Association Between Iliotibial Band Syndrome Status and Running Biomechanics in Women
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University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 8-2013 Association between Iliotibial Band Syndrome Status and Running Biomechanics in Women Eric Henri Foch [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Musculoskeletal System Commons, and the Sports Sciences Commons Recommended Citation Foch, Eric Henri, "Association between Iliotibial Band Syndrome Status and Running Biomechanics in Women. " PhD diss., University of Tennessee, 2013. https://trace.tennessee.edu/utk_graddiss/2422 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Eric Henri Foch entitled "Association between Iliotibial Band Syndrome Status and Running Biomechanics in Women." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Philosophy, with a major in Kinesiology and Sport Studies. Clare E. Milner, Major Professor We have read this dissertation and recommend its acceptance: Jeffrey A. Reinbolt, Songning Zhang, Eugene C. Fitzhugh Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) Association between Iliotibial Band Syndrome Status and Running Biomechanics in Women A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Eric Henri Foch August 2013 Copyright © 2013 by Eric Henri Foch. All rights reserved. ii ACKNOWLEDGEMENTS Clare, through your mentorship, you have given me the confidence to go out and be an independent researcher. Thank you. I truly appreciated it when we were sitting in the lab earlier this semester and you said that over the past few months we have developed a relationship as two colleagues would. I would also like to thank Dr. Jeff Reinbolt, Dr. Gene Fitzhugh, and Dr. Songning Zhang for their insight towards this project. Jeff, I would like to thank you in particular for working with me as much as you did on our modeling paper, as well as our conversations we had. Your insight and energy are inspiring. Lastly, I would like to thank Jake and Trey. Jake, you are the man. Trey, I would still be collecting runners for my first year study if it had not been for your selfless nature to help me recruit runners, much obliged kind sir. iii ABSTRACT Iliotibial band syndrome (ITBS) is common knee overuse injury that is twice as likely to afflict women compared to men. Etiological factors associated with ITBS include atypical biomechanics during running, as well as iliotibial band flexibility and hip abductor muscle weakness. This dissertation implemented a combination of discrete and continuous analyses to identify lower-extremity and trunk movement patterns that may be associated with ITBS injury status in female runners with current ITBS, previous ITBS, and controls. Three studies were conducted. Study 1 examined discrete joint and segment biomechanics during running, iliotibial band mechanics via musculoskeletal modeling and dynamic simulation, and hip physiological measures. Study 2 examined lower- extremity, as well as trunk – pelvis inter-segmental coupling variability using a vector coding technique. Study 3 characterized entire kinematic and kinetic waveforms using a principal components analysis approach. The findings of these studies can be summarized as follows: 1) runners with current ITBS lean their trunk more towards the stance limb than runners with previous ITBS and controls; 2) runners with previous ITBS exhibit less isometric hip abductor strength compared to controls; 3) runners with previous ITBS were more variable in frontal plane pelvis motion relative to the trunk and thigh compared to runners with current ITBS and controls; 4) a more complex movement pattern exists within pelvis and hip motion during running that cannot be explained in the first three principal components. Collectively, this information can be used by iv clinicians to address hip abductor muscle weakness and atypical pelvis/hip motion during running in female runners with current ITBS and previous ITBS. v TABLE OF CONTENTS PART 1 ................................................................................................................. 1 Introduction, Literature Review, and Methods ................................................... 1 CHAPTER 1 ...................................................................................................... 2 Introduction ....................................................................................................... 2 Discrete Variables Associated with ITBS ....................................................... 3 Modeling and Simulation of the Iliotibial Band during Running ...................... 6 Hip Muscle Strength ...................................................................................... 7 Continuous Methods to Investigating ITBS .................................................... 7 Principal Components Analysis ..................................................................... 9 Purpose: Study 1 ......................................................................................... 10 Hypotheses .................................................................................................. 10 Purpose: Study 2 ......................................................................................... 11 Hypotheses .................................................................................................. 11 Purpose: Study 3 ......................................................................................... 11 Hypotheses .................................................................................................. 12 Assumptions ................................................................................................ 12 Delimitations ................................................................................................ 12 Limitations.................................................................................................... 13 CHAPTER II .................................................................................................... 14 Literature Review ............................................................................................ 14 Abstract ....................................................................................................... 14 Iliotibial Band Anatomy ................................................................................ 15 Iliotibial Band Syndrome .............................................................................. 15 Discrete Biomechanical Factors Associated with ITBS ................................ 17 Hip Muscle Strength .................................................................................... 33 Continuous Methods to Investigating ITBS .................................................. 36 Principal Components Analysis ................................................................... 46 Summary of Literature Review ..................................................................... 49 CHAPTER III ................................................................................................... 52 Methods .......................................................................................................... 52 Participant Details ........................................................................................ 52 Power Analysis ............................................................................................ 53 Data Collection ............................................................................................ 53 Data Analysis: Study 1 ................................................................................. 58 Data Analysis: Study 2 ................................................................................. 63 Data Analysis: Study 3 ................................................................................. 65 References .................................................................................................. 68 PART 2 ............................................................................................................... 80 CHAPTER IV ................................................................................................... 80 Iliotibial Band Syndrome Status Affects Running Biomechanics and Hip Physiological Measures ................................................................................... 80 Abstract ....................................................................................................... 81 Introduction: ................................................................................................. 83 vi Methods: ...................................................................................................... 86 Results: ........................................................................................................ 92 Discussion: .................................................................................................