Effect of hip and knee position on tensor fasciae latae elongation during stretching: An ultrasonic shear wave elastography study
Umehara J, Ikezoe T, Nishishita S, Nakamura M, Umegaki H, Kobayashi T, Fujita K and Ichihashi N. Clin Biomech. 2015. [Epub Ahead of Print].
Take Home Message: To maximize tensor fasciae latae stretching, patients should be positioned with their hip adducted and extended and with more than 90º of knee flexion.
Iliotibial band (ITB) syndrome is a common chronic condition and is often treated by stretching the tensor fasciae latae (TFL) muscle. However, no study has looked at the most effective patient position to maximize TFL stretching. By identifying patient positioning guidelines, clinicians can more effectively treat ITB syndrome. Therefore, Umehara and colleagues investigated the effect of hip and knee positioning on muscle elongation during TFL stretching using ultrasonic shear wave elastography. Twenty men (~23 years old, non-athletes, no history of orthopedic injury or nervous system disease) participated in the study. All volunteers laid supine on a table with their trunk secured and their legs extended beyond the table. The authors assessed each participant’s right limb with the hip in adduction and extension. A trained investigator stretched participants in 12 different positions using a combination of hip in maximal external rotation, maximal internal rotation, or neutral rotation, and knee flexed to 0º, 45º, 90º, and 135º. The trained investigator held each stretch for < 15 seconds. During each stretch a second investigator applied the ultrasonic shear wave elastography to determine stretch (muscle elongation). The reliability of the ultrasonic shear wave elastography was excellent. Overall, the authors found that the knee angle during a TFL stretch influenced the muscle elongation. Specifically, they demonstrated that the stretch was more effective at 90º and 135º of knee flexion than at 0º and 45º. Hip rotation did not have a significant effect on the effectiveness of the stretch.
Clinicians should note that when stretching the TFL they should position their patients with ≥ 90º of knee flexion and with the hip adducted and extended. However, we need to keep in mind that the participants were non-athletes and did not have ITB syndrome. More research should be completed to understand if this would be as effective in an athletic or symptomatic population. Furthermore, it would be beneficial to complete future research with larger populations as there may be other individual variations that clinicians should be mindful of. Until that time however, clinicians may want to consider using this patient positioning because no standard existed prior to this research and placing patients in this position posed no risk to the patient’s well-being.
Questions for Discussion: What patient positioning do you use when attempting to stretch the TFL? Have you found this stretching beneficial in the treatment of ITB syndrome?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Umehara, J., Ikezoe, T., Nishishita, S., Nakamura, M., Umegaki, H., Kobayashi, T., Fujita, K., & Ichihashi, N. (2015). Effect of hip and knee position on tensor fasciae latae elongation during stretching: An ultrasonic shear wave elastography study Clinical Biomechanics DOI: 10.1016/j.clinbiomech.2015.09.007