The Effect of Instrument Assisted Soft Tissue Mobilization on Iliotibial Band Extensibility and Hip Abduction Strength

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2013-07
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The purpose of this investigation was: 1) to determine if Graston Technique (GT) is effective in increasing hip adduction ROM and 2) to determine if GT is effective in increasing hip abduction strength. Prior to beginning the study all subjects were pseudo-randomly assigned by gender in either the Graston Technique (9 males and 13 females; 19.59 ± .96yrs; 172.20 ± 11.36cm; 69.17 ± 13.27kg) or control group (10 males and 13 females; 19.13 ± 1.01yrs; 170.85 ± 8.55cm; 65.76 ± 10.29kg). Normative values for ITB flexibility is 10-26 degrees.22 Subjects with less than 26 degrees of hip adduction were identified as “at risk” due to their predisposition to ITB related pathology. Subjects were then randomly assigned to the GT or sham microcurrent group. Subjects in the GT group underwent a warm-up, GT instrumentation, and strengthening exercises. The sham microcurrent group underwent a no intensity microcurrent treatment which served as the control condition. Means and standard deviations of hip adduction ROM and hip abduction strength was calculated for the three trials on 4 testing days (Pre treatment, after 1 week of treatment, immediately post treatment, and 1 month follow up). Four repeated mixed factor measure analysis of variance were completed, one for each dependent variable. The analyses included one between subjects factor (group at 2 levels) and one within subjects factor (time at 4 levels). Bonferroni post hoc testing was completed on all significant findings. A priori alpha level will be p<.05. Results of the repeated measures ANOVA identified a significant time by group interaction for hip abduction strength (F3,129 = 3.06, p = .03, ηp2 = .07, power = .71). Following the post hoc test, we identified that the GT group had significantly more force production from baseline to post treatment (mean difference: 1.57 + .45; p = .01; 95% CI: .32 to 2.83), from baseline to 1 month follow up (mean difference: 1.88 + .45; p = .01; 95% CI: .64 to 3.13), and from mid treatment to post treatment (mean difference: 1.26 + .34; p = .01; 95% CI: .32 to 2.21). No significant time by group interaction was identified for hip adduction ROM, pain, or function. Results of this study indicate that after six treatment sessions, subjects in the GT group improved hip abduction strength. Furthermore, the increase in strength continued at the one-month follow up. As no treatment was performed between the post treatment measurement and one month follow up, we believe that the IASTM application was effective in decreasing soft tissue restrictions to provide a more functional contractile unit. By decreasing soft tissue restrictions in the gluteal region, TFL, and throughout the length of the ITB, the muscle fibers could align in a more optimal position. While there was no significance between the GT group and control group in hip adduction ROM, an upward trend was seen, especially at the one month follow up in the GT group. As ROM continued to increase after the end of treatment, it is possible that the effects of IASTM could be long lasting. The continuance of increasing ROM with no treatment indicates that the IASTM potentially decreased soft tissue adhesions and elongated the entire ITB unit.
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