More evidence that IT band stretching is futile

PainSci » bibliography » Wilhelm et al 2017
updated Nov 10, 2017

Tags: etiology, IT band pain, stretch, running, scientific medicine, knee, anatomy, neat, pro, leg, limbs, pain problems, overuse injury, injury, exercise, self-treatment, treatment, tendinitis, muscle

Three pages on PainSci cite Wilhelm 2017: 1. The Complete Guide to IT Band Syndrome 2. The Unstretchables 3. IT Band Stretching Does Not Work

PainSci commentary on Wilhelm 2017: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is an in vitro study of the effect of pulling on a dissected IT band, removed from a corpse. This is not necessarily a pointless thing to do (in vitro experiments have their uses), but in this case the IT band was aggressively harvested: completely removed from its complex anatomical context, cleaned, frozen, warmed up to 20˚ C, and then machine-stretched … although we can learn things from this, it’s important to emphasize that the differences from biological and clinical reality are piled high here.

The abstract of the paper “advertises” a statistically significant effect of machine stretching on an excised IT band … but not a clinically significant effect. They report an elongation of just a few millimeters. In the main text, they concede that “the current study’s findings are in agreement with those of Falvey et al. demonstrating minimal stretching of the ITB”! (Falvey et al is the paper most cited to argue that the IT band cannot be meaningfully stretched, and this paper is “in agreement” with it, demonstrating “minimal stretching.”)

They also write: “it is unlikely that … ‘clinical stretching’ produces permanent ITB deformation.” So despite superficial appearances to the contrary, this paper clearly actually reinforces the point that IT band stretching is futile (to the extent that stretching a completely dissected IT band can tell us anything at all).

I got a chuckle out of this:

“While the tissue used for the present analysis was harvested from a specimen sample that was older than those individuals who would likely develop ITB pain, it is difficult to obtain cadaveric tissue samples from a younger population for testing.”

Indeed.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Iliotibial Band (ITB) syndrome is a troublesome condition with prevalence as high as 12% in runners. Stretching has been utilized as a conservative treatment. However, there is limited evidence supporting ITB elongation in response to a stretching force.

PURPOSE/HYPOTHESES: The purpose of this study was to describe the iliotibial band tensor fascia lata complex (ITBTFLC) tissue elongation response to a simulated clinical stretch in-vitro. The authors hypothesized that the ITBTFLC would undergo statistically significant elongation when exposed to a clinical-grade stretching regimen, with the majority of the elongation occurring within the proximal ITBTFLC region.

STUDY DESIGN: Within subjects repeated measures in-vitro design.

METHODS: The strain response of six un-embalmed ITBTFLCs to a simulated clinical stretch of 2.75% elongation was assessed. Four sets of array marks were placed along the length of the ITBTFLC. Photographic images were taken in resting position (with 1.0% in-situ elongation) and with an additional 2.75% elongation. Tissue elongation was compared between proximal, middle, and distal ITBTFLC regions.

RESULTS: A paired samples t-test demonstrated a significantly longer ITBTFLC in the "stretched" versus resting condition (p = 0.001). Significant elongation was observed in the proximal (3.96mm (SD = 1.35); p = 0.001), middle (2.12mm (SD = 1.49); p = 0.018) and distal (2.25mm (SD = 1.37); p = 0.01) regions during the "stretched" versus the resting condition. A one-way ANOVA demonstrated a significant main effect for region (p = 0.002). The proximal region exhibited significantly greater elongation versus the middle (p = 0.003) and distal (p = 0.007) regions, with no significant difference between the middle and distal regions (p = 0.932).

CONCLUSION: The results of this study demonstrate that the ITBTFLC is capable of elongation in response to a clinically simulated stretch. The proximal ITB region underwent significantly greater elongation than the middle and distal regions and may be more likely to respond to "stretching" in clinical situations. Future investigation should assess the ITBTFLC load/deformation properties to determine whether a short-term clinically available stretch translates into permanent tissue elongation.

LEVEL OF EVIDENCE: III.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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