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].

Home Message: To maximize tensor fasciae latae stretching, patients should be
positioned with their hip adducted and extended and with more than 90
º 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

Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

Related Posts:

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