A tsunami of IT band syndrome updates 🌊

I’ve finished publishing a tsunami of iliotibial band syndrome e-book updates for a tsunami of new customers from a bulk sale. Whenever I have a big wave of new readers like that, I pull out all the stops to make sure the content is current. There are about 20 significant updates, plus a major audio version upgrade, plus this here rebooted e-book cover:

Ilio-what now? A quick primer: IT band syndrome (ITBS) is one of the two common kinds of runners’ knee (with patellofemoral pain). It’s a tendinitis-y overuse injury of the huge iliotibial band, a massive connective tissue structure on the side of the thigh, and surprisingly weird and notoriously stubborn. I started writing about it after I got a nasty case of it myself on an “exciting” hiking trip (grizzly included, one of my best stories).

I’ve been writing about ITBS for about twenty years, so you’d think I’d have the topic licked by now, but my work is literally never done. Due to lack of any obvious updates, the book hadn’t been updated in quite a while, probably the biggest maintenance lull in its history. But it only took a few minutes of review to reveal plenty of work to do. So I dove in, and here are just the highlights from the changes to the book this year so far. (Although the full updates are all in a paywalled book, in many cases here you can get free detailed notes on the citations.)

• I rewrote the chapter “IT band syndrome may be more about physiological vulnerability than knee stress,” which directly addresses the “surprisingly weird and notoriously stubborn” nature of the beast. Before revision: a minor chapter musing about some of the more mysterious cases. After: a substantial, evidence-based chapter that sheds some genuine light on the problem.
• Another update to that chapter, complementary but separate, was a drop-in citation based on a lot of analysis of a low-quality genetic study of the causes of ITBS … which I dug into anyway, because it inadvertently undermines the authors’ pet theory that it’s all about hip weakness. That analysis is free to anyone in the PainSci bibliography, see Yao et al.
• One study, Sanchez-Gomez et al., was good for two seemingly unrelated updates:
  • Justification for a tepid recommendation to at least consider orthotics to limit supination (not pronation). Kind of a long shot, and at odds with one of my biases, but it would have been intellectually dishonest not to include it, so … included.
  • A good fresh example of very weak science about the role of the TFL in IT band syndrome.
• Cited He et al. on the state and history of ITBS research, and the most cited papers on this topic, which was a nice find … although not as nice as it might have been, because fully half of them have almost nothing to do with ITBS. Weirdly and annoyingly, they are mostly about using pieces of the tough IT band like a patch in ACL injuries. But I did make sure that all the others are cited in the book, which was easy because most were already there.
• One of the few most-cited papers I’d never cited before myself was a 2010 paper by Powers. That should have been in the book since at least 2015 just because it was so popular — and now it is, FWIW. Not a good paper, though: just a single author’s opinion that “motion impairments at the hip may underlie [knee] injuries” based on his read of the literature.
• Speaking of hip weakness, I also added a much fresher and more substantive citation to Leppänen et al., which is actually more important, and it challenges my bias against hip weakness as a cause of IT band syndrome. One of the only studies that does. 😜
• And still more hip-is-the-knee-key stuff, and another entertainingly bad study: Jahanshahi et al., a trial of functional motor control exercises for wrestlers with ITBS. It had suspiciously huge effects and was unblinded, among other critical flaws — barely better than propaganda for a belief. (Why do I cite low-value studies? We must make do with scientific scraps in this business.)
• I updated the introduction with prevalence data from Taunton et al. and Marais et al.
• I added a fascinating discussion of ITBS induced by surgery. Takagi et al. is a very illuminating report on four cases of ITBS after knee replacement, all involving obstructions under the IT band.
• Manon et al.. is a cool study of IT band microanatomy and its layering and fibre directions, which was a nice addition to a good collection of other anatomical “fun facts” about the IT band. And more anatomy: cited Claes on the re-discovery of the “anterolateral ligament” in 2013.
• Cited and discussed two experiments, Heiderscheit et al. and Baggaley et al. showing reduced knee loading with shorter, quicker steps — a good addition to the chapter on the role of tempo/pace.

Sooooo many updates! A lot of work, but worth it for a large batch of new readers.