This week's View is a continuation of last week's "Exploring the Stubborn Iliotibial Band" (you may want to digest last week’s View first if you have not yet). You read about a problem commonly found in runners – the Iliotibial Band Syndrome (IT Band Syndrome). You learned the IT Band Syndrome, contrary to popular belief, is not primarily caused by a tight IT Band but more by a weakness or lack of control of the hip muscles specifically the external rotators and abductors. Next, how do you test for muscle weakness of the hip abductors and external rotators?
The most commonly used methods for testing the strength of these muscles is typically in either a sitting position (external rotators) or in a sidelying position (abductors) both of which can be helpful in identifying very weak muscles. But is it possible to discover a strong muscle in those tests and still have inadequate control of the femur in a weight bearing position? Is the test in sitting or sidelying close enough to the functional use to uncover functional weakness?
Here's an idea for you (and if you would like to see pictures of this test, click on the link below to go to our website's "Share the Magic" section). You will need either a pressure gauge / dynamometer or a blood pressure cuff (BPC). If you use the blood pressure cuff, wrap it on itself and pump it up to 20-30 mmHg. Follow the instructions below.
1. Position of the subject: standing with weight equally distributed.
2. Position of the examiner: behind the subject.
3. Ask the subject to stand on one leg while maintaining your index fingers over the subject's iliac crests. Did the index finger on the crest of the weight bearing leg rise (or the finger on the non-weightbearing side drop)? If so, you now know there is some degree of weakness of the hip abductors on the weightbearing side (since the muscles should maintain a level pelvis).
4. Clip the gauge of the BPC into the subjects' pants, shorts or belt. Place the BPC in your hand against the buttock of the non-weightbearing side and grasp the front of the pelvis on the weightbearing side.
5. Push against the BPC while pulling with the other hand. This will create a turning force on the hip toward the weightbearing side. The subject should attempt to remain still not allowing you to move them.
6. Watch the gauge and note the pressure reading when the subject can no longer maintain a stationary position.
7. Subtract the initial starting pressure from the final reading and record the result.
8. Repeat two more times.
9. Perform the same procedure on the other side.
In most cases, you will find substantial differences in pressure readings when comparing one side to the other. There are no known norms for this test. Compare one side to the other to obtain a percentage difference.
This test does not isolate the hip from the rest of the body. The test results indicate the functional strength of the lower extremity and, to a lesser extent, trunk in the transverse plane. This is likely why, for example, you may test a person's hip rotators in sitting and discover very good strength yet in a functional position the strength is significantly less. Both tests have a purpose but the functional test provides you with information of how well the muscles are working together.
Now that you know there is some degree of transverse plane weakness, what do you do about it? I will be posting drills to improve transverse plane strength on our website within the next two weeks and will send you a notice. In the meantime, try practicing this test on a colleague or friend to get comfortable with the skill. Remember, as the hip turns so does control of the tranverse plane - the key to solving the problem of the iliotibial band.
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