A Pathoanatomical Paradigm for Iliotibial Band Pathology: A Synthesis of Evidence

Abstract:
Evidence-based practice compels clinicians to challenge existing paradigms, especially when desired outcomes remain elusive. Insidious lateral knee pain involving the iliotibial band (ITB) in running based athletes has been conceptualized as ITB friction syndrome, an unsubstantiated clinical paradigm based on Renne´s 1975 theory that the ITB rolls over the lateral femoral epicondyle during repetitive flexion/extension movements, irritating the ITB and underlying bursa. Contemporary anatomical, biomechanical, and interventional evidence directly challenges this long-held paradigm. Given this new evidence, ITB Impingement Syndrome is presented as a more robust, evidence-informed paradigm for evaluating and treating problematic ITB related pathologies.

Objectives:

  • Participants will be able to distinguish between the existing and widely held paradigm for ITB pain and dysfunction known as iliotibial friction syndrome and the newly proposed iliotibial band impingement syndrome., 
  • Participants will be able to evaluate athletes presenting with ITB impingement syndrome, based on a new biomechanically based and evidence-informed model of assessment that focuses on deficient hip muscle function., 
  • Participants will be able to design and implement more effective, evidence-informed treatment programs for athletes suffering from ITB impingement syndrome by focusing on greater closed chain gluteal muscle function and timing.

Level:
Advanced

Domains:
Domain 1: Risk Reduction Wellness and Health Literacy, Domain 2: Assessment Evaluation and Diagnosis, Domain 4: Therapeutic Intervention

CEUs: 1.0 Category A

Keywords: knee, iliotibial band, ITB, impingement, bursa, running,

Paul Geisler, EdD, AT Ret.

Associate Dean Geisler is a native of Lakeville, MA and current resident of Boston, MA. A certified athletic trainer since 1987 with over 15 years of varied clinical practice and 23 years' experience directing athletic training education programs at Georgia Southern University and Ithaca College. He is deeply interested in the development and assessment of the medico-clinical thinking processes of novice and experienced clinicians, the development of adaptive expertise in clinicians, progressive curriculum design, capability-based education, and meaningful programmatic assessment. He has over 170 national and international presentations and publications on clinical and educational based subjects in athletic training and health professions education to his credit. He is a member of the European Board of Medical Assessors, and past member of the Association of Medical Education, Europe.

As a scholar, he is the recipient of two manuscript awards from the Journal of Athletic Training and the Athletic Training Education Journal. For his many professional contributions, he has been the recipient of the NATA Athletic Training Service Award and NATA Most Distinguished Athletic Trainer Award. As an educator, he was awarded the NATA Executive Council on Education's Sayers "Bud" Miller Distinguished Educator Award in 2021 and has received two Dean's Awards for Excellence & Innovation in Teaching, a Dean's Excellence Award for Diversity and Inclusion in Teaching and Learning, and the all college Faculty Excellence Award, all from Ithaca College.

He admits to being an enthusiastic but slow road cyclist, an amateur shutterbug of nature and wonder, an aspiring wine snob and amateur foodie, and an unabashed promoter of equal rights, freedom, justice, and authentic democracy for all living beings. Susan, his life partner and wife of 34 years and he are fulfilled parents of two amazing young men – Nicholas, a writer living in Los Angeles, CA and Benjamin, a photographer and artist living in Brooklyn, NY.



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