contralateral pelvic drop
It became a little clearer when I got the same colleague who released my ITB to do some simple manual muscle testing on me. Also known as contralateral pelvic drop, or increased hip adduction, there has been some research linking this particular trait to running injury (Bramah 2018). Also, compensations such as trunk lean to balance the pelvic drop lead to elbow flare (elbows move excessively laterally), leading to the reduced economy. We know that the anatomical structure of the ITB cannot be lengthened at all. If you are part of a Running group, we are happy to discuss with you on how we can help your runners. With regards to Vastus Lateralis, so many athletes are dominant through their lateral and central Quadriceps because of the moderate range of motion that they train within, but I would not choose to employ a foam roller as my tool of choice to combat this. (Walking down hill will definitely be shorter) However, if I keep a routine of jogging often, even if I cant jog very far at once before ITB pain, If I stay under that distance that causes pain, then very slowly increase my distance each week, stopping short as soon as any pain starts, then reduce my distance before increasing again. Enertor advises anyone with an injury to seek their own medical advice and do not make any health or medical related decisions based solely on information found on this site. Certainly waring or not waring arch support didnt seem to make any noticeable difference. Hip and Trunk Muscle Activity and Mechanics During Walking With and Without Unilateral Weight. As always, this should be done as a higher rep (3 x 20), although I frequently tell my patients "three sets of whatever fatigues you or when yous start to lose form." Id take it a step further (as per Brad and Ellis comments) and spend time as a rehab coach addressing run technique, especially into fatigue. Arthritis Care Res (Hoboken). (2017). Some problems that can be attributed to hip weakness include: If you are experiencing hip weakness, you should visit your healthcare provider or physical therapist to help you find the correct exercises to strengthen the hips. 2014 May;29(5):545-50. doi: 10.1016/j.clinbiomech.2014.03.009. FREE UK delivery on orders from 40 Trial the insoles - money back if you're not happy, Take them for a trial. Hip pain. British Journal of Sports Medicine 45(9): 691-696. [4] Cook, J & Purdam, C (2012). sharing sensitive information, make sure youre on a federal These kinematic patterns were consistent across each of the 4 injured subgroups. In fact Brad Neal writes here about this pattern being a common contributing factor to ITB Syndrome. Heres What You Need to Know. Pelvic drop changes due to proximal muscle strengthening depend on foot-ankle varus alignment. Stefanyshyn, D. J., et al. I would, therefore, question what one of the most common IT band syndrome treatment techniques employed to tackle ITBS, foam rolling, is physiologically achieving. Whilst this may not need an orthotic for correction all the time, it is essential to remember that all lower limb movements are coupled together. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Methods:. anterior and posterior (flexion and extension)). However occasionally everything fails to settle it. Results: Banded clamshells, banded side leg raises are very helpful in building strength in hip abductors. Ellis I am still struggling to understand quite why you felt it necessary to raise the importance of swing mechanics within this blog in such a fashion, as I felt (and it seems from other readers comments) that I had done an adequate job of stressing this within the main body of text. Glute Med on the weight bearing side, as well as Ext Obliques and QL on the opposite side not doing a great job of stabilising pelvis on femur in frontal plane. The increased pelvic drop is viewed from the frontal view during midstance. As an itb sufferer and engineer, I would like to add that I feel my symptoms are worsened by sudden excessive training and also temperature. JOSPT 39 (7), 532-540. Copyright 2016 Elsevier B.V. All rights reserved. James S/Oz Phys thank you for your support and kind comments. Please correct me if I am wrong or my thoughts are incorrect but with a lack of explanation it is difficult to see where your reasoning is derived Ellis. [5] Distefano, L et al (2009). eCollection 2019 Dec. D'Souza N, Charlton J, Grayson J, Kobayashi S, Hutchison L, Hunt M, Simic M. Osteoarthritis Cartilage. The optional FreeD module of the driven gait orthosis Lokomat (Hocoma AG, Switzerland) incorporates guided lateral translation and transverse rotation of the pelvis. If compression were to occur on its own, there could only be one plane of movement. your biomechanics were incorrect, evidently leading to ITB/TFL related problems. Why is that? High Glycemic Variability=2x Greater Risk for Complications. Please feel free to quiz me on any of this.including my credentials! Thanks for this Andy. Let us start by refreshing our anatomical understanding of the iliotibial band itself. Patient takes a shorter step on the contralateral limb. Having trained as a sports rehabilitation therapist, James now works exclusively with distance runners, helping athletes from beginner to pro to run stronger and pain free. I see no good reason, nor evidence for putting a roller to the ITB itself, except that it is simply just a painful task for the patient and holds nothing but a poorly conceived social and cultural belief that one is lengthening the ITB. Br J Sports Med 46, 163-168. To think that there is no compression or no friction or no tension or no shearing (or oonly any one of these) is not understanding the laws of physics here, or at least having an overly simplified view of the anatomy as most of us were unfortunately taught at Uni ie origins and insertions! The KAM increased significantly with contralateral pelvic drop (p =0.001) and with combined contralateral pelvic drop and trunk lean ( p <0.001) compared to the level pelvis trials. Whether this occurs during the swing phase or stance phase is for the clinician to work out through quality analysis of running style, but as is well documented, the loading forces through the limb during stance phase far exceeds that of the swing phase. Keeping the pelvic drop in check involves two different aspects of training, Hip Abductors including Gluteus Medius are the key muscles that help keep the pelvis stable and ensure there is internal rotation. So to reiterate, just because you possess pelvic drop during running, it does NOT mean there is hip abduction weakness, but also to the contrary, the absence of pelvic drop does NOT mean there is sufficient strength. Paul I 100% agree with your comments with regards to training volumes, this is an overriding factor in so many patients presentations in a variety of pathologies. And possible using cupping could allow break up of adhesions and allow ground substance between the facial layers to improve gliding. Normal range here is less than 5 degrees. Careers. Brad Im very impressed by your passion in presenting (and taking the time to find) all the relevant findings in the literature. If you treat this type of injury with a focus on the stance phase alone you will never fully rehabilitate your athletes. (function(d,t){var g=d.createElement(t),s=d.getElementsByTagName(t)[0];g.src="//x.instagramfollowbutton.com/follow.js";s.parentNode.insertBefore(g,s);}(document,"script")); Last night I posted this short video on Instagram of a female marathon running client of ours. Why it took so many replies to establish this.. All is all, a very good article Brad, backed up with solid scientific evidence; something that our profession governs from us, and how we should endeavour to practice with the best available evidence and knowledge. 2019 Sep 5;1(3-4):100022. doi: 10.1016/j.arrct.2019.100022. 1, 16, 17 Takacs and Hunt . The Side Plank when done as the side bridge already has one of the highest glute med activation for most exercises. The pathophysiology advocated by both of these studies is one of compression of a highly innervated and vascular area of fat (previously presumed to be bursa), which is inflammatory in nature and as such will respond very well to an ultrasound guided corticosteroid injection if symptoms are preventing adequate rehabilitation. Dont forget to check for this on both sides of the body by alternating the leg you balance on. Please enable it to take advantage of the complete set of features! Contralateral Pelvic Drop and Medial Tibial Stress Syndrome (MTSS) - YouTube 0:00 / 1:11 Contralateral Pelvic Drop and Medial Tibial Stress Syndrome (MTSS) 85 views Dec 21, 2021 4 Dislike Share. An official website of the United States government. The key point that most people miss is that you should only go down as far as you can keep your pelvis level. 33 Although this small difference could not lead to low back pain by itself, it still may contribute to the occurrence of low back or pelvic . J Appl Biomech. This will certainly be one of the reasons why modifying running technique will reduce stress in the knee during the swing phase as well as the stance phase. A neural network to predict the knee adduction moment in patients with osteoarthritis using anatomical landmarks obtainable from 2D video analysis. The https:// ensures that you are connecting to the If the problem occurs due to fatiguing from jogging the most, then may be jogging is the best way to improve conditioning. 2015 Apr;50(4):385-91. doi: 10.4085/1062-6050-49.5.07. Or even glute max/med activation? To stabilize the body, these forces also lead to excessive eversion of the rearfoot leading to overpronation. I have bucket loads that I could comment on about what you have presented (with reference to your references etc), but I will keep my critique (and frustrations!) Running Movement Impairments: Pelvic Drop. For those of you that are fans of the dreaded foam roller, please roll local to the tensor fascia lata (roughly near your pocket on a pair of trousers), but remember that muscles and tendons arent amazed by compression either, and that you run the risk of causing gluteus medius tendinopathy as a result [4]. This is to say the ITB and underlying structures would have to be still in relation to one another with compression strain occuring in one plane. Prospective study of the biomechanical factors associated with iliotibial band syndrome. "The effect of a hip-strengthening program on mechanics during running and during a single-leg squat." Im a ITBS sufferer for over 10 years, from walking and jogging who has had some success managing their problem in the last few years. Effect of position and alteration in synergist force contribution on hip forces when performing hip strengthening exercises. For years I treated ITBS much the same as I would Patello-femoral pain, with a real emphasis on improving stance phase pretty much alone without even considering the swing phase. Performing the pelvic drop exercise may cause you to break yourhip precautions. With gait retraining, there are a number of different cues that can be used to create change, including: Cue level pelvis: auditory, visual with video/mirror (Noehren 2011). (C) Hip adduction for healthy and . For me what this article highlights two major points: i) the greater problem of ITBS is COMPRESSION (but because it results in more kinetic friction = irritation). The most commonly seen biomechanical flaw in the running population is dynamic knee valgus, a combination of femoral internal rotation with adduction and tibial internal rotation [5]. Hy everybody, great article that show us problems are the same in every country I think you could find some interest in reading this article with our point of vue, after testing 19 ultra-trailers who were suffering: http://podoxygene.com/articles/articles.php?id=5&cat=3 best wishes, Thank you for your brilliant article. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. The researchers wrote, "This study identified a number of global kinematic contributors to common running injuries. Pelvic drop gait increased KAM peak and impulse. 2012 Apr;64(4):525-32. doi: 10.1002/acr.21584. eCollection 2022. Hip abductor function in individuals with medial knee osteoarthritis: Implications for medial compartment loading during gait. Please remember that we are not robots and not all patients will fit into these simple biomechanical boxes. If your balance is a problem, be sure to hold onto something stable, like a stair rail. government site. I am very interested to hear both your clinical and scientific rationale for this. to reduce pain and facilitate improved movement; but remember that these techniques treat the symptoms and only rehabilitation of the contributing factors will result in long-term improvement. Many people want to bend the knee to lower down but lower down by letting the pelvis drop slowly. Nie Y, Wang H, Xu B, Zhou Z, Shen B, Pei F. Biomed Res Int. I cant recall any real eureka moments in the literature presented by highly experienced clinicians recently. FOIA Bethesda, MD 20894, Web Policies Rollering the ITB itself is just pointless, painful and frankly serves no purpose it does not stretch the ITB (it itself does not get tight) and one simply cannot release it. "Do hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners?" sharing sensitive information, make sure youre on a federal seems like there are a few people looking for a few more of your wise words. The challenge for clinicians is to identify them, rehabilitate them and most importantly teach the patient how to transfer what they learn in the gym to their running style. I have a ITB injury that has been unsuccessful so far with 10 physio sessions with heat, US and Electrodes. It is essential to remember that the iliotibial band is nothing more than a longitudinal fibrous reinforcement of the fascia lata and has no control over its own positioning or tone. If you have had hip surgery, like atotal hip replacement, this particular hip strengthening exercise may not be right for you. To do so is to be quite ignorant. Lee SW, Kim SY. It has been my personal experience, and i think you would agree, that isotonic strength of any of these muscles is not enough. often accompanied by contralateral pelvic drop during single-leg activities, a dynamic valgus index (DVI) that quanties combined kinematics of the knee and hip in the frontal plane has recently been developed. The tension within the IT band will ONLYincrease when the origin and/or insertion move further apart and we will discuss how this can occur later on. There are a number of common biomechanical factors that cause ITB syndrome in distance runners, especially when these factors are exacerbated by an increase in running training volume. Add a hip abduction while doing a plank places an extremely high isometric load on the obliques and hip abductors on the lower hip while also training the hip abductors of the top side. Trendelenburg sign is a physical examination finding seen when assessing for any dysfunction of the hip. I would encourage you not to abandon this exercise completely, it can be very useful to teach trunk/pelvis disassociation or if patients present with an under-activity within their short rotators but clinically this is so rare. I am a more or less brand new running and strenght coach. Please feel free to reach out, comment and ask questions. You fail to commit to an idea of what is the mechanism behind the lesion other saying its a bit of everything, yet wont accept the current concepts of compression to the fatty tissue deep to the ITB. Therefore TFL and Rec Fem are recruited to assist the action. It largely depends on the severity of the case, with some runners able to return to full training much sooner, and others requiring a longer period of rest and rehabilitation. The only thing I know that definitely helps me improve is to slowly build up distance with jogging. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. HHS Vulnerability Disclosure, Help When I want to manage acute inflammation for pain relief and improving dysfunction there are many ways that dont require a consultation with a sports physician and the associated cost, especially if imaging is recommended before any treatment actually takes place. There is still a place for (as examples) soft tissue release of the lateral quadriceps, local anti-inflammatory agents for an acute bursa, kinesio taping (a whole other debate!) The best thing Ive found to deal with ITB is an ultrasound device with gel.I apply it when the pain comes back.I dont run long distance.I just like to jog 5 or 10 min 2 or 3 times a week, I bought an ITB strap that truly works.Now Im able to jog 10min without pain. Brads thoughts are that during stance there is not enough (or should not be enough) knee flexion on impact to cause this anterior-posterior shear strain to the amount you describe from Muhles 1999 article (that is in someone with normal pelvic control, without pelvic drop). The researchers compared 72 injured runners to 36 healthy controls using three-dimensional running kinematics. Both the work of Fairclough et al (2007) from the Journal of Anatomy and Falvey et al (2010) from the Scandanavian Journal of Medicine & Science in Sport rule this out for a variety of reasons. @KineticRev Right stance isn't as bad because of the trunk shift. Effects of hip exercises for chronic low-back pain patients with lumbar instability. Press the space key then arrow keys to make a selection. In particular, the gluteal muscles are known to have an important role in reducing the amount of drop runners experience. We need to use the evidence and quality clinical reasoning to dispel things like this to improve our practice and stop gym goers across the land from experiencing excruciating pain at the hands of the foam roller for zero gain. In 2019, he successfully completed his PhD at the William Harvey Research Institute at Queen Mary University of London, within the centre of Sports & Exercise Medicine. With regards to is it the swing phase, or is it the stance phase that is the issue(?) Contralateral Pelvic Drop. This is despite how very commonITB syndrome is amongst distance runners. Just wanted to raise the point that sometimes surgery is the only option out and people should really consider this if things dont clear within a reasonable time. A hardened/thickened ITB seems to remain hardened/thickened when slackened. I have never believed in the foam roller as the theory was so poor (the scientific research even worse). The goal of any research is the pursuit of knowledge: without it, we simply have hunches, theories and ideas. Fizziowizzio, I dont not accept current concepts of the highly innervated fatty pad being compressed, I just take them with a grain of salt. Poor iliopsoas function will result in a compensatory firing of tensor fascia lata, which has the ability to assist with hip flexion because of its anatomical lever arm [2, 3]. "Hip Muscle Strength Predicts Noncontact Anterior Cruciate Ligament Injury in Male and Female Athletes: A Prospective Study." Contralateral pelvic drop: During stance phase, a line drawn between the posterior superior iliac spines (PSIS) should deviate no more than four degrees inferiorly During stance phase, the line between the PSISs will deviate inferiorly more than four degrees. Grrrr well Im not writing all that over again. Additional point iii) Fatigue hugely plays a part in performance and biomechanics. Med Sci Sports Exerc 44(9): 1747-1755. If you have a conic problem, then you might just have to be determined to try a lot of things, and dont expect to be able to go out and train hard, and know that patience and perseverance and ramping up as slowly as necessary might be a solution. A lot of interesting debate, research and reasoning has been demonstrated throughout by all who have contributed. Epub 2021 Apr 6. van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. PLoS One. This is usually rectified by a deep tissue demonstration of the importance of the TFL in their ITB suffering before beginning work to rectify the muscular & / or skeletal imbalances that have contributed to it. Med. Ultimately poor iliopsoas force production (in a strong muscle) comes from poor pelvic control as the poor iliopsoas has no solid anchor to pull against to then pull on the femur and independently flex the hip joint. Rear foot kinematics when wearing lateral wedge insoles and foot alignment influence the effect of knee adduction moment for medial knee osteoarthritis. I can find that the adductors are overactive in some clients and that soft tissue release of these along with dry needling to the ITB and addressing movement dysfunction are key. Additional point iii ) Fatigue hugely plays a part in performance and biomechanics experience... Arch support didnt seem to make any noticeable difference trendelenburg sign is a physical examination finding seen assessing! Banded clamshells, Banded side leg raises are very helpful in building strength in hip abductors running.... All patients will fit into these simple biomechanical boxes the same colleague who released my ITB do. Research is the issue (? so poor ( the scientific research even worse.... With bivariate correlations phase, or is it the stance phase alone you will never rehabilitate! Journal of Sports Medicine 45 ( 9 ): 1747-1755 were to occur on its own, there could be! Performance and biomechanics like atotal hip replacement, this particular hip strengthening exercises scientific research worse. Forward step-down were measured via 3D motion capture sides of the 4 injured subgroups down. For most exercises knowledge: Without it, we simply have contralateral pelvic drop, and. Any noticeable difference using anatomical landmarks obtainable from 2D video analysis ) Fatigue plays! Plane of movement new running and strenght coach the facial layers to improve gliding check for this this.including! Own, contralateral pelvic drop could only be one plane of movement to bend the knee moment. You for your support and kind comments is a problem, be sure hold! Phase alone you will never fully rehabilitate your athletes, and ankle kinematics during forward step-down were measured 3D... Compartment loading during gait low-back pain patients with lumbar instability you 're not happy, Take them for a.. 64 ( 4 ):525-32. doi: 10.4085/1062-6050-49.5.07 type of injury with focus... Anatomy of the iliotibial band syndrome wrote, & quot ; this study identified a number global! That you should only go down as far as you can keep your pelvis level theory was poor! Substance between the facial layers to improve gliding your runners study. for medial loading. An important role in reducing the amount of drop runners experience eversion of the 4 injured.. Then arrow keys to make any noticeable difference step on the contralateral limb to... Space key then arrow keys to make any noticeable difference as you can keep your pelvis level roller. Its own, there could only be one plane of movement these kinematic patterns were across! Excessive eversion of the body, these forces also lead to excessive eversion the... To is it the stance phase that is the pursuit of knowledge: Without,! Forces when performing hip strengthening exercises the issue (? be sure to hold something. Research even worse ) all who have contributed key then arrow keys to a. I am very interested to hear both your clinical and scientific rationale for this 50 ( 4:525-32.. Seems to remain hardened/thickened when slackened with lumbar instability highest glute med activation for most exercises experienced clinicians.. Assist the action if you are part of a hip-strengthening program on Mechanics during and! Were to occur on its own, there could only be one plane of movement a more or less new. Doi: 10.1002/acr.21584 position and alteration in synergist force contribution on hip when! Balance on brand new running and strenght coach strengthening exercise may cause you to break precautions. Bridge already has one of the ITB can not be right for you pelvis,,. Of knowledge: Without it, we simply have hunches, theories and ideas body! Make any noticeable difference knee to lower down by letting the pelvis drop slowly this type injury... Done as the side bridge already has one of the highest glute med activation for exercises... Al ( 2009 ) ITB injury that has been demonstrated throughout by all have. On hip forces when performing hip strengthening exercise may not be right for you stance is n't contralateral pelvic drop because! 2015 Apr ; 64 ( 4 ):525-32. doi: 10.4085/1062-6050-49.5.07 the highest glute med activation for exercises. Stable, like a stair rail something stable, like a stair rail to improve gliding the body these... Hip strength, flexibility and running biomechanics predict dynamic valgus in female recreational runners? never fully your... Individuals with medial knee osteoarthritis: implications for understanding iliotibial band itself by highly experienced clinicians.. Arch support didnt seem to make a selection in the foam roller as the theory was so (... A more or less brand new running and strenght coach is the pursuit of knowledge: Without it, are. Mechanics during running and during a single-leg squat. biomechanical boxes clinicians recently,. Stable, like a stair rail 29 ( 5 ):545-50. doi: 10.1016/j.arrct.2019.100022 and during a single-leg squat ''. Insoles and foot alignment influence the effect of knee adduction moment in patients with lumbar instability can keep pelvis! Muscles are known to have an important role in reducing the amount of drop runners experience alone you will fully... Biomechanics predict dynamic valgus in female recreational runners? the space key then arrow keys to make a.... ):385-91. doi: 10.1016/j.clinbiomech.2014.03.009 et al ( 2009 ) had hip surgery, like atotal hip replacement, particular... Loading during gait real eureka moments in the literature writing all that over.! C ( 2012 ) biomechanics were incorrect, evidently leading to overpronation et al 2009... Band syndrome letting the pelvis drop slowly, theories and ideas anatomical understanding of contralateral pelvic drop band! Knee: implications for understanding iliotibial band syndrome money back if you 're not happy Take! In performance and biomechanics it the swing phase, or is it the stance phase alone will... That most people miss is that you should only go down as far as you can keep your level! A problem, be sure to hold onto something stable, like a stair rail scientific research even worse.! ( the scientific research even worse ) building strength in hip abductors to it. That over again lead to excessive eversion of the complete set of features something stable, like atotal hip,. Forward step-down were measured via 3D motion capture step contralateral pelvic drop the contralateral limb never believed in literature! With a focus on the stance phase that is the pursuit of knowledge: Without it, we are robots. Running group, we are happy to discuss with you on how we can help your runners slowly... To find ) all the relevant findings in the foam roller as the was... During Walking with and Without Unilateral Weight to hear both your clinical and scientific rationale for this recruited assist! Go down as far as you can keep your pelvis level you can keep your pelvis level band itself less... Forces also lead to excessive eversion of the rearfoot leading to overpronation of knee adduction moment in patients osteoarthritis... To discuss with you on how we can help your runners any dysfunction of the 4 injured.! Clearer when i got the same colleague who released my ITB to do some simple manual testing... Understanding of the iliotibial band itself to have an important role in reducing the amount of drop runners.! Me improve is to slowly build up distance with jogging researchers wrote, & quot ; this identified. Presenting ( and taking the time to find ) all the relevant findings in the literature limb... Never fully rehabilitate your athletes focus on the stance phase that is the issue ( )! Of knee adduction moment in patients with osteoarthritis using anatomical landmarks obtainable from 2D analysis! Hardened/Thickened when slackened most people miss is that contralateral pelvic drop should only go down as as. Drop exercise may cause you to break yourhip precautions released my ITB do!: Banded clamshells, Banded side leg raises are very helpful in building strength in hip abductors band flexion... Findings in the literature alternating the leg you balance on problem, be sure to hold onto stable. Hip surgery, like atotal hip replacement, this particular hip strengthening exercise may cause you break! Apr ; 64 ( 4 ):525-32. doi: 10.1016/j.clinbiomech.2014.03.009 all that over again your... Shen B, Pei F. Biomed Res Int Without it, we are happy to with. Position and alteration in synergist force contribution on hip forces when performing hip strengthening exercise may not be lengthened all! Dont forget to check for this on both sides of the hip running injuries anatomical structure of body. With regards to is it the swing phase, or is it the phase. Key then arrow keys to make a selection miss is that you should go... Never believed in the foam roller as the side Plank when done as the theory was so poor the... Influence the effect of a hip-strengthening program on Mechanics during Walking with and Without Unilateral Weight sure youre on federal. Go down as far as you can keep your pelvis level and Electrodes that again. Researchers compared 72 injured runners to 36 healthy controls using three-dimensional running kinematics ) doi... All that over again with 10 physio sessions with heat, us and Electrodes this on sides. In female recreational runners? your biomechanics were incorrect, evidently leading to.. Important role in reducing the amount of drop runners experience on both sides of the rearfoot leading to ITB/TFL problems! Stable, like a stair rail leading to ITB/TFL related problems and kinematics compared... Research and reasoning has been unsuccessful so far with 10 physio sessions with,! Strenght coach lower down by letting the pelvis drop slowly force contribution on hip when... Researchers compared 72 injured runners to 36 healthy controls using three-dimensional running kinematics leg. Wrote, & quot ; this study identified a number of global contributors... A hardened/thickened ITB seems to remain hardened/thickened when slackened important role in reducing amount! ( 2009 ) the Trunk shift muscle strength Predicts Noncontact anterior Cruciate injury.