not increased in the affected legs of runners with ITBS compared to the healthy leg or a physical active control group, respectively. Current approaches to the conservative management of ITBS appear ineffective in lowering ITB tone.

Keywords: Iliotibial band syndrome; Iliotibial tract; Lateral knee pain; Muscle weakness; Runner’s knee; Shear wave elastography.

MeSH terms

  • Adolescent
  • Adult
  • Biomechanical Phenomena
  • Elasticity Imaging Techniques / adverse effects
  • Elasticity Imaging Techniques / methods*
  • Female
  • Humans
  • Iliotibial Band Syndrome / physiopathology
  • Iliotibial Band Syndrome / rehabilitation*
  • Knee Joint / diagnostic imaging
  • Knee Joint / physiopathology*
  • Male
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging
  • Muscle, Skeletal / physiopathology*
  • Physical Therapy Modalities*
  • Running / physiology*
  • Young Adult