by Charlotte Softly – Advanced Clinical Massage Therapist
As the final part of my BTEC level 6 training in Advanced Clinical and Sports Massage with Jing Institute, beginning in February I will be carrying out a research project investigating the effects of Massage Therapy on Iliotibial band syndrome (ITBS) in long distance runners. If you think you might be interested in taking part, or just in finding out a bit more about ITBS, then read on!
Firstly, what exactly is the Iliotibial Band (ITB)?
The ITB is not actually a separate structure at all, it is a thickened part of the fascia that surrounds the thigh (the fascia lata). It acts as the insertion for the Tensor Fascia Lata (TFL) muscle in the anterior hip and for the upper fibres of the Gluteus Maximus. The ITB is securely anchored to the femur along its length (via the intermuscular septum), and to the lateral epicondyle of the femur by thick fibrous bands. At it’s furthest end, it attaches to ‘Gerdy’s tubercle’ on the tibia (the shin bone), just below the knee joint. It has an important function in stabilizing the lateral hip and knee.
(Baker, Souza, & Fredericson, 2011) GT = Greater Trochanter
How do I know if I have ITBS?
The defining symptom of ITBS is pain on the outside of the knee which is worst when the knee is flexed to around 30 degrees. Sometimes people can wrongly diagnose themselves with ITBS when they have pain in the outside of the hip. Hip pain may occur alongside a case of ITBS, but ITBS itself is defined by pain on the outside of the knee. It will often come on after a sudden change in training load, such as increases in mileage or the addition of more intense speed work. This lateral knee pain may or may not be present during walking or normal daily activities. It may only come on after a certain number of miles whilst running, or may become so severe that it is not possible to run at all.
Why does it hurt?
ITBS has been traditionally considered a friction injury, caused by the ITB rubbing over the lateral epicondyle of the femur as the knee flexes and extends. However, some researchers (Fairclough et al. 2006; Falvey et al. 2010) claim that due to the anatomical structure of the ITB, it is not actually possible for it to move over the lateral epicondyle. They suggest that irritation is caused by compression of a highly innervated fat pad between the ITB and the lateral epicondyle. In any case, it tends to result from activities involving repeated flexion and extension of the knee, such as occurs during running or cycling.
Some information about my research project
For this project, I will be testing how a specific massage protocol can affect the symptoms of ITBS. There has been very little research done on conservative treatment options for ITBS and none that I have been able to find on Massage Therapy. However, Falvey et al (2010), mentioned above, have speculated that soft tissue work to the TFL and Gluteus Maximus muscles may be worth investigating due to the role that these muscles have in tensioning the ITB.
What kind of massage is it?
The protocol I will be using will combine elements of hot stone therapy, myofascial release techniques, trigger point therapy, stretching and acupressure points. It is based on the protocol taught by Jing Institute. Although in clinical practice each massage session is individually tailored, for the purposes of this project, my ITBS massage protocol will be standardised so that each participant will receive the same treatment for each session.
I think I might have ITBS, what does the study involve?
First of all, participants will need to attend for an introductory interview to clarify what is involved and complete an assessment. I’ll take a health history and details of your injury and training and do some tests to confirm an assessment of ITBS. If I have enough people, the group will be randomly divided into an experimental group and a control group. Unfortunately, only the experimental group will receive the Massage Therapy intervention! However, as a thank you for the valuable contribution of the control group, I will offer the same course of treatment at the same great rate when the trial is over – assuming that it is successful!
The experimental group will be required to attend once a week for 6 weeks for the Massage Therapy intervention. This will take place at ‘A Natural Balance’ clinic in Hove. Treatments will be offered at a much-reduced rate of only £20 per session. This is a fantastic opportunity to receive an advanced massage therapy for your stubborn case of ITBS at a hugely discounted rate and contribute to science at the same time!
Please call me on 07596 464162 or email me at firstname.lastname@example.org for a brief chat, ask me any questions you like about the study and if you would like to take part, we can make an appointment for an initial interview.
Charlotte Softly is an Advanced Clinical Massage Therapist specialising in the treatment of chronic pain and sports injury.
Baker, R.L., Souza, R.B. & Fredericson, M., 2011. Iliotibial Band Syndrome: Soft Tissue and Biomechanical Factors in Evaluation and Treatment. PM and R, 3(6), pp.550–561. Available at: https://dx.doi.org/10.1016/j.pmrj.2011.01.002.
Fairclough, J. et al., 2006. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of Anatomy, 208(3), pp.309–316. Available at: https://doi.wiley.com/10.1111/j.1469-7580.2006.00531.x [Accessed December 31, 2016].
Falvey, E.C. et al., 2010. Iliotibial band syndrome: An examination of the evidence behind a number of treatment options. Scandinavian Journal of Medicine and Science in Sports.