The Potential Impact of Myofascial Release Therapy on Iliotibial Band Syndrome: A Preliminary Randomised Controlled Trial

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While hip strength training is commonly used for ITBS management, the adjunctive role of myofascial release (MFR) remains underexplored. This study investigated whether combining MFR with hip strength training enhances outcomes in pain relief, iliotibial band (ITB) thickness reduction, and functional improvement compared to hip strength training alone. Methods: In this single-blind randomized controlled trial, 16 patients with ITBS (mean age 22.2 ± 1.6 years) were stratified by gender and allocated to an experimental group (MFR + hip strength training, n=8) or a control group (hip strength training alone, n=8). Interventions were delivered twice weekly for 4 weeks, with assessments at baseline, weeks 2, 4 (post-intervention), and week 8 (follow-up). Primary outcomes included pain (Visual Analogue Scale, VAS), ITB thickness (ultrasound imaging), and functional performance (Kujala scale). Mixed-model factorial ANOVA analyzed group-by-time interactions. Results: The experimental group showed significantly greater reductions in pain at week 2 (F=10.000, P=0.007) and ITB thickness at week 4 (F=8.163, P=0.013) compared to controls. No between-group differences were observed in functional performance (F=0.579, P=0.542). Both groups improved over time in all outcomes (P<0.001), but MFR provided earlier pain relief and greater structural improvement. Conclusions: MFR combined with hip strength training accelerates pain reduction and ITB thickness normalization in ITBS patients, though functional gains were comparable between groups. These findings support MFR as a valuable adjunct to standard care, potentially mitigating recurrence risk through tissue remodeling. Further studies with larger samples are warranted to optimize MFR protocols. Trial registration: The trail was prospectively registered in the Chinese Clinical Trial Registry on 09/05/2024 (reference no.ChiCTR2400084034). iliotibial band syndrome myofascial release hip strength training iliotibial band thickness alleviating pain ultrasound image Introduction Iliotibial band syndrome (ITBS) is a common injury characterized by recurrent lateral knee pain and lower extremity motor dysfunction, frequently affecting runners and soldiers. [ 1 ] Recent reviews report an incidence of ITBS in runners ranging from 3.4–15.7%, with an increasing trend since 1981. [ 2 ] Patients typically have a history of overuse related to knee flexion and extension, with pain intensifying during exercise and weight-bearing activities, particularly at 30° of knee flexion. [ 3 , 4 ] Since ITBS commonly affects athletes and sports enthusiasts, its severe pain can significantly hinder performance and may even lead to the cessation of competitions or sports careers, [ 5 ] highlighting the urgency of effective treatment. The current clinical approach to treating ITBS focuses on reducing pain and improving lower extremity function. [ 6 , 7 ] Arthroscopic surgery and nonsteroidal anti-inflammatory drug (NSAID) injections are typically reserved for severe cases that do not respond to conservative treatments. [ 8 – 10 ] Shockwave therapy and dry needling may offer pain relief, but their limited mechanistic evidence and the need for specialized equipment hinder their widespread use. [ 11 , 12 ] Foam rolling, by applying pressure to the iliotibial band (ITB), could potentially worsen symptoms due to the compression mechanism involved in ITBS. [ 7 , 13 ] Hip strength training is widely used in clinical practice. However, recent study suggests that diminished hip strength is more likely to be a result of ITBS than a cause. [ 4 , 7 ] The effectiveness of hip strength training in alleviating pain is thought to result from changes in central pain processing and a reduction in local nociceptive sensitization. [ 7 , 14 ] Hip strength training can increase tissue stiffness and tension around the ITB. [ 6 ] As ITB thickening is associated with the progression of ITBS, combining strength training with interventions targeting tissue tension is recommended. [ 6 , 10 ] Addressing ITB thickening could be crucial for prolonging treatment effectiveness. [ 10 ] Myofascial release (MFR) is a manual therapy technique designed to restore tissues to their optimal length and thickness, alleviate pain, and improve function. Previous studies have demonstrated that MFR can reduce pain and enhance motor function in patients with back and neck pain, as well as improve tissue length and thickness in affected areas. [ 15 – 17 ] Therefore, we believe that incorporating MFR into hip strength training may enhance the effectiveness of ITBS treatment. We conducted a single-blind, randomized controlled trial to compare the short-term outcomes and maintenance effects of MFR combined with hip strength training versus hip strength training alone on pain, lower limb function, and ITB thickness. Specifically, we hypothesized that, compared to hip strength training alone, the combination of MFR and hip strength training would yield superior improvements in pain relief, lower limb motor function, and ITB thickness in patients with ITBS in the short term, while also offering better long-term retention of treatment effects. Material and methods Participants Sixteen patients with ITBS (males = 8, females = 8, age = 22.19 ± 1.60) were recruited for this study. The inclusion criteria were: experiencing lateral knee pain or had a history of chronic pain for more than 2 months that intensified during and after exercise, significant tension or hardness around the ITB during palpation, a positive noble's test. [ 7 , 18 ] The exclusion criteria were: no history of lower limb fracture or surgery, no any other knee disease that triggered the lateral pain and the motor function of the lower limb, such as patellofemoral pain syndrome, patellar tendinitis, patellar dislocation and contraindications to MFR such as malignancy, pregnancy, local skin or tissue necrosis. [ 15 , 19 , 20 ] After a detailed instruction of the experimental procedure, each participant signed an informed consent form. The study protocol was approved by the Ethical Review Board affiliated with one of the authors (approval number: 2024138H), and the trail was prospectively registered in the Chinese Clinical Trial Registry on 9 May 2024 (reference no.ChiCTR2400084034). Randomization, allocation concealment and blinding In this study, the participants were randomly and gender-balanced divided into two groups by using a random number table method. First, a researcher who not involved in the assessment or delivery of intervention generated a random sequence containing eight random numbers, and numbered the participants and placed them in two opaque cloth bags according to their gender. Subsequently, a second independent researcher drew a pair of numbers in sequence from the two bags, corresponding to a random number font size. Finally, the third independent researcher grouped participants based on the font size of the random numbers: the four participants with larger numbers were allocated to the experimental group, while those with smaller numbers were assigned to the control group. To ensure further randomization, the third researcher randomized the order of interventions for the 16 participants and drew a table of the order of interventions to be delivered to the experimental operator and informed the experimental operator of the intervention to be used at the time of the first intervention for each patient. The order of intervention for the participants was known only to 3 study researcher (LY, YL and QG) and concealed from the other researchers until the first intervention. Due to the nature of the intervention, it was not feasible to blind the therapist to group allocation. Protocol In this single-blind and randomized study, the experimental group received MFR intervention followed by hip strength training 8 times in 4 weeks. The control group received only hip strength training 8 times in 4 weeks. Both groups were intervened for 4 weeks, 2 times a week, with an interval of 2 days. The participants completed the Kujala scale, the visual analogue score(VAS) and ITB thickness tests before intervention. After the intervention of week 2 and week 4, all participants immediately completed the Kujala scale test and VAS test. The ITB thickness was measured after the intervention of week 4. At week 8, all participants finished the follow-up of this study by completed the Kujala scale test and VAS test. A flowchart of the study procedures is shown in Supplementary Figure S1 . All participants were instructed to avoid vigorous exercise, nonsteroidal anti-inflammatory drugs, physical therapy, and any other treatment and training other than this study’s during the study and follow-up period. These requirements are detailed in the informed consent form, and the participant who doesn’t comply with this requirement will interrupted from the intervention and their data excluded. Interventions Myofascial release (MFR) The MFR therapy consisted of two techniques, the experimental group was treated with both of them for each intervention.The entire session lasted no more than 20 minutes and was performed by the same MFR-trained therapist. The technique which was firstly performed consists of three basic maneuvers:(1) First, the participant is asked to flex the knees and hips with the injured ITB lying on the overlying side.(2) Simultaneously, the therapist stands facing the participant and places his palm or elbow as a tool on the distal ITB. In this step, the therapist first applies a certain amount of pressure vertically to the tissue to enter the deep fascia layer where the ITB is located, and subsequently decreases the angle of contact to apply a shear force.(3) The participant flexes and extends the knee slowly and evenly, and the tool slides from the distal ITB to a stop near the greater trochanter. [ 21 ] Immediately after the end of this technique, the second technique was used to continue treatment. The second technique consists of three basic maneuvers:(1) First, the participant is asked to flex the knees and hips with the injured ITB lying on the overlying side.(2) Secondly, the therapist sits on the edge of the bed facing the participant's back side and uses his flat or point of elbow as a tool on the muscles attached to the greater trochanter.(3) The participant rotates the pelvis slowly and evenly while simultaneously sliding the tool from the greater trochanter towards the anterior superior iliac spine, the iliac crest, and the posterior superior iliac spine, respectively. [ 21 ] Hip strength training Hip strength training consisted of four movements: (1) Resisted clam shell, 15 repetitions per set for 3 sets. (2) Single-leg glute bridge, 30 seconds per set for 3 sets. (3) Kneeling resisted hip posterior extension, 15 reps per set, 3 sets total. (4) Lateral band walks, 10 steps to one side for each set, 3 sets total. [ 22 ] The interval between each movement was 30s, and the interval between each set was 1min. All movements were to be completed within 20min. For load, female participants used a 15-pound elastic band and male participants used a 20-pound elastic band for training. The load could be adjusted according to the participant’s requirements and the principle of adjustment was to reduce the load of the elastic band every 5 pounds until the subject could complete the training. Outcomes The Kujala scale test The primary outcome of lower limb functions was Kujala scale, which was used to examine improvement of movement functions. The Kujala scale is a self-administered scale designed to assess subjective symptoms and dysfunction around the knee. The Kujala scale is a self-administered scale originally developed by Kujala et al. to assess subjective symptoms and dysfunction around the knee. [ 23 ] The scale consists of 13 questions and it is scored from a minimum of 0 to a full score of 100, with higher scores indicating fewer symptoms and dysfunction. [ 24 ] This outcome is measured to assess the patients’ functional performance with ITBS. The visual analogue score (VAS) test The primary outcome of pain symptom was VAS, which was used to examine alleviating of pain. VAS is based on a 10-cm line with two endpoints consisting of the numbers “0” and “10”, where “0” indicates no pain and “10” indicates severe pain. The 16 patients were instructed to mark the location of their identified pain on the line segment they were facing to describe the level of pain around their ITB at that time. ITB thickness measure We examine ITB thickness, which serve as a potential outcome of ITB structure and can indicate the deterioration or improvement of ITBS. ITB thickness was measured by ultrasound scanner (SIUI Apogee 1000Neo, Shantou Institute of Ultrasonic Instrumentation). Ultrasound examination of the thickness and echo intensity of the distal ITB can demonstrate the progression of ITBS. [ 10 ] Each patient was assessed on the affected side using an 8.0MHz linear array probe (SIUI L8L38C, Shantou Institute of Ultrasonic Instrumentation). When the patient are in a side by ITB at the top side, lateral femoral condyle position determined by palpation. The ITB thickness was then measured through the coronal plane of the knee(Supplementary Figure S2 ). [ 25 ] The marking and all of the ultrasonic measurement was done by the same researcher. Statistical Analysis Effect sizes (0.31–0.92) for changes of tissue thickness in neck pain treated with different types of MFR. [ 16 ] To generate a conservative sample-size estimate, we used an effect size of 0.40, alpha of 0.05, and power of 80%, an intra-cluster correlation coefficient (ICC) of 0.7 (established from a previous study). [ 25 ] A sample size of 5 participants per group was indicated to detect a group-by-time interaction. Anticipating a 15% loss to follow-up, we aimed to recruit 6 participants per group, for a total of 12. The priori sample-size calculation were performed using G*Power (Version 3.1.9.6, Kiel University). Management and statistical analyses were performed with SPSS Statistics 26.0.0 software for windows (SPSS Inc, Chicago, IL). The significance level was set at p < 0.05. Descriptive statistics (i.e., mean, standard deviation (SD)) were used to summarize the demographic characteristics of the participants. Shapiro-Wilk tests were used to examine if the data were normally distributed. Data that were normally distributed were described using “Mean (SD)”, and those not normally distributed were described using "median (interquartile range)" (M (P25, P75)). Two-way (group × time) mixed-model factorial Analysis of Variance (ANOVA) models were used to examine these study variables. The model factors for the two-way mixed-model factorial ANOVA models included group, time, and their interaction. Pairwise Bonferroni comparisons were performed to explore the differences between-group and within-group when a significant interaction was observed. Results All patients completed all treatments and assessments, and their data were included in the analysis (Supplementary Table S1 ). One participant in the experimental group reported localized tenderness at the MFR treatment site the day following the first intervention. No adverse feedback was reported by the other participants. In the baseline measurement, the data of the experimental group and the control group were not significantly different (P > 0.551). The effects of MFR on functional performance Two-way mixed-model factorial ANOVA models demonstrated no significant group-by-time interaction effect of Kujala scores (F = .579, P = 0.542). Only main effect of time on Kujala scale test was observed (F = 35.896, P < 0.001). Both groups were better at 2 weeks, 4 weeks and 8 weeks after intervention than baseline(Supplementary Figure S3 A). The effects of MFR on pain Two-way mixed-model factorial ANOVA models demonstrated a significant interaction between group and time for VAS (F = 2.861, P = 0.048). Post-hoc analyses showed that the VAS of experimental group was significantly lower than that of control group at week 2 (F = 10.000, P = 0.007), but there was no significant difference between VAS of the experimental group and control group at week 4 (F = 2.215, P = 0.159) and week 8 follow-up (F = 1.878, P = 0.192) (Supplementary Figure S3 B). The effects of MFR on ITB thickness Two-way mixed-model factorial ANOVA models demonstrated a significant group-by-time interaction for the ITB thickness (F = 8.123, P = 0.013). Post-hoc analyses showed the ITB thickness of experimental group was significantly lower than that of control group at week 4 (F = 8.163, P = 0.013) (Supplementary Figure S3 C). Discussion To our knowledge, this study is the first to discuss the short-term and long-term effects of MFR on ITBS in combination with hip strength training versus hip strength training alone. In our study, MFR combined with hip strength training was more effective at improving pain and ITB thickness than hip strength training alone, but had no better performance in lower limb motor function. Adding MFR into treatment could decreased ITB thickness after 4 weeks intervention, potentially demonstrating the underlying mechanisms through which MFR can improve the symptoms of the patient with ITBS. Previous studies of hip strength training have shown improvements on lower limb functions in patients with ITBS. [ 6 , 26 , 27 ] Our study observed that there is not significant difference in the lower limb functions of experimental group and control group. On the one hand, it indicates that the effect of hip strength training on lower limb function is sufficient, and MFR may not have influenced it, or the effect of MFR is insufficient compared with hip strength training. On the other hand, the range of Kujala scale is too large to reflect subtle changes in lower limb functions, and thus does not reflect the effect of MFR on the patients with ITBS. Although previous studies have been successful in the treatment of pain in patients with ITBS, [ 6 , 7 , 28 , 29 ] there are still many limitations. It was well documented that few patient fully recovered and the pain symptom often persist or recur. [ 26 ] Our study addresses this problem, through the treatment mechanism of MFR that can restore the structure of ITB altered by inflammatory factors and erroneous tissue tension in patients with ITBS. This is also confirmed by the changes in ITB thickness in our results. Our study observed ITB thickness can be significant decreased by MFR. The result of another study, that MFR can improve suboccipital muscle thickness in patients with chronic neck pain, [ 16 ] corroborated our view that MFR can restore tissue length and thickness.The potential pathway behind this phenomenon is that applying pressure to the fascial trigger point could improve the increased acetylcholine effect, increased muscle-fiber tension, and local release of sensitizing substances, [ 30 ] but this mechanism is still unclear and needs further exploration in the future. The limitations associated with this study should be considered. Currently-the appropriate dose and timing of MFR has not been determined. In this study, we designed the protocol based upon the knowledge from previous studies, which, however, did not observe excepted significant difference in lower limb functions ( though higher score of Kujala scale was observed in the experimental group than control group). This insignificance may be related to small size of study sample and high Kujala baseline, suggesting that future work with larger sample size of participant or more serious patient with ITBS are needed to determine the protocol that can maximize the benefits of MFR. Although the MFR therapist underwent training procedures and demonstrated proficiency, variations in clinical experience and level of comfort administering interventions may have influenced outcomes. Conclusions In conclusion, our study demonstrated that MFR, which has a positive effect on pain symptoms and ITB thickness in patients with ITBS, is a potentially advantageous treatment for ITBS. Adding MFR to the original plan in the clinical conservative treatment of ITBS can alleviate pain symptoms better and reduce the risk of recurrence.This practice helps to promote the structure of ITB recovering, accelerate the improvement process of pain symptoms and lower limb function, and avoid recurrence and deterioration in the long term. Abbreviations Kujala (Kujala scale test) ITB (iliotibial band) ITBS (iliotibial band syndrome) MFR (myofascial release) NSAID (nonsteroidal anti-inflammatory drug) VAS (Visual Analogue Score Scale) Declarations Reporting guidelines This study was conducted and reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A completed CONSORT checklist is provided as Supplementary File 1. Ethics approval and consent to participate ： This study was approved by the Sports Science Experiment Ethics Committee of Beijing Sport University (approval number: 2024138H) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to participation. Consent for publication ： Not applicable. Availability of data and material ： The datasets generated and analyzed during this study are available from the corresponding author upon reasonable request (contact via email: [email protected] ). Competing interests ： None. Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' Contributions statement: Concept/idea/research design: LL; GD and ZB. Acquisition of data: LL and GD. Analysis and interpretation of data: LL; GD; QG and ZM. Writing/review/editing of manuscript: LL; GD; LY; ZM; XH; QG; ZB and YL. 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Journal of Musculoskeletal Pain . 2004/01/01 2004;12(3–4):15–21. 10.1300/J094v12n03_03 Tables Table 1 Primary Outcomes at Each Data-Collection Time Point Outcomes/Time Point Experimental Group(n = 8) Control Group(n = 8) P Value Kujala Baseline 83.38 (7.86) 84.88 (8.95) 0.727 Week 2 91.50 (4.24) 92.00 (5.93) 0.849 Week 4 96.00 (1.93) 95.12 (3.36) 0.533 Week 8 98.25 (1.67) 96.37 (3.20) 0.164 VAS(cm) Baseline 5.38 (1.51) 4.63 (1.77) 0.376 Week 2 1.88 (0.84) 3.13 (0.74) 0.007 * Week 4 1.25 (0.89) 1.88 (0.79) 0.159 Week 8 0.94 (1.08) 1.63 (0.92) 0.192 ITB thickness (mm) Baseline 4.16 (0.64) 4.45 (0.55) 0.356 Week 4 3.55 (0.45) 4.21 (0.48) 0.013 * Abbreviations:ITB, iliotibial band; Kujala, Kujala scale test; VAS, visual analogue score test; Value are Mean (SD); P Value show the results of Post-hoc analyses (Bonferroni comparisons) ; * indicates a significant between-group difference at same time point. Additional Declarations No competing interests reported. Supplementary Files CONSORTChecklist.doc SupplementaryTableS1.docx SupplementaryFigureS1.Studyflowdiagram.AbbreviationsITBiliotibialbandMFRmyofascialreleaseVASvisualanaloguescoretest.jpg SupplementaryFigureS2.MeasurementofthethicknessoftheiliotibialbandbetweenpointsAandBatthelevelofthelateralfemoralepicondyle.jpg SupplementaryFigureS3.Outcomesvaluemeanswith95confidenceintervalsatbaselineweek2week4andweek8ofexperimentalgroupandcontrolgroup.AKujalascalescoreBVASscoreCITBth.jpg Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6377617","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452684184,"identity":"a3bd1660-d215-446b-b8d7-9b09471c7fd8","order_by":0,"name":"Liyu Luo","email":"","orcid":"","institution":"Beijing Sport University","correspondingAuthor":false,"prefix":"","firstName":"Liyu","middleName":"","lastName":"Luo","suffix":""},{"id":452684185,"identity":"f3063b03-5296-4ccc-a627-2aa49202bcea","order_by":1,"name":"Gengxin Dong","email":"","orcid":"","institution":"Beijing Sport University","correspondingAuthor":false,"prefix":"","firstName":"Gengxin","middleName":"","lastName":"Dong","suffix":""},{"id":452684186,"identity":"5f9a0c99-f680-4327-8323-acea0d2d7a2d","order_by":2,"name":"Lei Yuan","email":"","orcid":"","institution":"Peking University Third Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Yuan","suffix":""},{"id":452684187,"identity":"8fbaa28f-7c8e-450f-8cbd-febce548a977","order_by":3,"name":"Ziwei Ming","email":"","orcid":"","institution":"Beijing Sport University","correspondingAuthor":false,"prefix":"","firstName":"Ziwei","middleName":"","lastName":"Ming","suffix":""},{"id":452684188,"identity":"469812a5-5861-4ff7-99b2-8cf502b9187b","order_by":4,"name":"Yutang Li","email":"","orcid":"","institution":"The First Hospital of Jilin University","correspondingAuthor":false,"prefix":"","firstName":"Yutang","middleName":"","lastName":"Li","suffix":""},{"id":452684189,"identity":"8c088afc-2e68-45f1-a455-b424c1c6c5ee","order_by":5,"name":"Xinhao He","email":"","orcid":"","institution":"Beijing Sport University","correspondingAuthor":false,"prefix":"","firstName":"Xinhao","middleName":"","lastName":"He","suffix":""},{"id":452684190,"identity":"5cca9c2b-f182-48d3-99c2-a451e4cd85c2","order_by":6,"name":"Zhenmin Bai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYBACAwbGBgaGigNgjgQJWs6QpgUIGNtI0WLOfrj50815d+wNDjAfvM3DYJdHUItlT2KDce62Z4kbDrAlW/MwJBcTdtiBxIbk3G2HEwwO8JhJ8zAAuQS1nH/YcDh3zmGgw/i/EanlRmJjc27DYcYNB3jYiNNiOeNhM3POsWeJMw+zGVvOMUgmrMWcP/3x55yaO/Z8x5sf3nhTYUdYCwIwg91JvPpRMApGwSgYBXgAAHcrQBEogJYAAAAAAElFTkSuQmCC","orcid":"","institution":"Beijing Sport University","correspondingAuthor":true,"prefix":"","firstName":"Zhenmin","middleName":"","lastName":"Bai","suffix":""},{"id":452684191,"identity":"b747b2d2-c895-463b-965f-f6c83f6db74b","order_by":7,"name":"Qi Gao","email":"","orcid":"","institution":"Beijing Sport University","correspondingAuthor":false,"prefix":"","firstName":"Qi","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2025-04-04 16:08:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6377617/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6377617/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87194111,"identity":"996cd526-9595-4b6d-ac04-fd12e84e0b63","added_by":"auto","created_at":"2025-07-21 11:53:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":549612,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/2f37cc8c-1b54-4e01-a924-bfaddc87029d.pdf"},{"id":82344148,"identity":"3a16ba61-1232-47c8-a045-d4f5b45f4767","added_by":"auto","created_at":"2025-05-09 09:44:38","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":203388,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORTChecklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/50d6b95922664a170f01bd5c.doc"},{"id":82344149,"identity":"3aad6a6d-8dde-4449-b28e-31c844aa4370","added_by":"auto","created_at":"2025-05-09 09:44:38","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":13954,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTableS1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/5be33889885a2230b34b99a1.docx"},{"id":82343302,"identity":"c65abd72-b067-4ecf-8b9d-8d21f434d186","added_by":"auto","created_at":"2025-05-09 09:36:38","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":150652,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigureS1.Studyflowdiagram.AbbreviationsITBiliotibialbandMFRmyofascialreleaseVASvisualanaloguescoretest.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/5e6940eb96ba6136119695c3.jpg"},{"id":82343293,"identity":"7bfcb907-1402-4b18-9590-f42fcd798b9e","added_by":"auto","created_at":"2025-05-09 09:36:38","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":19452,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigureS2.MeasurementofthethicknessoftheiliotibialbandbetweenpointsAandBatthelevelofthelateralfemoralepicondyle.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/dc8369724866511bbc28b3cf.jpg"},{"id":82344150,"identity":"95f74bbc-72ce-46b8-9104-0eb7a63a6e78","added_by":"auto","created_at":"2025-05-09 09:44:38","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":53668,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigureS3.Outcomesvaluemeanswith95confidenceintervalsatbaselineweek2week4andweek8ofexperimentalgroupandcontrolgroup.AKujalascalescoreBVASscoreCITBth.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6377617/v1/26e81edf4c0b5fab56eafeb5.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Potential Impact of Myofascial Release Therapy on Iliotibial Band Syndrome: A Preliminary Randomised Controlled Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIliotibial band syndrome (ITBS) is a common injury characterized by recurrent lateral knee pain and lower extremity motor dysfunction, frequently affecting runners and soldiers.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Recent reviews report an incidence of ITBS in runners ranging from 3.4\u0026ndash;15.7%, with an increasing trend since 1981.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Patients typically have a history of overuse related to knee flexion and extension, with pain intensifying during exercise and weight-bearing activities, particularly at 30\u0026deg; of knee flexion.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Since ITBS commonly affects athletes and sports enthusiasts, its severe pain can significantly hinder performance and may even lead to the cessation of competitions or sports careers,\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e highlighting the urgency of effective treatment.\u003c/p\u003e \u003cp\u003eThe current clinical approach to treating ITBS focuses on reducing pain and improving lower extremity function.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Arthroscopic surgery and nonsteroidal anti-inflammatory drug (NSAID) injections are typically reserved for severe cases that do not respond to conservative treatments.\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Shockwave therapy and dry needling may offer pain relief, but their limited mechanistic evidence and the need for specialized equipment hinder their widespread use.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e Foam rolling, by applying pressure to the iliotibial band (ITB), could potentially worsen symptoms due to the compression mechanism involved in ITBS.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e Hip strength training is widely used in clinical practice. However, recent study suggests that diminished hip strength is more likely to be a result of ITBS than a cause.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e The effectiveness of hip strength training in alleviating pain is thought to result from changes in central pain processing and a reduction in local nociceptive sensitization.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Hip strength training can increase tissue stiffness and tension around the ITB.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e As ITB thickening is associated with the progression of ITBS, combining strength training with interventions targeting tissue tension is recommended.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Addressing ITB thickening could be crucial for prolonging treatment effectiveness.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMyofascial release (MFR) is a manual therapy technique designed to restore tissues to their optimal length and thickness, alleviate pain, and improve function. Previous studies have demonstrated that MFR can reduce pain and enhance motor function in patients with back and neck pain, as well as improve tissue length and thickness in affected areas.\u003csup\u003e[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e Therefore, we believe that incorporating MFR into hip strength training may enhance the effectiveness of ITBS treatment. We conducted a single-blind, randomized controlled trial to compare the short-term outcomes and maintenance effects of MFR combined with hip strength training versus hip strength training alone on pain, lower limb function, and ITB thickness. Specifically, we hypothesized that, compared to hip strength training alone, the combination of MFR and hip strength training would yield superior improvements in pain relief, lower limb motor function, and ITB thickness in patients with ITBS in the short term, while also offering better long-term retention of treatment effects.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eSixteen patients with ITBS (males\u0026thinsp;=\u0026thinsp;8, females\u0026thinsp;=\u0026thinsp;8, age\u0026thinsp;=\u0026thinsp;22.19\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60) were recruited for this study. The inclusion criteria were: experiencing lateral knee pain or had a history of chronic pain for more than 2 months that intensified during and after exercise, significant tension or hardness around the ITB during palpation, a positive noble's test.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e The exclusion criteria were: no history of lower limb fracture or surgery, no any other knee disease that triggered the lateral pain and the motor function of the lower limb, such as patellofemoral pain syndrome, patellar tendinitis, patellar dislocation and contraindications to MFR such as malignancy, pregnancy, local skin or tissue necrosis.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e After a detailed instruction of the experimental procedure, each participant signed an informed consent form. The study protocol was approved by the Ethical Review Board affiliated with one of the authors (approval number: 2024138H), and the trail was prospectively registered in the Chinese Clinical Trial Registry on 9 May 2024 (reference no.ChiCTR2400084034).\u003c/p\u003e \u003cp\u003eRandomization, allocation concealment and blinding\u003c/p\u003e \u003cp\u003eIn this study, the participants were randomly and gender-balanced divided into two groups by using a random number table method. First, a researcher who not involved in the assessment or delivery of intervention generated a random sequence containing eight random numbers, and numbered the participants and placed them in two opaque cloth bags according to their gender. Subsequently, a second independent researcher drew a pair of numbers in sequence from the two bags, corresponding to a random number font size. Finally, the third independent researcher grouped participants based on the font size of the random numbers: the four participants with larger numbers were allocated to the experimental group, while those with smaller numbers were assigned to the control group. To ensure further randomization, the third researcher randomized the order of interventions for the 16 participants and drew a table of the order of interventions to be delivered to the experimental operator and informed the experimental operator of the intervention to be used at the time of the first intervention for each patient. The order of intervention for the participants was known only to 3 study researcher (LY, YL and QG) and concealed from the other researchers until the first intervention. Due to the nature of the intervention, it was not feasible to blind the therapist to group allocation.\u003c/p\u003e \u003cp\u003eProtocol\u003c/p\u003e \u003cp\u003eIn this single-blind and randomized study, the experimental group received MFR intervention followed by hip strength training 8 times in 4 weeks. The control group received only hip strength training 8 times in 4 weeks. Both groups were intervened for 4 weeks, 2 times a week, with an interval of 2 days. The participants completed the Kujala scale, the visual analogue score(VAS) and ITB thickness tests before intervention. After the intervention of week 2 and week 4, all participants immediately completed the Kujala scale test and VAS test. The ITB thickness was measured after the intervention of week 4. At week 8, all participants finished the follow-up of this study by completed the Kujala scale test and VAS test. A flowchart of the study procedures is shown in Supplementary Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAll participants were instructed to avoid vigorous exercise, nonsteroidal anti-inflammatory drugs, physical therapy, and any other treatment and training other than this study\u0026rsquo;s during the study and follow-up period. These requirements are detailed in the informed consent form, and the participant who doesn\u0026rsquo;t comply with this requirement will interrupted from the intervention and their data excluded.\u003c/p\u003e \u003cp\u003eInterventions\u003c/p\u003e \u003cp\u003eMyofascial release (MFR)\u003c/p\u003e \u003cp\u003eThe MFR therapy consisted of two techniques, the experimental group was treated with both of them for each intervention.The entire session lasted no more than 20 minutes and was performed by the same MFR-trained therapist. The technique which was firstly performed consists of three basic maneuvers:(1) First, the participant is asked to flex the knees and hips with the injured ITB lying on the overlying side.(2) Simultaneously, the therapist stands facing the participant and places his palm or elbow as a tool on the distal ITB. In this step, the therapist first applies a certain amount of pressure vertically to the tissue to enter the deep fascia layer where the ITB is located, and subsequently decreases the angle of contact to apply a shear force.(3) The participant flexes and extends the knee slowly and evenly, and the tool slides from the distal ITB to a stop near the greater trochanter.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e Immediately after the end of this technique, the second technique was used to continue treatment. The second technique consists of three basic maneuvers:(1) First, the participant is asked to flex the knees and hips with the injured ITB lying on the overlying side.(2) Secondly, the therapist sits on the edge of the bed facing the participant's back side and uses his flat or point of elbow as a tool on the muscles attached to the greater trochanter.(3) The participant rotates the pelvis slowly and evenly while simultaneously sliding the tool from the greater trochanter towards the anterior superior iliac spine, the iliac crest, and the posterior superior iliac spine, respectively.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHip strength training\u003c/p\u003e \u003cp\u003eHip strength training consisted of four movements: (1) Resisted clam shell, 15 repetitions per set for 3 sets. (2) Single-leg glute bridge, 30 seconds per set for 3 sets. (3) Kneeling resisted hip posterior extension, 15 reps per set, 3 sets total. (4) Lateral band walks, 10 steps to one side for each set, 3 sets total.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e The interval between each movement was 30s, and the interval between each set was 1min. All movements were to be completed within 20min. For load, female participants used a 15-pound elastic band and male participants used a 20-pound elastic band for training. The load could be adjusted according to the participant\u0026rsquo;s requirements and the principle of adjustment was to reduce the load of the elastic band every 5 pounds until the subject could complete the training.\u003c/p\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003cp\u003eThe Kujala scale test\u003c/p\u003e \u003cp\u003eThe primary outcome of lower limb functions was Kujala scale, which was used to examine improvement of movement functions. The Kujala scale is a self-administered scale designed to assess subjective symptoms and dysfunction around the knee. The Kujala scale is a self-administered scale originally developed by Kujala et al. to assess subjective symptoms and dysfunction around the knee.\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e The scale consists of 13 questions and it is scored from a minimum of 0 to a full score of 100, with higher scores indicating fewer symptoms and dysfunction.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e This outcome is measured to assess the patients\u0026rsquo; functional performance with ITBS.\u003c/p\u003e \u003cp\u003eThe visual analogue score (VAS) test\u003c/p\u003e \u003cp\u003eThe primary outcome of pain symptom was VAS, which was used to examine alleviating of pain. VAS is based on a 10-cm line with two endpoints consisting of the numbers \u0026ldquo;0\u0026rdquo; and \u0026ldquo;10\u0026rdquo;, where \u0026ldquo;0\u0026rdquo; indicates no pain and \u0026ldquo;10\u0026rdquo; indicates severe pain. The 16 patients were instructed to mark the location of their identified pain on the line segment they were facing to describe the level of pain around their ITB at that time.\u003c/p\u003e \u003cp\u003eITB thickness measure\u003c/p\u003e \u003cp\u003eWe examine ITB thickness, which serve as a potential outcome of ITB structure and can indicate the deterioration or improvement of ITBS. ITB thickness was measured by ultrasound scanner (SIUI Apogee 1000Neo, Shantou Institute of Ultrasonic Instrumentation). Ultrasound examination of the thickness and echo intensity of the distal ITB can demonstrate the progression of ITBS.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e Each patient was assessed on the affected side using an 8.0MHz linear array probe (SIUI L8L38C, Shantou Institute of Ultrasonic Instrumentation). When the patient are in a side by ITB at the top side, lateral femoral condyle position determined by palpation. The ITB thickness was then measured through the coronal plane of the knee(Supplementary Figure \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e).\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e The marking and all of the ultrasonic measurement was done by the same researcher.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eEffect sizes (0.31\u0026ndash;0.92) for changes of tissue thickness in neck pain treated with different types of MFR.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e To generate a conservative sample-size estimate, we used an effect size of 0.40, alpha of 0.05, and power of 80%, an intra-cluster correlation coefficient (ICC) of 0.7 (established from a previous study).\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e A sample size of 5 participants per group was indicated to detect a group-by-time interaction. Anticipating a 15% loss to follow-up, we aimed to recruit 6 participants per group, for a total of 12. The priori sample-size calculation were performed using G*Power (Version 3.1.9.6, Kiel University).\u003c/p\u003e \u003cp\u003eManagement and statistical analyses were performed with SPSS Statistics 26.0.0 software for windows (SPSS Inc, Chicago, IL). The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Descriptive statistics (i.e., mean, standard deviation (SD)) were used to summarize the demographic characteristics of the participants. Shapiro-Wilk tests were used to examine if the data were normally distributed. Data that were normally distributed were described using \u0026ldquo;Mean (SD)\u0026rdquo;, and those not normally distributed were described using \"median (interquartile range)\" (M (P25, P75)). Two-way (group \u0026times; time) mixed-model factorial Analysis of Variance (ANOVA) models were used to examine these study variables. The model factors for the two-way mixed-model factorial ANOVA models included group, time, and their interaction. Pairwise Bonferroni comparisons were performed to explore the differences between-group and within-group when a significant interaction was observed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAll patients completed all treatments and assessments, and their data were included in the analysis (Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). One participant in the experimental group reported localized tenderness at the MFR treatment site the day following the first intervention. No adverse feedback was reported by the other participants. In the baseline measurement, the data of the experimental group and the control group were not significantly different (P\u0026thinsp;\u0026gt;\u0026thinsp;0.551).\u003c/p\u003e \u003cp\u003eThe effects of MFR on functional performance\u003c/p\u003e \u003cp\u003eTwo-way mixed-model factorial ANOVA models demonstrated no significant group-by-time interaction effect of Kujala scores (F\u0026thinsp;=\u0026thinsp;.579, P\u0026thinsp;=\u0026thinsp;0.542). Only main effect of time on Kujala scale test was observed (F\u0026thinsp;=\u0026thinsp;35.896, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Both groups were better at 2 weeks, 4 weeks and 8 weeks after intervention than baseline(Supplementary Figure \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e A).\u003c/p\u003e \u003cp\u003eThe effects of MFR on pain\u003c/p\u003e \u003cp\u003eTwo-way mixed-model factorial ANOVA models demonstrated a significant interaction between group and time for VAS (F\u0026thinsp;=\u0026thinsp;2.861, P\u0026thinsp;=\u0026thinsp;0.048). Post-hoc analyses showed that the VAS of experimental group was significantly lower than that of control group at week 2 (F\u0026thinsp;=\u0026thinsp;10.000, P\u0026thinsp;=\u0026thinsp;0.007), but there was no significant difference between VAS of the experimental group and control group at week 4 (F\u0026thinsp;=\u0026thinsp;2.215, P\u0026thinsp;=\u0026thinsp;0.159) and week 8 follow-up (F\u0026thinsp;=\u0026thinsp;1.878, P\u0026thinsp;=\u0026thinsp;0.192) (Supplementary Figure \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e B).\u003c/p\u003e \u003cp\u003eThe effects of MFR on ITB thickness\u003c/p\u003e \u003cp\u003eTwo-way mixed-model factorial ANOVA models demonstrated a significant group-by-time interaction for the ITB thickness (F\u0026thinsp;=\u0026thinsp;8.123, P\u0026thinsp;=\u0026thinsp;0.013). Post-hoc analyses showed the ITB thickness of experimental group was significantly lower than that of control group at week 4 (F\u0026thinsp;=\u0026thinsp;8.163, P\u0026thinsp;=\u0026thinsp;0.013) (Supplementary Figure \u003cspan refid=\"MOESM3\" class=\"InternalRef\"\u003eS3\u003c/span\u003e C).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this study is the first to discuss the short-term and long-term effects of MFR on ITBS in combination with hip strength training versus hip strength training alone. In our study, MFR combined with hip strength training was more effective at improving pain and ITB thickness than hip strength training alone, but had no better performance in lower limb motor function. Adding MFR into treatment could decreased ITB thickness after 4 weeks intervention, potentially demonstrating the underlying mechanisms through which MFR can improve the symptoms of the patient with ITBS.\u003c/p\u003e \u003cp\u003ePrevious studies of hip strength training have shown improvements on lower limb functions in patients with ITBS.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e Our study observed that there is not significant difference in the lower limb functions of experimental group and control group. On the one hand, it indicates that the effect of hip strength training on lower limb function is sufficient, and MFR may not have influenced it, or the effect of MFR is insufficient compared with hip strength training. On the other hand, the range of Kujala scale is too large to reflect subtle changes in lower limb functions, and thus does not reflect the effect of MFR on the patients with ITBS.\u003c/p\u003e \u003cp\u003eAlthough previous studies have been successful in the treatment of pain in patients with ITBS,\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e there are still many limitations. It was well documented that few patient fully recovered and the pain symptom often persist or recur.\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e Our study addresses this problem, through the treatment mechanism of MFR that can restore the structure of ITB altered by inflammatory factors and erroneous tissue tension in patients with ITBS. This is also confirmed by the changes in ITB thickness in our results.\u003c/p\u003e \u003cp\u003eOur study observed ITB thickness can be significant decreased by MFR. The result of another study, that MFR can improve suboccipital muscle thickness in patients with chronic neck pain,\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e corroborated our view that MFR can restore tissue length and thickness.The potential pathway behind this phenomenon is that applying pressure to the fascial trigger point could improve the increased acetylcholine effect, increased muscle-fiber tension, and local release of sensitizing substances,\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e but this mechanism is still unclear and needs further exploration in the future.\u003c/p\u003e \u003cp\u003eThe limitations associated with this study should be considered. Currently-the appropriate dose and timing of MFR has not been determined. In this study, we designed the protocol based upon the knowledge from previous studies, which, however, did not observe excepted significant difference in lower limb functions ( though higher score of Kujala scale was observed in the experimental group than control group). This insignificance may be related to small size of study sample and high Kujala baseline, suggesting that future work with larger sample size of participant or more serious patient with ITBS are needed to determine the protocol that can maximize the benefits of MFR. Although the MFR therapist underwent training procedures and demonstrated proficiency, variations in clinical experience and level of comfort administering interventions may have influenced outcomes.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, our study demonstrated that MFR, which has a positive effect on pain symptoms and ITB thickness in patients with ITBS, is a potentially advantageous treatment for ITBS. Adding MFR to the original plan in the clinical conservative treatment of ITBS can alleviate pain symptoms better and reduce the risk of recurrence.This practice helps to promote the structure of ITB recovering, accelerate the improvement process of pain symptoms and lower limb function, and avoid recurrence and deterioration in the long term.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eKujala (Kujala scale test)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eITB (iliotibial band)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eITBS (iliotibial band syndrome)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMFR (myofascial release)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNSAID (nonsteroidal anti-inflammatory drug)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVAS (Visual Analogue Score Scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch3\u003eReporting guidelines \u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eThis study was conducted and reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A completed CONSORT checklist is provided as Supplementary File 1. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study was approved by the Sports Science Experiment Ethics Committee of Beijing Sport University (approval number: 2024138H) and conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent prior to participation.\u0026nbsp;\u003c/p\u003e\n\u003cp skip=\"true\"\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe datasets generated and analyzed during this study are available from the corresponding author upon reasonable request (contact via email: [email protected]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding :\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions statement:\u003c/strong\u003e Concept/idea/research design: LL; GD and ZB. Acquisition of data: LL and GD. Analysis and interpretation of data: LL; GD; QG and ZM. Writing/review/editing of manuscript: LL; GD; LY; ZM; XH; QG; ZB and YL. Final approval of the manuscript: LL; GD; LY; ZM; XH; QG; ZB and YL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e The authors thank the participants for their participation in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEllis R, Hing W, Reid D. Iliotibial band friction syndrome\u0026ndash;a systematic review. Man therapy Aug. 2007;12(3):200\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.math.2006.08.004\u003c/span\u003e\u003cspan address=\"10.1016/j.math.2006.08.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKakouris N, Yener N, Fong DTP. 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Sonographic measurement of iliotibial band thickness: an observational study in healthy adult volunteers. \u003cem\u003eKnee surgery, sports traumatology, arthroscopy: official journal of the ESSKA\u003c/em\u003e. 2011;19(3):458\u0026ndash;61. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00167-010-1269-z\u003c/span\u003e\u003cspan address=\"10.1007/s00167-010-1269-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeals C, Flanigan D. A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population. 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Hip abductor weakness in distance runners with iliotibial band syndrome. Clin J sport medicine: official J Can Acad Sport Med Jul. 2000;10(3):169\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/00042752-200007000-00004\u003c/span\u003e\u003cspan address=\"10.1097/00042752-200007000-00004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKay J, Maffulli N, Aicale R, Taunton J. Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study. J Orthop Surg Res May. 2020;24(1):188. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s13018-020-01713-7\u003c/span\u003e\u003cspan address=\"10.1186/s13018-020-01713-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimons DG. New Aspects of Myofascial Trigger Points: Etiological and Clinical. \u003cem\u003eJournal of Musculoskeletal Pain\u003c/em\u003e. 2004/01/01 2004;12(3\u0026ndash;4):15\u0026ndash;21. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1300/J094v12n03_03\u003c/span\u003e\u003cspan address=\"10.1300/J094v12n03_03\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePrimary Outcomes at Each Data-Collection Time Point\u003c/div\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eOutcomes/Time Point\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eExperimental Group(n\u0026thinsp;=\u0026thinsp;8)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eControl Group(n\u0026thinsp;=\u0026thinsp;8)\u003c/div\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eP Value\u003c/div\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eKujala\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBaseline\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e83.38 (7.86)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e84.88 (8.95)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.727\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e91.50 (4.24)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e92.00 (5.93)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.849\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e96.00 (1.93)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e95.12 (3.36)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.533\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e98.25 (1.67)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e96.37 (3.20)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.164\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eVAS(cm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBaseline\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5.38 (1.51)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.63 (1.77)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.376\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 2\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.88 (0.84)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.13 (0.74)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.007\u003csup\u003e*\u003c/sup\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.25 (0.89)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.88 (0.79)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.159\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 8\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.94 (1.08)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1.63 (0.92)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.192\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eITB thickness (mm)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eBaseline\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.16 (0.64)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.45 (0.55)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.356\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eWeek 4\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3.55 (0.45)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4.21 (0.48)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations:ITB, iliotibial band; Kujala, Kujala scale test; VAS, visual analogue score test;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eValue are Mean (SD);\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eP Value show the results of Post-hoc analyses (Bonferroni comparisons) ;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003e indicates a significant between-group difference at same time point.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"iliotibial band syndrome, myofascial release, hip strength training, iliotibial band thickness, alleviating pain, ultrasound image","lastPublishedDoi":"10.21203/rs.3.rs-6377617/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6377617/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: I\u003c/strong\u003eliotibial band syndrome (ITBS) is a prevalent overuse injury among athletes, causing lateral knee pain and functional impairment. While hip strength training is commonly used for ITBS management, the adjunctive role of myofascial release (MFR) remains underexplored. This study investigated whether combining MFR with hip strength training enhances outcomes in pain relief, iliotibial band (ITB) thickness reduction, and functional improvement compared to hip strength training alone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this single-blind randomized controlled trial, 16 patients with ITBS (mean age 22.2 ± 1.6 years) were stratified by gender and allocated to an experimental group (MFR + hip strength training, n=8) or a control group (hip strength training alone, n=8). Interventions were delivered twice weekly for 4 weeks, with assessments at baseline, weeks 2, 4 (post-intervention), and week 8 (follow-up). Primary outcomes included pain (Visual Analogue Scale, VAS), ITB thickness (ultrasound imaging), and functional performance (Kujala scale). Mixed-model factorial ANOVA analyzed group-by-time interactions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The experimental group showed significantly greater reductions in pain at week 2 (F=10.000, P=0.007) and ITB thickness at week 4 (F=8.163, P=0.013) compared to controls. No between-group differences were observed in functional performance (F=0.579, P=0.542). Both groups improved over time in all outcomes (P\u0026lt;0.001), but MFR provided earlier pain relief and greater structural improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eMFR combined with hip strength training accelerates pain reduction and ITB thickness normalization in ITBS patients, though functional gains were comparable between groups. These findings support MFR as a valuable adjunct to standard care, potentially mitigating recurrence risk through tissue remodeling. Further studies with larger samples are warranted to optimize MFR protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003e The trail was prospectively registered in the Chinese Clinical Trial Registry on 09/05/2024 (reference no.ChiCTR2400084034).\u003c/p\u003e","manuscriptTitle":"The Potential Impact of Myofascial Release Therapy on Iliotibial Band Syndrome: A Preliminary Randomised Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 09:36:33","doi":"10.21203/rs.3.rs-6377617/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb54461c-17a1-4d97-b4f6-dee8870427f8","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-21T11:53:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 09:36:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6377617","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6377617","identity":"rs-6377617","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}