Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
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Iliotibial Band Stretching in the Modified Thomas Test Position Changes Hip Abduction Angle and Vastus Medialis Activity in Individuals With Tight Iliotibial Band

  • Baik, Seung-min (Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University) ;
  • Jeong, Hyo-jung (Movement Science Program, Program in Physical Therapy, Washington University School of Medicine) ;
  • Lee, Ji-hyun (Department of Physical Therapy, Division of Health Science, Baekseok University) ;
  • Park, Dong-hwan (Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University) ;
  • Cynn, Heon-seock (Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University)
  • Received : 2019.01.14
  • Accepted : 2019.02.15
  • Published : 2019.02.19
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Abstract

Background: A tight iliotibial band (ITB) may lead to lateral patellar maltracking, compression, and tilt, and dominant vatus lateralis (VL) muscle activation relative to vastus medialis oblique (VMO) can laterally displace the patella, which leads to anterior knee pain. Therefore, an effective management technique is needed to stabilize the patella in individuals with tight ITB. Increased stability during the modified Thomas test has the potential to decrease compensatory motion and thus to selectively stretch the ITB. Objects: The purpose of this study was to determine the effects of ITB stretching in the modified Thomas test position on ITB flexibility, patellar translation, and muscle activities of the VMO and VL during quadreceps-setting (QS) exercise in individuals with tight ITB. Methods: Twenty-one subjects with tight ITB were recruited. Digital inclinometer was used to measure the hip adduction angle during the modified Ober test. Universal goniometer was used to measure the hip abduction angle during the modified Thomas test. Ultrasonography was used to measure the patella-condylar distance. Electromyography was performed to collect data of muscle activities. Paired t-test was used to determine the statistical significance between pretest and posttest. Results: The range of hip adduction in modified Ober test increased (p=.04) and the range of hip abduction in the modified Thomas test decreased after ITB stretching (p<.01). There was no difference between lateral patellar translation (p=.18). VMO muscle activity significantly increased after ITB stretching during QS (p<.01). VL muscle activity had no difference after stretching. Conclusion: The ITB stretching in the modified Thomas test position can be suggested as a management method for improving ITB flexibility and VMO muscle activity in individuals with tight ITB.

Keywords

References

  1. Ahmed AM, Burke DL, Yu A. In-vitro measurement of static pressure distribution in synovial joints-part II: Retropatellar surface. J Biomech Eng. 1983;105(3):226-236. https://doi.org/10.1115/1.3138410
  2. Bandy WD, Irion JM, Briggler M. The effect of time and frequency of static stretching on flexibility of the hamstring muscles. Phys Ther. 1997;77(10):1090-1096. https://doi.org/10.1093/ptj/77.10.1090
  3. Bowyer D, Armstrong M, Dixon J, et al. The vastus medialis oblique: Vastus lateralis electromyographic intensity ratio does not differ by gender in young participants without knee pathology. Physiotherapy. 2008;94(2):168-173. https://doi.org/10.1016/j.physio.2007.08.007
  4. Criswell E. Cram's Introduction to Surface Electromyography. Maryland, USA, Aspen Publishers, 2010.
  5. Crossley K, Bennell K, Green S, et al. Physical therapy for patellofemoral pain a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. 2002;30(6):857-865. https://doi.org/10.1177/03635465020300061701
  6. DePino GM, Webright WG, Arnold BL. Duration of maintained hamstring flexibility after cessation of an acute static stretching protocol. J Athl Train. 2000;35(1):56-59.
  7. Douciette SA, Goble EM. The effect of exercise on patellar tracking in lateral patellar compression syndrome. Am J Sports Med. 1992;20(4):434-440. https://doi.org/10.1177/036354659202000412
  8. Earl JE, Schmitz RJ, Arnold BL. Activation of the vmo and vl during dynamic mini-squat exercises with and without isometric hip adduction. J Electromyogr Kinesiol. 2001;11(6):381-386. https://doi.org/10.1016/S1050-6411(01)00024-4
  9. Ferber R, Kendall KD, McElroy L. Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. J Athle Train. 2010;45(4):344-348. https://doi.org/10.4085/1062-6050-45.4.344
  10. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sports Med. 2006;16(3):261-268. https://doi.org/10.1097/00042752-200605000-00013
  11. Fredericson M, White JJ, Macmahon JM, et al. Quantitative analysis of the relative effectiveness of 3 iliotibial band stretches. Arch Phys Med Rehabil. 2002;83(5):589-592. https://doi.org/10.1053/apmr.2002.31606
  12. Fredericson M, Wolf C. Iliotibial band syndrome in runners. Sports Medicine. 2005;35(5):451-459. https://doi.org/10.2165/00007256-200535050-00006
  13. Godges JJ, MacRae PG, Engelke KA. Effects of exercise on hip range of motion, trunk muscle performance, and gait economy. Phys Ther. 1993;73(7):468-477. https://doi.org/10.1093/ptj/73.7.468
  14. Gray H, Standring S, Ellis H, et al. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 39th ed. London, United Kingdom, Elsevier Health Sciences, 2005.
  15. Harvey D. Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med. 1998;32(1):68-70. https://doi.org/10.1136/bjsm.32.1.68
  16. Herrington L, Payton CJ. Effects of corrective taping of the patella on patients with patellofemoral pain. Physiotherapy. 1997;83(11):566-572. https://doi.org/10.1016/S0031-9406(05)65961-5
  17. Herrington L, Rivett N, Munro S. The relationship between patella position and length of the iliotibial band as assessed using Ober's test. Man Ther. 2006;11(3):182-186. https://doi.org/10.1016/j.math.2006.06.008
  18. Hudson Z, Darthuy E. Iliotibial band tightness and patellofemoral pain syndrome: A case-control study. Man Ther. 2009;14(2):147-151. https://doi.org/10.1016/j.math.2007.12.009
  19. Kang SY, Choung SD, Park JH, et al. The relationship between length of the iliotibial band and patellar position in Asians. Knee. 2014;21(6):1135-1138. httts://doi.org/10.1016/j.knee.2014.09.005
  20. Kendall FP, McCreary EK, Provance PG, et al. Testing and Function with Posture and Pain. Baltimore, MD, Lippincott Williams & Wilkins, 2005.
  21. Kim HS, Yoon TL. Comparison by ultrasound of relative thickness of the iliotibial band in healthy subjects following four self-stretching exercises. Phys Ther Kor. 2012;19(4):24-31. https://doi.org/10.12674/ptk.2012.19.4.024
  22. Lee JH, Cynn HS, Kwon OY, et al. Different hip rotations influence hip abductor muscles activity during isometric side-lying hip abduction in subjects with gluteus medius weakness. J Electromyogra Kinesiol. 2014;24(2):318-324. https://doi.org/10.1016/j.jelekin.2014.01.008
  23. Lucas CA. Iliotibial band friction syndrome as exhibited in athletes. J Athl Train. 1992;27(3):250-252.
  24. McConnell J. Management of patellofemoral problems. Man Ther. 1996;1(2):60-66. https://doi.org/10.1054/math.1996.0251
  25. Merican AM, Amis AA. Anatomy of the lateral retinaculum of the knee. J Bone Joint Surg Br. 2008;90(4):527-534. https://doi.org/10.1302/0301-620X.90134.20085
  26. Merican AM, Amis AA. Iliotibial band tension affects patellofemoral and tibiofemoral kinematics. J Biomech. 2009;42(10):1539-1546. https://doi.org/10.1016/j.jbiomech.2009.03.041
  27. Muragod A, Patil VR, Nitsure P. Immediate effects of static stretching versus myofascial release in iliotibial band tightness in long distance runners-a randomised clinical trial. EUJSM. 2014;2(1):31-38.
  28. Puniello MS. Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther. 1993;17(3):144-148. https://doi.org/10.2519/jospt.1993.17.3.144
  29. Sahrmann S. Diagnosis and Treatment of Movement Impairment Syndromes. St Louis, United States, Elsevier Health Sciences, 2001.
  30. Strauss EJ, Kim S, Calcei JG, et al. Iliotibial band syndrome: Evaluation and management. J Am Acad Orthop Surg. 2011;19(12):728-736. https://doi.org/10.5435/00124635-201112000-00003
  31. Tanigawa MC. Comparison of the hold-relax procedure and passive mobilization on increasing muscle length. Phys Ther. 1972;52(7):725-735. https://doi.org/10.1093/ptj/52.7.725
  32. Thomas A, Kümmel S, Fritzsche F, et al. Real-time sonoelastography performed in addition to b-mode ultrasound and mammography: Improved differentiation of breast lesions? Academic radiology. 2006;13(12):1496-1504. https://doi.org/10.1016/j.acra.2006.08.012
  33. Vieira EL, Vieira EA, Da Silva RT, et al. An anatomic study of the iliotibial tract. Arthroscopy. 2007;23(3):269-274. https://doi.org/10.1016/j.arthro.2006.11.019
  34. Wang TG, Jan MH, Lin KH, et al. Assessment of stretching of the iliotibial tract with Ober and modified Ober tests: An ultrasonographic study. Arch Phys Med Rehabil. 2006;87(10):1407-1411. https://doi.org/10.1016/j.apmr.2006.06.007
  35. Winters MV, Blake CG, Trost JS, et al. Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: A randomized clinical trial. Phys Ther. 2004;84(9):800-807. https://doi.org/10.1093/ptj/84.9.800
  36. Zakaria D, Harburn KL, Kramer JF. Preferential activation of the vastus medialis oblique, vastus lateralis, and hip adductor muscles during isometric exercises in females. J Orthop Sports Phys Ther. 1997;26(1):23-28. https://doi.org/10.2519/jospt.1997.26.1.23