Treatment of distal iliotibial band syndrome in a long distance runner with gait re-training emphasizing step rate manipulation.

Abstract

BACKGROUND & PURPOSE: Iliotibial band syndrome (ITBS) is a common injury associated with long distance running. Researchers have previously described biomechanical factors associated with ITBS. The purpose of this case report is to present the treatment outcomes in a runner with distal ITBS utilizing running gait re-training to increase step rate above the runner's preferred or self-chosen step rate. CASE DESCRIPTION: The subject was a 36 year old female runner with a diagnosis of left knee ITBS, whose pain prevented her from running greater than three miles for three months. Treadmill video analysis of running form was utilized to determine that the subject had an excessive stride length, strong heel strike, decreased knee flexion angle at initial foot contact, and excessive vertical displacement. Cadence was 168 steps/minute at a preferred running pace of 6.5 mph. Treatment emphasized gait re-training to increase cadence above preferred. Treatment also included iliotibial band flexibility and multi-plane eccentric lower extremity strengthening. OUTCOMES: The subject reported running pain free within 6 weeks of the intervention with a maximum running distance of 7 miles and 10-15 miles/week progressing to half marathon distance and 20-25 miles/week at 4 month follow up. Step rate increased 5% to 176 steps/minute and was maintained at both the 6 week and 4 month follow up. 5K run pace improved from 8:45 to 8:20 minutes/Km. LEFS score improved from 71/80 to 80/80 at 4 month follow up. DISCUSSION: This case demonstrated that a 5% increased step rate above preferred along with a home exercise program for hip strengthening and iliotibial band stretching, improved running mechanics and reduced knee pain in a distance runner. LEVEL OF EVIDENCE: 4-single case report.