Myofascial Release With and Without METS of Gluteus Maximus and Tensor Fascia Lata in ITB Syndrome
Condition: Iliotibial Band Syndrome
MeSH terms: Syndrome; Iliotibial Band Syndrome
Study type: Interventional

Summary: 
      This Study Will Be Conducted to Evaluate the Effects Of myofascial release of IT band with or
      without muscle energy technique of gluteus maximus and tensor fascia Lata with iliotibial
      band syndrome. Data Will Be Collected from Haider memorial hospital in Vehari. Study will
      include 24 patients of both genders with pain on lateral side of pain confirmed by positive
      ober test. Treatment group patient will receive myofascial release and muscle energy
      technique of gluteus maximus & tensor fascia Lata muscle to relieve pain of IT band syndrome
      while control group will only receive myofascial release treatment. All 24 patients will be
      stable during the study period. Study will be conducted based on 06 month time period after
      approval of synopsis. Patients will be studied and fill out questionnaire. All possible
      patients with iliotibial tract syndrome will be taken using consecutive sampling. Informed
      consent will be taken from all recruited patients. The results of this study will help to
      manage the pain of iliotibial tract & will be a randomized controlled trial
    

Detailed description: 
      The iliotibial tract is a dense fibrous connective tissue thickening of the fascia Lata on
      lateral side of the thigh. The ITB is attached proximally at the greater trochanter of femur
      with fascial involvement of the tensor fascia Lata and the gluteus maximus and gluteus Medius
      muscles to lateral condyle of tibia. The most common injury of lateral knee is iliotibial
      band syndrome(ITBS). ITBS is an overuse injury results from repetitive friction of the
      iliotibial band (ITB) over the lateral femoral epicondyle, biomechanical studies explained
      that a maximal zone of impingement is at approximately 30° of knee flexion. Prevalence of
      ITBS accounts for 15% to 24% in all overuse injuries in non-experimental investigations.
      Epidemiologic studies demonstrates ITBS as the most common cause of lateral knee symptoms
      with a reported incidence ranging from 1.6% to 12%.

      ITBS is an overuse injury from repetitive movements cause friction, irritation, and pain when
      moving the knee joint. Prospective research demonstrate that the greater internal rotation at
      the knee joint and increased adduction angles of the hip joint play important role in the
      etiology of ITBS and that the strain rate in the iliotibial bands is greater in persons with
      repetitive movements of knee joints compared to other persons.

      Presentation of Iliotibial band syndrome is increased knee internal rotation, decreased rear
      foot eversion, tibial internal rotation and hip adduction angles at heel strike with maximum
      internal rotation at the knee and decreased total abduction and adduction range of motion at
      the hip during stance phase during stance. It also exhibits greater invertor moments at their
      feet, decreased abduction and flexion at their hip joint and to reach maximum hip flexion
      angles earlier than healthy individuals. female gender may be a predisposing factor of
      iliotibial band syndrome. Iliotibial band friction syndrome is an overuse injury mostly seen
      in long distance runners, cyclists, and military personnel with estimated incidence of
      1.6%-52% .ITB length is measured by Ober's test and modified Ober's test, with hip adduction
      angle that is monitored by using a fluid goniometer.

      Manual therapy is first choice in treatment of ITBS consists of soft tissue release and
      medial patella mobilizations for relieve of pain and lengthening the ITB. Myofascial release
      with use of foam roller as a myofascial release tool is used to break up soft-tissue
      adhesions in the ITB . Studies also showed that myofascial release is beneficial for
      relieving lateral knee pain. With progression of patient performing the stretching regimen
      without pain, strengthening is also added to the rehabilitation program. Physical
      Interventions such static stretching, strengthening, manual therapy and neuromuscular
      re-education and muscle energy techniques are performed for treatment of ITBS. Active Release
      Technique and Myofascial Release Technique are also effective in patients with
      musculoskeletal pain but researches revealed that Myofascial Release Technique demonstrated
      has better outcomes than Active Release Technique in the management of Chronic pain.

      The increased tone of gluteus maximus can be corrected with active pump techniques, combining
      of soft tissue mobilization with muscle energy techniques. Isometric of hip abduction and
      adduction strengthening also performed for relieve and gain range of motion in ITBS. MET is a
      treatment technique includes a willful constriction of a subject's muscle in a controlled
      bearing, against a counterforce that is given by the specialist. MET is utilized to diminish
      the pain, extend the tight muscles and belts, decrease muscle tone, enhances nearby flow,
      strengthen the feeble musculature, and mobilizes the joint restrictions. MET increase the
      extensibility of muscles and spinal range of motion, treating patients with reduced mobility.
      Muscle energy techniques involve post isometric relaxation and post facilitation stretching
      techniques. METS of specific muscles are used for improvement the efficacy of neurodynamic
      and lymphatic system
    

Intervention name(s): Muscle energy technique of gluteus maximus and tensor fascia lata; Myofascial release of iliotibial band syndrome
Intervention type(s): Other; Other
Intervention description(s): it is used for lengthening of hypertonic muscles for relief of pain and range of motion.Position of patient is supine lying and therapist is at side of table .The patient leg is fully adducted to stretch IT band and then patient attempts to abduct the leg against resistance contracting the muscles being stretched at approximately 25% of maximum effort for 10 seconds. They then relax and the therapist lengthen it.; Myofascial release of IT band Syndrome. Therapist fingers track up and down your ITB with fingertips to find the most tender spots and use a tennis ball to apply small, circular, light release in those places.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: ITB syndrome; Muscle energy technique (METS); Myofascial release