Unpublished claim that hip strengthening will relieve the pain of ITBS

CONTEXT: Biomechanically, hip muscle strength and flexibility are necessary to control and facilitate proper distal limb motion while running. Only one study has investigated the effectiveness of rehabilitation of running injuries via hip muscle strengthening and only involved iliotibial band syndrome.

OBJECTIVE: To determine if increases in hip muscle strength and flexibility are associated with a significant reduction in pain associated with running injuries. It was hypothesized that patients would demonstrate a significant improvement in hip muscle strength and flexibility and a minimum 50% reduction in pain following a 4-6 week rehabilitation program.

DESIGN: Pre-test/post-test.

SETTING: Patients presenting to the Running Injury Clinic.

PATIENTS OR OTHER PARTICIPANTS: 284 consecutive patients presenting to the Clinic for various musculoskeletal running injuries (females: 183; males: 101; age: 37 years±8.3; weekly running mileage 35.7 km±9.4).

INTERVENTIONS: Patients were asked to report the average amount of pain they were experiencing while running using a 10cm visual analog scale (VAS). Hip internal and external rotator muscle flexibility was measured using a goniometer. The Thomas and Ober clinical tests were used to determine hip flexor and IT band flexibility. Hip muscle strength was measured using a standard 0-5 manual muscle scale. For statistical analysis, strength values were converted from a 0-5 scale to a percentage score assuming 5/5 equalled 100% and 3/5 equalled 50% of maximum isometric force. Minimum standards for each strength and flexibility measure were established through pilot work and literature. A rehabilitation program was prescribed to improve hip strength and/or flexibility where necessary. Paired t-tests (alpha=0.05) were used for statistical comparisons.

MAIN OUTCOME MEASURES: Pre-post comparisons of VAS and hip strength and flexibility measures following 4-6 weeks of rehabilitation.

RESULTS: Patellofemoral pain syndrome (n=54), iliotibial band syndrome (n=40), medial tibial stress syndrome (n=13), Achilles tendinopathy (n=10), and plantar fasciitis (n=10) accounted for the majority of injuries. 165 patients (58%) returned for follow-up assessment and reported a significant improvement in pain (VAS pre: 6.11cm±0.87 post: 0.89cm±1.22; P=0.01) and 89% reported at least a 50% improvement in pain. These patients also exhibited significant improvements in hip abductor (pre: 78.55%±11.07 post: 95.32%±7.81; P=0.02), flexor (pre: 77.11%±13.92 post: 91.94%±6.78; P=0.03), and external rotator (pre: 76.06%±14.94 post: 90.48%±10.70; P=0.03) muscle strength. Significant increases in hip internal rotator (pre: 39.67 deg±6.29 post 45.39 deg ±4.99; P=0.01) and external rotator (pre: 36.71 deg ±4.26 post: 44.16 deg ±3.74 deg; P=0.01) muscle flexibility was measured. 86% of patients who exhibited a positive Thomas or Ober’s test prior to the rehabilitation program exhibited no tissue inflexibility at follow-up.

CONCLUSIONS: The results from this study suggest that a hip strength and flexibility rehabilitation program, based on the biomechanics of running and specific clinical criteria, can effectively resolve pain associated with various musculoskeletal running injuries.