Author Names
Zemadanis, K; Betsos, T
Reviewer Name
Alexis Hawbaker, SPT
Reviewer Affiliation(s)
Duke Doctor of Physical Therapy Division
Paper Abstract
Background: It is well known that Iliotibial band syndrome (ITBS) is the most frequent overuse injury in recreational runners. Given the fact that there are no clear guidelines on the optimal conservative treatment approach regarding ITBS rehabilitation, manual therapy effect by a functional joint mobilization is still unknown. The purpose of the study was to investigate whether implementation of mobilization-with-movement (MWM) and auto-mobilization had a significant short-term improvement in pain and functionality of recreational runners with ITBS. Methods: Participants: thirty ITBS patients, were randomly assigned into two groups. Design and Settings: One group pre-test /post-test with the control group. Interventions: Runners on the treatment group followed an MWM protocol of six sessions with an additive program of auto-MWM, while the control group received a SHAM form of MWM. Outcome measurements: Pain and functionality were measured at baseline and post-treatment, via Numeric Pain Rating scale and Lower Extremity Functional Scale respectively. Mixed-ANOVA test detected possible differences among treatment phases and between groups, but also interactions among factors. Result: The present findings revealed significant interactions between factors and significant main effects of each TIME and GROUP factors on pain and functionality. MWM-treatment group showed significant improvement in post-intervention NPRT and LEFS scores, compared to baseline scores (p<.001). SHAM-MWM group exhibited no significant differences on post-NPRT and LEFS scores, compared to baseline (p>.001). Differences between groups were significant in post-treatment scores (p<.001). Conclusion: Our findings suggest that MWM and auto-MWM are a significant treatment approach, improving pain and functionality in recreational runners suffering from ITBS.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- Yes
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Cannot Determine, Not Reported, or Not Applicable
Key Finding #1
Pain (Numeric Pain Rating Scale during running) and functionality (LEFS) measures were more significantly improved over the course of treatment within the MWM group compared to within the sham group.
Key Finding #2
Post-treatment measures were more significantly improved in the MWM group compared to the sham group.
Key Finding #3
Use of MWM in recreational runners with ITBS may allow for an earlier return to running than conventional ITBS interventions.
Reviewer Summary:
The authors chose 5 MWM exercises that addressed the IT band both proximally and distally based on common biomechanical patterns noted in ITBS literature. The specific dosage parameters of the MWM intervention make the study easy to replicate and apply in clinical practice. Notably, numeric pain rating scale values were obtained as subjects were running, which was sensible given that ITBS pain typically arises during running. This study had a small sample size and uniquely incorporates joint mobilization into ITBS rehabilitation, so further research is required to elucidate the utility of MWM in treating ITBS and whether its effects are generalizable to elite and differently aged runner populations.
Clinical Interpretation:
The described ITBS MWM intervention is easily replicable and, based on the length of treatment in the study (2 weeks), may allow for an earlier return to recreational running than conventional ITBS interventions. Presumably, specific exercises may be chosen out of the 5 described based on patient-specific impairments and gait mechanics. As previously mentioned, further research is needed to determine whether other populations would benefit from this intervention.
