Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment

Objective. Iliotibial band friction syndrome (ITBFS) is the second most common cause of knee pain in runners, and the most common cause of lateral knee pain. This systematic review and meta-analysis evaluates 1) lower-limb biomechanics and 2) conservative interventions in ITBFS. Methods. The MEDLINE, CINAHL, SPORTSDiscus, Web of Science, and Google Scholar databases were searched in April 2018 for studies investigating lower limb biomechanics and conservative treatment in iliotibial band friction syndrome. Results. Eighteen studies were identified. Moderate evidence from prospective studies indicate 1) greater hip adduction and knee internal rotation (IR) at footstrike and through stance, and 2) greater rearfoot eversion at foot strike represent possible mechanisms for ITBFS. Moderate evidence from case-control studies indicate ITBFS participants exhibit 1) reduced hip adduction, 2) greater knee and hip IR at footstrike and through stance, and 3) reduced rearfoot eversion at foot strike. Moderate evidence indicates that a six-week rehabilitation programme involving NSAID prescription, ITB stretching, and hip abductor strengthening reduces knee pain during physical activity, and prevents ITBFS recurrence in the medium term (<= 6 months). Conclusion. Greater hip adduction, knee IR, and rearfoot eversion represent possible risk factors for ITBFS. Greater hip adduction and rearfoot eversion appear to be risk factors which are reduced by ITBFS patients, to lower pain associated with ITB strain, ITB friction and compression. Addressing the absence of research evaluating lower limb electromyography is needed to understand the influence of muscle function on ITBFS. A six-week rehabilitation programme involving NSAID prescription, ITB stretching, and hip abductor strengthening effectively reduces pain and prevents recurrence for up to six months.