Dear Tom, thanks for the article. I agree completely with your concept of ‘Proactive Rest’. It’s interesting that as humans we all recognise that rest in and of itself rarely changes things, yet when it comes to the rehabilitation and solution finding of a running injury such as ITBFS, it is so often the default of the injured runner. Rest and ‘hopefully’ all will settle. It would be convenient if it were the case, however rarely (if ever) is it a useful strategy. Thank you for sharing your knowledge around this. Brad Beer, Physiotherapist
Proximal ITB syndrome is a recently described entity. As defined in the original description, it is a strain injury of the proximal ITB enthesis at the iliac tubercle. The reports to date have been retrospective and little is known about the true incidence. Early results suggest that most patients who are imaged are female, some are runners, some are non-athletic and some have a specific antecedent traumatic event. The appropriate therapy is unknown and is likely conservative in most patients. MR imaging appears to be an excellent modality for diagnosing and evaluating the severity of Proximal ITB Syndrome.
Hip adduction and pelvic drop has been shown to reduce with gait retraining (Noehren et al 2011). External cues in the laboratory can include electro goniometry and video feedback, while for the average user mirror feedback on the gym treadmill may prove useful. Cadence may be changed using a simple metronome app on a smartphone. High cadence (greater number of steps) means that each step is shorter, reducing ground contact time and total load on the weight bearing leg. Subjects have been shown to increase step rate (%), and to reduce vertical load rate (%) and peak hip adduction (°), following an eight session training program using a simple wireless accelerometer of the type found in a smartphone or sports watch (Willy et al 2016), so the results of laboratory investigations have made their way directly into the field to help subjects performing recreational sport.