Myofascial Release With and Without METS of Gluteus Maximus and Tensor Fascia Lata in ITB Syndrome

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

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

Eligibility Criteria:
Inclusion Criteria:

* patient having pain on lateral side of knee with positive ober's test

Exclusion Criteria:

* medically unstable patients
* others causes of lateral knee pain like meniscus and ligaments tear
* trauma causes
* other pathological condition of knee