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Title: The effectiveness of three treatment protocols in the treatment of iliotibial band friction syndrome
Authors: Turnbull, Grant S. D. 
Issue Date: 2010
Iliotibial Band Friction Syndrome (ITBFS) is an overuse injury induced by friction of the iliotibial
band (ITB) over the lateral epicondyle of the femur (LFE) with secondary inflammation. ITBFS is
a prevalent condition and is the most common cause of lateral knee pain in long distance
runners and cyclists.
There are a significant number of aetiological factors related to ITBFS. As a result of this the
general chiropractic approach to the treatment of ITBFS is multimodal and include interventions
such as joint manipulation, cryotherapy, orthotics, massage, electrical stimulation, acupuncture
type procedures and therapeutic exercise. Dry-needling is an effective therapy in the treatment
of active Myofascial Trigger Points (MFTP’s) that are associated with ITBFS. However, the
available literature suggests that to determine its efficacy, it should be performed in isolation.
The association of sacroiliac joint dysfunction in ITBFS has also been addressed and are
thought to co-exist and perpetuate one another. It is recommended that chiropractors include
pelvic manipulation in their treatment protocol for ITBFS however there is a paucity of literature
showing its effectiveness in the treatment of this condition.
There appears to be a need for further research in the form of randomized controlled clinical
trials with regard to chiropractic specific procedures, performed in isolation, in the treatment of
ITBFS. Therefore this study aimed to add to the literature by assessing the effect of the
sacroiliac joint manipulation and dry needling in the treatment of ITBFS.
The study aimed to determine the comparative effectiveness of dry needling alone versus
manipulation alone, as well as a combination of the two interventions in the treatment of ITBFS.
This study was a randomised, open label trial. 47 participants with ITBFS were divided into
three groups, each group receiving a different intervention i.e.: group one received dry needling
of the active MFTP’s in the Tensor Fascia Lata (TFL) and ITB, group two received sacroiliac
joint manipulation, group three received a combination of the two interventions. Subjective
measurements, in the form of the Numerical Pain Rating Scale-101 (NRS-101), and objective
measurements, in the form of algometer readings in the TFL, ITB and Nobles Compression test
as well as digital inclinometer readings of Modified Obers test, were utilised to determine the
effects of the respective interventions. These measurements were recorded twice, once prior to
commencing the treatment programme. These values were then evaluated to compare the
efficacy of the different treatment interventions. Each participant received four treatments over a
two week period.
There were no statistically significant differences between the three treatment groups as they all
seemed to parallel one another with regards to overall improvement in subjective and objective
measurements (P<0.5). However on closer examination subtle differences between the groups
were noted. An interesting endpoint is that the combination group did not fair the best
throughout the study, which was contrary to the original hypothesis. The groups receiving only
the single intervention appeared to fair marginally better over the combination group. A
secondary endpoint that became evident during the study and on analysis of the data, was that
hip joint instability must also be considered when treating ITBFS when there is concomitant
sacroiliac joint dysfunction.
A decision needs to be made with regard to which intervention best suits the individual at the
time. A combination therapy, which originally was thought to be the best treatment option,
should possibly be reconsidered. Perhaps a single intervention of manipulation or dry needling
should be decided upon. In totality, all intervention proved to be effective in the treatment of
Mini-dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2010.
Appears in Collections:Theses and dissertations (Health Sciences)

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