Dee Physical Therapy is proud to announce that two of our physical therapists, Justine Dee and Timothy Gould, have been published in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT). Their abstract “Motor Learning, Neuroplasticity, and Recovery in a Runner with Iliotibial Band Syndrome: A Case Report” can be found in the January issue of JOSPT, considered to be the foremost publication in orthopaedic physical therapy research.
This achievement highlights the emphasis that Dee Physical Therapy clinicians place on evidence based practice, contributing to the body of research, and pushing the standard of physical therapy practice ever higher.
Our treatment principles and techniques are based on the best available research and we believe them to be the most effective in the field. It is an honor to be recognized as contributors to the body of evidence in our profession.
Please also note that one of the authors of this article, Dr. Timothy Gould, PT, conducts a program called Runner’s Rx out of our Dee Physical Therapy Shelburne location that is a physical assesment with video analysis to improve runners performance and prevent injury. For more information about, or to sign up for this program, please email firstname.lastname@example.org, or contact the receptionist at Dee PT Shelburne.
TITLE: Case Report: Motor learning, Neuroplasticity, and Recovery in a Runner with Iliotibial Band Syndrome
Dee J, University of Vermont, Burlington, Vermont
Gould T, Dee Physical Therapy, Shelburne, Vermont
Padgett P, University of Vermont Medical Center, Burlington, Vermont
Background & Purpose: Iliotibial band syndrome (ITBS) is reported in up to 12% of runners and pain associated with it can limit or prevent running. Typically, physical therapy is focused on strengthening programs targeting weak hip musculature. However, it is now hypothesized that faulty movement patterns at the hip and knee are major contributors to ITBS. Therefore, without correction of the underlying faulty movement pattern, runners’ symptoms may not improve or may recur. Intervention utilizing motor learning principles to achieve the desired movement patterns results in neuroplastic changes in the CNS, effectively and efficiently normalizing runner’s functional movements to allow for healing and longevity in their sport.
Case Description: A 46-year old male, elite runner was seen 9 weeks after initial onset of ITBS symptoms. He had attempted rest and a 4-week course of physical therapy that included hip strengthening and manual therapies, without improvement. Lower extremity examination included a functional movement assessment, video running gait analysis and the lower extremity functional scale (LEFS). Of note were findings of 3+/5 hip abduction strength bilaterally. Excessive genu valgus positioning was observed during functional movements, particularly on the affected side. Running analysis revealed bilateral femoral internal rotation during stance phases. The patient participated in physical therapy 1-2 times per week for 6 weeks. Treatment emphasized motor control training utilizing verbal and visual feedback with a mirror to promote proper hip and knee alignment during functional movements, treadmill running and dynamic hip stabilization exercise. Over the course of the intervention feedback was faded to promote motor learning.
Outcomes: The patient recorded a clinically meaningful improvement in LEFS score from 65 to 80. Affected leg peak dynamic genu valgus improved by 29 degrees during single and double limb squat, and by 20 degrees during lateral step-down and 8-inch drop landing tests. Hip abduction strength gains were minimal, improving from 3+/5 to 4/5. Of greatest significance, the patient improved from a baseline running tolerance of 2 miles to more than 15 miles. He returned to running 4 times per week with total weekly distances exceeding 50 miles at a sub-7 minute-mile pace, and reintroduced varied terrain without symptom provocation.
Conclusion: This case illustrates the benefit of interventions that incorporate motor learning principles to address faulty movement patterns. Strengthening exercises alone may lack in functional carryover, while promoting neuroplastic changes by motor pattern re-training has the potential to expedite and maintain outcomes. In this case, the patient experienced significant functional gains despite demonstrating minimal changes in hip strength. Specifically, orthopedic physical therapists can address ITBS symptoms with gait re-training utilizing motor learning techniques.
Ferber R, Noehren B, Hamill J, Davis I. Competitive Female Runners With a History of Iliotibial Band Syndrome Demonstrate Atypical Hip and Knee Kinematics. J Orthop Sports Phys Ther. 2010 Feb;40(2):52-8
Grooms D, Applebaum G, Onate J. Neuroplasticity Following Anterior Cruciate Ligament Injury: A Framework for Visual-Motor Training Approaches in Rehabilitation. J Orthop Sports Phys Ther. 2015 May;45(5):381-93.
Noehren B, Scholz J, Davis I. The Effect of Real-Time Gait Retraining on Hip Kinematics, Pain and Function in Subjects with Patellofemoral Pain Syndrome. Br J Sports Med. 2011;45:691-96
Powers C. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sports Phys Ther. 2010 Feb;40(2):42-51
Willy R, Davis I. Varied Response to Mirror Gait Retraining of Gluteus Medius Control, Hip Kinematics, Pain and Function in 2 Female Runners with Patellofemoral Pain. J Orthop Sports Phys Ther. 2013 Dec;43(12):864-74
Wulf G, Shea C, Lewthwaite R. Motor Skill Learning and Performance: A Review of Influential Factors. Medical Education. 2010; 44:75-84
Yamato TP, Saragiotto BT, Lopes AD. A consensus definition of running-related injury in recreational runners: a modified Delphi approach. J Orthop Sports Phys Ther. 2015 May;45(5):375-80.
Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011;19:726–736.