International Journal of Physiotherapy and Research,

Int J Physiother Res 2015, Vol 3(1):894-04. ISSN 2321-1822

DOI: 10.16965/ijpr.2015.105
Original Article
EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG
NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME
Jayanta Nath.
PhD Scholar, Department of Orthopaedics (PMRT, GMCH), Padmashree Institute of Physiotherapy,
Bangalore, Karnataka, India.
ABSTRACT
Background and Objectives: The study was carried out to find out the effect of hip abductor strengthening among
non-professional cyclists with iliotibial band friction syndrome.
Subjects: 40 non-professional cyclists with ipsilateral ITBFS subject including male and female age between 18
to 50 with positive ober’s and nobble test were included in this study.
Methods: 40 subject were selected according to the inclusion criteria and they were assessed pre and post for
ROM (hip adduction, IR), hip abductor strength and pain using goniometer,sphygmomanometer and VAS .Subject
were assign experimental group(group A 20 subject) who received IT band stretching,US,and hip abductor
strengthening exercise and control group (group B 20 subject) who received same treatment except hip abductor
strengthening.
Data Analysis and Results: Based on statistical analysis using Wilcoxon test to compare the pre and post test
pain in both group,Mann- whitney U- test to compare the post test pain scores of between groups ,Paired t - test
to compare the pre and post ROM and strength in both groups, Unpaired t – test to compare post test ROM in
between groups showed that pre post difference within group A there was significant difference for adduction
ROM (p value <.0001),IR (p value <.0001),VAS(p value <.0001),and strength improve pre mean 40.80 to post
mean 66.30 (p value <.0001).However in group B adduction ROM and VAS were found to be significant.
In comparision in difference between groups it was found that adduction ROM,IR ROM,VAS and strength all
were significant. Baseline data for outcome variable were not statistically significant.
Conclusion: Based on outcome variable there was significant difference of hip abductor strengthening among
non-professional cyclist with iliotibial band friction syndrome.
KEYWORDS: Iliotibial band, Iliotibial band friction syndrome, Repetitive stress injury,hip abduction strength,VAS,
Cycling injury.
Address for correspondence: Jayanta Nath, MPT, PhD Scholar, Department of Orthopaedics (PMRT,
GMCH), Padmashree Institute of Physiotherapy, Bangalore, Karnataka, India.
E-Mail: [email protected]

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Received: 19-01-2015 Accepted : 29-01-2015
Peer Review: 19-01-2015 Published (O): 11-02-2015
DOI: 10.16965/ijpr.2015.105 Revised: None Published (P): 11-02-2015

INTRODUCTION
ITBFS is associated with overuse in long distance
Iliotibial band friction syndrome (ITBFS) is a runners, cyclists, and military personnel [3]. It
common overuse injury of knee that occurs as a is caused by friction of the iliotibial band (ITB)
result of repetitive soft-tissue trauma [1,2]. across the lateral femoral epicondyle during
Iliotibial band friction syndrome involves pain sporting activities [4,5]. Pain caused by ITBFS
in region of lateral femoral condyle or slightly occurs when the knee is flexed between 0 and
inferior to it, that occurs after repetitive motion 30 degree, but especially at 300, where the
of knee. posterior fibers of the ITB experience the great-
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 Jayanta Nath.EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

-est friction [5]. More common in age between cadence (70 RPM) than competitive cyclists (80–
15 to 50 years [6]. 90 RPM) for a moderate rate of work intensity
A number of etiological factors have been related (150 W) [11].
to ITBS include training errors, biomechanical In cycling, the ITB is pulled anteriorly on the
factors like genu varum, foot hypersupination, pedaling down stroke and posteriorly on the
foot overpronation, or cavus foot, and leg length upstroke. The ITB is predisposed to friction,
discrepancies, footwear with poor shock irritation, and microtrauma during this repetitive
absorption and most recently, hip abductor movement because its posterior fibers adhere
weakness [14]. closely to the lateral femoral epicondyle.
Incidence & prevalence: It is generally accepted Cyclists with an external tibia rotation greater
that ITBFS is the most common running injury of than 200 stress is created on the ITB if the
the lateral knee with an incidence between 1.6% athlete’s cycling shoe is placed in a straight-
and 12% [8,9]. ITBFS comprises 22% of lower ahead position or the toe is in a cleat position.
extremity injuries [10]. Although it is most Cyclists with varus knee alignment or active
common in distance runners, there is a growing pronation place a greater stretch on the distal
number of cyclists with ITBFS. ITBFS accounts ITB when they ride with internally rotated cleats.
for approximately 15% of all overuse injuries at Poorly fitted bicycle saddle, a high-riding saddle
the knee in cycling [5]. causes the cyclist to extend the knee more than
1500 . This exaggerated knee extension causes
Pathomechanics: The pathogenesis of ITBFS
the distal ITB to abrade across the lateral
involves inflammation and irritation of the lateral
femoral condyle. Bicycle saddles that are
synovial recess (Renne et al.), as well as
positioned too far back cause the cyclist to reach
continued irritation of the posterior fibres of the
for the pedal, with a resultant stretch to the ITB
ITB (Ekman et al.) and inflammation of the
[12].
periosteum of the lateral femoral epicondyle
(McNicol et al.), all of which describes the The power exerted on the pedal is the most
pathogenesis of ITBFS. reliable parameter to determine the training load
in cycling biomechanically and hence a crucial
The iliotibial band is a thick strip of fascia that
factor to optimize performance [13]. Commercial
originates from tubercle of iliac crest, continues
power meters are meanwhile part of the
down the lateral side of thigh, and inserts into
standard equipment of professional cyclists, but
the lateral tibial condyle (Gerdy’s tubercle) and
also used by an increasing number of non
into the lateral proximal fibular head [4,7]. When
professional cyclists [13].
knee is flexed to an angle greater than 30o, the
ITB lies posterior to the lateral femoral Proximally, the ITB acts as a lateral hip stabilizer
epicondyle, when knee is extended however, the resisting hip adduction (Fredickson et al., 2000).
ITB moves anterior to this landmark.Therefore, It originates in the facial components of the
friction occurs at or slightly less than 300 of knee gluteus maximus, gluteus medius, and tensor
flexion when the ITB crosses over the lateral fasciae latae muscles (Muhle et al., 1999;
femoral epicondyle [4]. Birnbaum et al., 2004; Terry et al., 1986). The
ITB is attached distally to the supracondyle
The high number of revolutions of the bicycle
tubercle of the femur and the lateral
cranks and tightness of the ITB resulting from
intramuscular septum. In addition it has fibers
muscular effort can result in inflammation of the
that attach to the patella (Muhle et al., 1999;
ITB during cycling. Additionally, a snapping of
Birnbaum et al., 2004; Terry et al., 1986). Due to
the ITB may occur as it slides over the lateral
these attachments, increased hip adduction is
femoral epicondyle of the femur, typically when
likely to lead to increased tension on the ITB.
the crank is approaching bottom center [5].
Increased hip adduction may necessitate a
Takaishi et al. calculated peak pedal force for greater eccentric demand from gluteal
various cycling cadences in both competitive musculature, resulting in a higher hip abduction
and noncompetitive cyclists and determined that moment.
non-competitive cyclists preferred a lower
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 Jayanta Nath.EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

Schafer recommends treating ITBFS as an acute and correcting primary etiological factors, such
sprain with initial cryotherapy and adequate rest as biomechanical abnormalities (eg: genu varus,
with ingestion of a nonsteroidal anti- cavus foot type, leg length inequalities,
inflammatory to help relieve the inflammatory sacroiliac joint fixations, and fibular head
process. Trigger points should be treated using fixations) also with varying results.
cross fibre friction massage for several minutes Some of the latest studies have identified an
as recommended by Simons. Treatments may be association between weak hip abductors
concluded by interferential current therapy to (especially the gluteus medius) and ITBS. These
achieve analgesia, followed by functional studies suggest that gluteus medius weakness,
muscle stimulation for muscle reeducation. and myofascitis of the gluteus medius is another
Bilateral passive and active stretching exercises contributing factor to ITBS in long distance
for the tensor fascia latae, hamstrings and runners. Gluteus medius strengthening in the
quadriceps should be prescribed. Training treatment of ITBS has been a recent focus of
should be modified to include non-percussive investigation in the literature. The literature
exercise such as cycling and swimming with ice reveals that the comparative effectiveness of
massage of the affected areas following the this new approach to ITBS treatment based on
activity. Surgical release of the ITB or removal gluteus medius strengthening, to any other form
of the lateral femoral epicondyle has been used of conservative treatment, requires further
when conservative treatment fails. However, investigation. Stretch therapy has traditionally
return to full and normal lower limb mechanics been the basis of the conservative treatment for
may not be achieved. ITBS i.e., to stretch the tight band and thereby
Studies have shown that ITBFS responds well to reduce the friction syndrome a proven effective
conservative treatment (Anderson, 1991; Kirk et component of conservative treatment for ITBS.
al., 2000; Levin, 2003) with success rates Fredericson explain that the gluteus medius and
reported as high as 94% (McNicol et al., 1981). tensor fascia latae are both hip abductors, but
A number of different treatment options are the gluteus medius (mainly its posterior fibres)
reported in the literature, however, it should be also externally rotates the hip, whereas the
questioned whether these treatments are tensor fascia latae also internally rotates the
delivered based on sound evidence. hip. They have consequently postulated that
Reid and Fredericson outline the following fatigued runners or those who have a weak
treatments: the reduction of inflammation (using gluteus medius are therefore prone to increased
ice and anti-inflammatory); reduction of thigh adduction and internal rotation at
tautness and myofascial trigger points in the midstance, leading to an increased valgus vector
band (employing stretch techniques and trigger at the knee, and that this increases tension on
point therapies); Corrective actions and the the ITB, making it more prone to impingement
correction of biomechanical abnormalities with on the lateral epicondyle of the femur, especially
orthotics. Surgery is sometimes opted for in during the early stance phase of gait (foot
especially stubborn chronic cases. contact).
Majority of the studies on ITBS thus far has ITBFS sufferers had hip abductor weakness or
focused mainly on the effectiveness of various increased hip adduction during the stance phase
treatment techniques to the ITB itself and its of gait, a finding which could be interpreted as
associated tensor fascia latae (TFL) muscle, with being due to hip abductor weakness [1,16,17].
varying results reported which include Several studies have investigated forces during
conservative therapies like rest, ice, and cycling while others have studied causes of ITBFS
stretching of the tight band; myofascial trigger in cyclists. In fact, Fredickson et al. (2000)
point therapies like dry needling. Nonoperative reported that runners who currently have ITBS
measures specific to cyclists consist of bicycle exhibited weak hip abductors. Since their
adjustments and training modifications [15]. subjects were already injured at the time of the
measurement, it is unclear whether the
Other studies have been aimed at identifying
weakness was the cause or result of the ITBS.
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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

There is conflicting evidence in the literature as knee, popliteal or biceps femoris tendinitis,
to whether ITBS is a true friction syndrome or common peroneal nerve injury, reffered pain from
more the result of tissue compression. From a lumbar spine, Sign symptoms of other knee
clinical perspective, training error combined with pathology (meniscal-tear, degenerative joint
hip muscle weakness tends to be the most disease, patellofemoral pain syndrome), history
consistent finding with variable contributions of any previous knee surgeries and any ongoing
from other factors. In triathletes it is not spine, hip or lower extremity injury.
uncommon for errors in bike setup to cause Materials used: Universal Goniometer,
muscle imbalances that cause ITBS to manifest Examination table, Ultrasound machine,
in the run (even if cycling is pain free). Theraband, Sphygmomanometer
It is hypothesized that ITBFS is a common Procedure: Subjects who fulfill the inclusion and
symptom among cyclist and athletes. Various exclusion criteria were included in the study. A
studies so far have done proved the efficacy of written consent form was taken from each of
various treatments like stretching, deep friction the subjects. General screening procedure was
massage and modified ober test. As hip abductor done by the examining physical
weakness is common finding in ITBFS and often therapist.Demographic data were collected from
neglected during physiotherapy management. the subject. Subjects were divided into two
The study is aimed to find out the effect of hip groups. Each group consist of 20 subjects.
abductor strengthening in non professional
GROUP A (experimental group)-physiotherapy
cyclists with iliotibial band friction syndrome.
including ITB stretching,Ultrasound therapy with
OBJECTIVES: To examine the effect of Hip hip abductor strengthening exercise were given.
abductor strengthening among non-professional
GROUP B (control group)- physiotherapy
cyclists with ITBFS and to compare the effect of
including ITB stretching, ultrasound therapy
Hip abductor strengthening over conventional
without hip abductor strengthening exercise.
physiotherapy among non-professional cyclists
with ITBFS. Duration of the study was six weeks. Pre test
evaluation was done before starting treatment
MATERIALS AND METHODS which includes pain assessment using VAS, hip
Source of data: 1. Padmashree Physiotherapy abductor strength using modified
&Rehabilitation Centre, Nagarbhavi, Bangalore. sphygmomanometer and ROM using
2. ESI hospital, Rajaji Nagar, Bangalore. 3. K.C.G. Goniometer. Patient received one session of
hospital, Malleshwaram, Bangalore 4. treatment per day up to six weeks.At the end of
Padmashree diagnostics,Bangalore. six weeks post test evaluation was conducted
for groups. The differences between pre and post
Collection of data: Population: Non-professional test values were compared within groups.
cyclists with ITBFS. Sample design: Convenient
sampling. Sample size : 40. Type of Study: pre Intervention to be conducted on participants:
and post test experimental design. Duration of Rehabilitation programme used in this study
study: 6 weeks. focused on improving hip abductor strength.The
Inclusion criteria: Non-professional cyclists with side-lying hip abduction exercise was gluteus
unilateral iliotibial band friction syndrome, medius isometric contraction held at
diagnosed by orthopaedic surgeon. Age approximately 30 degree of hip abduction with
between 18 to 50 years, Both genders with slight hip external rotation and neutral hip
Positive ober’s and nobble test. extension. This exercise was done with the back
against a wall. In the fourth week, a 1-metre-
Exclusion criteria: Presence of anatomical limb long green theraband was added around the
length discrepancies of more than 1cm, Subjects ankle.
with other associated pathologies of the lower
limbs like ankle sprains, anterior cruciate Hip abduction exercise: Side-lying hip abduction
ligament injuries, meniscal injuries, exercises and pelvic drops to strengthen the
degenerative joint disease, lateral injury of gluteus medius was started at 1 set of 10

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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

repetitions and over a course of several weeks Iliotibial band stretching: Standing IT band
increased to the goal of 3 sets of 30 repetitions. stretch: Stretches were maintained for 60
The patients were instructed to increase by five seconds each and conducted twice daily for the
repetitions per day provided there will no entirety of the programme. Standing lateral
significant post work-out soreness the following fascia stretch with trunk lateral flexion/rotation
day. For the side-lying hip abduction, specific contralateral to involved leg.The involved leg is
instructions were given to keep the lower leg crossed behind the uninvolved.
flexed for balance, the abdominals braced, and Outcome Measure: Pain (Visual analogue
the upper leg in slight hip extension and external scale), Strength (Modified sphygmomanometer).
rotation. Instructions ensured that the leg should
Range of motion (adduction & internal rotation
be slowly brought into an arc of abduction of
of hip).
20–30° with each repetition, held for 1 second
at extremes of motion and then slowly returned Data analysis: Wilcoxon test used to compare
to adduction. the pre and post test pain in both group.
The pelvic drop exercise involved standing on a Mann- whitney U- test used to compare the post
step with the involved leg, while holding onto a test pain scores of between groups, Paired t -
wall or stick if necessary for support with both test used to compare the pre and post ROM
knees locked, the opposite, non involved pelvis and strength in both groups, Unpaired t – test
will be lowered towards the floor, shifting one’s used to compare post test ROM in between
body weight to the inside part of the foot and groups, The statistical analysis was done using
involved leg, creating a swivel action at the hip. SPSS software.
Then, by contracting the gluteus medius on the Ethical clearance: As this study involve human
involved side, the pelvis will be brought back to subjects; the ethical clearance has been
a level position. obtained from the ethical committee of
All subjects instructed to discontinue running, Padmashree institute of physiotherapy,
cycling and any other activities that continued Nagarbhavi, Bangalore, as per ethical guidelines
to cause pain. Subjects needed to be pain free research from biomedical research on human
with all daily activities and have progressed to subjects, 2000, ICMR, New Delhi.
3 sets of 30 repetitions of the 2 strength RESULTS
exercises before being allowed to start a return
to running program at the end of the 6-week Study design: A pre and post test experimen-
rehabilitation program. tal design study was done consisting of 40
subjects.In which there were 30 male 10 females
Treatment parameters for Ultrasound
in age group of 18-50 years. All subject were
therapy:
able to complete their intervention, there was
Duration: 6 Minutes no drop out.
Mode :continuous Table 1 show that for baseline variables, mean
Intensity : 1 watt/cm2 age of Group A was 33.60 with SD (9.97) and
Group B was 35.45 with SD (9.23) which was
Frequency: 6 treatment session every alternate
not statistically significant (p>0.546).
day
Progression of Hip Abduction exercise.

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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

Number of male and female in Group A was 15 (1.30), post test score mean was 0.95 and SD
and 5 respectively and Group B was 15 and 5 (0.89) with p value <0.0001 which was
respectively which was not statistically signifi- statistically significant.
cant (p=1) For Strength pre test score mean was 40.80
Table 1: Baseline data for demographic variables. and SD (12.02), post test score mean was 66.30
Sl .No: Variables Group A Group B Þ-value and SD (14.66) with p value <0.0001 which was
1 Age 33.60±9.97 35.45±9.23 >.546 statistically significant.
Gender Table 4: Pre-post difference within the group B.
2 15/15 15/15 1
(M/F) Sl .No: Variables Pre Post Þ-value
*Data are mean±S.D. 1 Adduction ROM 14.75±4.44 19.80±4.40 <.0001

Table 2: Baseline data for outcome variables. 2 Internal Rotation ROM 37.00±2.96 37.65±2.68 >.091
3 VAS 6.95±1.10 3.90±1.29 <.0001
Sl .No: Variables Group A Group B Þ-value 4 Strength 40.75±14.17 41.50±13.68 >.083
1 Adduction ROM 16.15±4.18 14.75±4.44 >.311
Table 4 shows that in group B, for Adduction
2 Internal Rotation ROM 36.35±3.25 37.00±2.96 >.512
ROM pre test score mean was14.75 and SD
3 VAS 6.70±1.30 6.95±1.11 >.529 (4.44), post test score mean was 19.80 and SD
4 Strength 40.80±12.02 40.75±14.17 >.952 (4.40) with p value <0.0001 which was
*Data are mean±S.D. statistically significant.
Table 2 show that Adduction ROM mean of For Internal Rotation pre test score mean was
Group A was 16.15 with SD (4.18) and Group B 37.00 and SD (2.96), post test score mean was
was14.75 with SD (4.44) which was not 37.65 and SD (2.68) with p value >.091 which
statistically significant (p>0.311). was statistically not significant.
Internal Rotation ROM mean of Group A was For VAS pre test score mean was 6.95 and SD
36.35 with SD(3.25) and Group B was 37.00 with (1.10), post test score mean was 3.90 and SD
SD (2.96) which was not statistically significant (1.29) with p value <0.0001 which was
(p>0.512 ). statistically significant.
VAS mean of Group A was 6.70 with SD (1.30) For Strength pre test score mean was 40.75
and Group B was6.95 with SD (1.11) which was and SD (14.17), post test score mean was 41.50
not statistically significant (p>0.529). and SD (13.68) with p value >.083 which was
Strength mean of Group A was 40.80 with SD statistically not significant.
(12.02) and Group B was 40.75 with SD (14.17) Table 5: Difference between group.
which was not statistically significant (p>0.952). Sl .No: Variables Group A Group B Þ-value
Table 3: Pre-post difference within the group A. 1 Adduction ROM 23.90±3.63 19.80±4.40 <.003
Sl .No: Variables Pre Post Þ-value 2 Internal Rotation ROM 39.70±2.90 37.65±2.68 <.026
1 Adduction ROM 16.15±4.18 23.90±3.63 <.0001 3 VAS 0.95±0.89 3.90±1.29 <.0001

2 Internal Rotation ROM 36.35±3.25 39.70±2.90 <.0001 4 Strength 66.30±14.66 41.50±13.68 <.0001

3 VAS 6.70±1.30 Table5 shows that Adduction ROM mean of

0.95±0.89 <.0001
4 Strength 40.80±12.02 66.30±14.66 <.0001 Group A was 23.90 with SD (3.63) and Group B
Table 3 shows that in group A, for Adduction was19.80 with SD (4.40) which was statistically
ROM pre test score mean was16.15 and SD significant (p value <.003).
(4.18), post test score mean was 23.90 and SD Internal Rotation ROM mean of Group A was
(3.63) with p value <0.0001 which was 39.70 with SD(2.90) and Group B was 37.65 with
statistically significant. SD (2.68) which was statistically significant (p
For Internal Rotation pre test score mean was value <.026).
36.35 and SD (3.25), post test score mean was VAS mean of Group A was 0.95 with SD (0.89)
39.70 and SD (2.90) with p value <0.0001 which and Group B was 3.90 with SD (1.29) which was
was statistically significant. statistically significant (p value <.0001).
For VAS pre test score mean was 6.70 and SD Strength mean of Group A was 66.30 with SD
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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

(14.66) and Group B was 41.50 with SD (13.68) which was statistically significant (p value <.0001).
Graph 1: No of subject in age Graph 2: No of subject in gender Graph 3: No of subject in gender
distribution. distribution in group A. distribution in group B.

Graph 4: Adduction, Internal Graph 5: VAS outcome variable in Graph 6: Strength outcome variable
rotation variable in group A & B. group A & B. in Group A & B.

Graph 7: Pre post difference within Graph 8: Pre post difference within
group A & B showing Internal Graph 9: Pre post difference within
group A & B showing Adduction
rotation ROM. group A & B showing VAS.
ROM.

Graph 10: Pre post difference Graph 11: difference between group Graph 12: difference between group
within group A & B showing Hip VAS score. strength score.
abductor strength.

Graph 13: Difference between group Adduc-

tion and Internal rotation ROM score.

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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

DISCUSSION Associated with Iliotibial Band Syndrome) found

Objective of the study was to examine the effect from their results that individuals who go onto
of hip abductor strengthening among non- to develop ITBS exhibit greater hip adduction and
professional cyclists with ITBFS and to compare knee internal rotation. These results suggest that
the effect of hip abductor strengthening over interventions should be directed at controlling
conventional physiotherapy among non- these motions.
professional cyclists with ITBFS. The parameters
Ferber et al. (2003) found that runners who went
selected were ROM, VAS score and strength.
on to develop ITBS had greater peak eversion,
In this study the baseline data of the greater peak eversion velocity and excursion. A
demographic and outcome variables did not hip mechanism for developing ITBS has been
show any statistically significant difference proposed as well. Weakness of the hip abductors
between the patient population in Group A and has been associated with ITBS (Fredrikson 2000).
Group B. Weakness of the hip abductors has been shown
Baseline data for outcome variable strength (hip to be related to increased hip adduction in
abductor) was not statistically significant this runners with patellofemoral pain syndrome
was similar to the study done by Amir M Arab, (Dierks 2005). However, there were no studies
Mohammad R Nourbakhsh (The relationship of the role of increased hip adduction in ITBS. It
between hip abductor muscle strength and is possible that increased hip adduction
iliotibial band tightness in individuals with low combined with knee internal rotation, increases
back pain) concluded that the relationship ITB tension. This could increase contact of the
between ITB tightness and hip abductor ITB with the lateral femoral condyle and lead to
weakness in patients with LBP was not irritation with repeated exposure. Another study
supported as assumed in theory which was ITB done by Michael Fredericson et al. (Quantitative
tightness in individuals with LBP was a Analysis of the Relative Effectiveness of 3
compensatory mechanism following hip Iliotibial Band Stretches) shows that adding an
abductor muscle weakness.They hypothesized overhead arm extension to the most common
that more clinical studies needed to assess the lateral ITB stretch increases average ITB length
theory of muscle imbalance of hip abductor change and average external adduction
weakness and ITB tightness in LBP. All patients moments in male elite-level distance runners,
in group A and group B were able to complete and that these differences are statistically
the study. significant.
The result in group A showed that for Adduction Improvement in hip abductor strength and VAS
ROM pre test score mean was16.15 and SD pre post difference within group A may be
(4.18), post test score mean was 23.90 and SD because of effect of hip abductor strengthening
(3.63) with p value <0.0001 which was and ultrasound treatment this was similar to the
statistically significant, for Internal Rotation pre study done by Reed Ferber, Karen D. et al A 3-
test score mean was 36.35 and SD (3.25), post week hip-abductor muscle-strengthening
test score mean was 39.70 and SD (2.90) with p protocol was effective in increasing muscle
value <0.0001 which was statistically strength and decreasing pain and stride-to-stride
significant,for VAS pre test score mean was 6.70 knee-joint variability in individuals with PFPS.
and SD (1.30), post test score mean was 0.95 Another study done by Michael Fredericson,
and SD (0.89) with p value <0.0001 which was Curtis et al where injured runners were enrolled
statistically significant,for Strength pre test in a 6-week standardized rehabilitation protocol
score mean was 40.80 and SD (12.02), post test with special attention directed to strengthening
score mean was 66.30 and SD (14.66) with p the gluteus medius. After rehabilitation, the
value <0.0001 which was statistically significant females demonstrated an average increase in
this was in accordance with study done by Brian hip abductor torque of 34.9% in the injured limb,
Noehren, Irene Davis and Joseph Hamill and the males an average increase of 51.4%.
(Prospective Study of the Biomechanical Factors After 6 weeks of rehabilitation, 22 of 24 athletes

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 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

were pain free with all exercises and able to running. Like in the study by Willson and Davis,
return to running and at 6- month’s follow-up there was a fair correlation (r = -.34) between
there were no reports of reoccurance. They hip-abductor strength and peak hip adduction
concluded that long distance runners with ITBS at the beginning of the run. After prolonged
have weaker hip abduction strength in the running, subjects with PFPS demonstrated a
affected leg compared with their unaffected leg higher correlation (r = –.74) between hip-
and unaffected long-distance runners. abductor strength and peak hip adduction. No
Additionally, symptom improvement with a association was found between hip external-
successful return to preinjury training program rotator weakness and peak hip internal rotation.
parallels improvement in hip abductor strength. In summary, these findings suggest that subjects
Another mechanism that accounts for pain relief with PFPS might not exhibit altered hip
(improvement of VAS) for both groups may be kinematics until their muscle strength falls
because of mild heating effect of ultrasound in below a certain threshold. More important, it
reducing pain and promoting the healing remains elusive whether hip weakness was the
process. Accelerated protein synthesis cause or the result of PFPS. Additional research
stimulates the rate of damaged tissues. is needed to better understand the association
between hip weakness, hip kinematics, and PFPS
However in group B mean VAS score improved
etiology.
from pre score of 6.95 to post score of 3.90 and
adduction ROM from 14.75 to 19.80 which was Pre post difference between groups there was
statistically significant this may be due to effect significant difference in adduction, IR ROM,VAS
of IT band stretching and ultrasound treatment. and hip abductor strength this was in accordance
to study done by Amanda Beers et al showed
However IR and strength pre post difference
that increases in hip abductor strength were
within group B was not significant this was in
observed over the course of the 6 weeks during
accordance to study done by Grau et al. found
which the participants were taking part in the
no significant difference for isometric,
standardized rehabilitation programme, and
concentric, or eccentric peak torque of the hip
these strength changes seemed to parallel
abductors in controls versus those with ITBS.
decreases in the symptoms of ITBFS.
For IR study done by Willson and Davis suggest
LIMITATION OF THE STUDY:
that subjects with PFPS exhibited greater hip
adduction, but also greater hip external rotation, 1. Sample size was small
than controls. The researchers did not assess 2. Duration of study was less.
hip strength, thus precluding the ability to note 3. No follow up was done.
an association between hip weakness and
4. Functional activity was not monitored.
altered kinematics. In a follow-up study, Willson
and Davis examined trunk, hip, and knee FURTHER RECOMMENDATION
strength, as well as hip and knee kinematics and 1. Isolated hip abductor strengthening in
kinetics during repeated single leg jumps. experimental group and control group without
Although subjects with PFPS demonstrated any treatment can be conducted.
greater hip-adduction excursion, they did not 2. Outcome using lower extremity functional
demonstrate differences in hip-internal-rotation scale for quality of life
excursion. When only analyzing subjects with
3. Isokinetic dynamometer can be used as a tool
PFPS, they found a fair correlation (r = –.40)
for measurement of strength as well as hand
between hip-abductor strength and hip
held dynamometer.
adduction excursion. There was a poor
correlation (r = –.07), however, between hip 4. Long term follow up needed.
external- rotator strength and hip-internal- CONCLUSION
rotation excursion. Dierks et al examined hip
strength and hip and knee kinematics in runners The primary objective of the study was to find
with and without PFPS before and after prolonged out the effect of hip abductor strengthening
among non-professional cyclist with ITBFS.
Int J Physiother Res 2015;3(1):894-04. ISSN 2321-1822 902
 Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION
SYNDROME.

The results of the study shows that there is institute of physiotherapy), Dr.Kabul Chandra
significant difference of hip abductor Saikia (Principal Cum Chief Superintendent
strengthening among nonprofessional cyclists GMCH).
with ITBFS.
Abbreviations
SUMMARY
ITBS- Iliotibial band friction syndrome
ITBFS is a common problem of lateral knee and
IR-Intrnal Rotation
comes under the repetitive stress injury cause
US- Ultrasound
due to repetitive flexion and extension
ITB- Iliotibial Band
associated with other biomechanical
TFL-Tensor Fascia Latae
abnormalities.Most common in runners and
PFPS- Petello Femoral Pain Syndorome
cyclists.A high incidence has been found among
cyclist. Conflicts of interest: None
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SYNDROME.

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How to cite this article:

Jayanta Nath. EFFECT OF HIP ABDUCTOR STRENGTHENING AMONG NON-
PROFESSIONAL CYCLISTS WITH ILIOTIBIAL BAND FRICTION SYNDROME.
Int J Physiother Res 2015;3(1):894-904. DOI: 10.16965/ijpr.2015.105

Int J Physiother Res 2015;3(1):894-04. ISSN 2321-1822 904