Exertion and pain do not alter coordination variability in runners with iliotibial band syndrome


      • Coordination variability was similar between uninjured and injured runners.
      • Exertion had minimal impact on coordination variability in all runners.
      • Presence or absence of pain did not appear to alter coordination variability.
      • Runners with iliotibial band syndrome had variable responses to the run to exertion.



      Iliotibial band syndrome is a common overuse running injury which results in altered mechanics. While injuries alter discrete mechanics, they may also cause a change in coordination variability, the stride-to-stride organization of runners' movement patterns. Uninjured and injured runners may experience a change in coordination variability during a run to exertion due to fatigue, pain, or a combination of these factors. The aim of the current study was to determine if runners with iliotibial band syndrome and uninjured runners display different segment coordination variability across the course of a run to exertion.


      3D kinematics were collected as 13 uninjured runners and 12 runners with iliotibial band syndrome ran on a treadmill. A modified vector coding technique was used to calculate coordination variability during stance for segment couples of interest. Coordination variability was compared between uninjured and injured runners at the beginning and end of the run. The influence of pain on coordination variability was also examined.


      There were no differences in coordination variability at the beginning or end of the run between uninjured runners and those with iliotibial band syndrome. The change in coordination variability due to the run was not different between uninjured runners, injured runners who experienced no change in pain, and injured runners who did experience a change in pain.


      Runners do not constrain the patterns of segment motion they use in response to exertion nor does it appear that occurrence of pain during running results in a differential change in coordination variability.


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        • Batschelet E.
        Circular Statistics in Biology.
        Academic Press, London; New York1981 (371 pp.)
        • Borg G.A.
        Psychophysical bases of perceived exertion.
        Med. Sci. Sports Exerc. 1982; 14: 377-381
        • Brown A.M.
        • Zifchock R.A.
        • Hillstrom H.J.
        • Song J.
        • Tucker C.A.
        The effects of fatigue on lower extremity kinematics, kinetics and joint coupling in symptomatic female runners with iliotibial band syndrome.
        Clin. Biomech. 2016; 39: 84-90
        • Chang R.
        • Van Emmerik R.
        • Hamill J.
        Quantifying rearfoot-forefoot coordination in human walking.
        J. Biomech. 2008; 41: 3101-3105
        • Cunningham T.J.
        • Mullineaux D.R.
        • Noehren B.
        • Shapiro R.
        • Uhl T.L.
        Coupling angle variability in healthy and patellofemoral pain runners.
        Clin. Biomech. 2014; 29: 317-322
        • DeLeo A.T.
        • Dierks T.A.
        • Ferber R.
        • Davis I.S.
        Lower extremity joint coupling during running: a current update.
        Clin. Biomech. 2004; 19: 983-991
        • Dierks T.A.
        • Davis I.S.
        • Hamill J.
        The effects of running in an exerted state on lower extremity kinematics and joint timing.
        J. Biomech. 2010; 43: 2993-2998
        • Farrar J.T.
        • Young Jr., J.P.
        • LaMoreaux L.
        • Werth J.L.
        • Poole R.M.
        Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
        Pain. 2001; 94: 149-158
        • Ferber R.
        • Noehren B.
        • Hamill J.
        • Davis I.S.
        Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics.
        J. Orthop. Sports Phys. Ther. 2010; 40: 52-58
        • Foch E.
        • Milner C.E.
        Frontal plane running biomechanics in female runners with previous iliotibial band syndrome.
        J. Appl. Biomech. 2014; 30: 58-65
        • Foch E.
        • Reinbolt J.A.
        • Zhang S.
        • Fitzhugh E.C.
        • Milner C.E.
        Associations between iliotibial band injury status and running biomechanics in women.
        Gait Posture. 2015; 41: 706-710
        • van Gent R.N.
        • Siem D.
        • van Middelkoop M.
        • van Os A.G.
        • Bierma-Zeinstra S.M.
        • Koes B.W.
        Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.
        Br. J. Sports Med. 2007; 41 (discussion 480): 469-480
        • Grau S.
        • Krauss I.
        • Maiwald C.
        • Axmann D.
        • Horstmann T.
        • Best R.
        Kinematic classification of iliotibial band syndrome in runners.
        Scand. J. Med. Sci. Sports. 2011; 21: 184-189
        • Hafer J.F.
        • Boyer K.A.
        Variability of segment coordination using a vector coding technique: reliability analysis for treadmill walking and running.
        Gait Posture. 2016; 51: 222-227
        • Hafer J.F.
        • Freedman Silvernail J.
        • Hillstrom H.J.
        • Boyer K.A.
        Changes in coordination and its variability with an increase in running cadence.
        J. Sports Sci. 2016; 34: 1388-1395
        • Hamill J.
        • van Emmerik R.E.
        • Heiderscheit B.C.
        • Li L.
        A dynamical systems approach to lower extremity running injuries.
        Clin. Biomech. 1999; 14: 297-308
        • Hamill J.
        • Miller R.
        • Noehren B.
        • Davis I.S.
        A prospective study of iliotibial band strain in runners.
        Clin. Biomech. 2008; 23: 1018-1025
        • Hamill J.
        • Palmer C.
        • Van Emmerik R.E.
        Coordinative variability and overuse injury.
        Sports Med. Arthrosc. Rehabil. Ther. Technol. 2012; 4: 45
        • Heiderscheit B.C.
        • Hamill J.
        • Van Emmerik R.E.
        Variability of stride characteristics and joint coordination among individuals with unilateral patellofemoral pain.
        J. Appl. Biomech. 2002; 18: 110-121
        • Hein T.
        • Schmeltzpfenning T.
        • Krauss I.
        • Maiwald C.
        • Horstmann T.
        • Grau S.
        Using the variability of continuous relative phase as a measure to discriminate between healthy and injured runners.
        Hum. Mov. Sci. 2012; 31: 683-694
        • Hodges P.W.
        • Tucker K.
        Moving differently in pain: a new theory to explain the adaptation to pain.
        Pain. 2011; 152: S90-S98
        • MacLean C.L.
        • van Emmerik R.
        • Hamill J.
        Influence of custom foot orthotic intervention on lower extremity intralimb coupling during a 30-minute run.
        J. Appl. Biomech. 2010; 26: 390-399
        • Meardon S.A.
        • Hamill J.
        • Derrick T.R.
        Running injury and stride time variability over a prolonged run.
        Gait Posture. 2011; 33: 36-40
        • Miller R.H.
        • Lowry J.L.
        • Meardon S.A.
        • Gillette J.C.
        Lower extremity mechanics of iliotibial band syndrome during an exhaustive run.
        Gait Posture. 2007; 26: 407-413
        • Miller R.H.
        • Meardon S.A.
        • Derrick T.R.
        • Gillette J.C.
        Continuous relative phase variability during an exhaustive run in runners with a history of iliotibial band syndrome.
        J. Appl. Biomech. 2008; 24: 262-270
        • Miller R.H.
        • Chang R.
        • Baird J.L.
        • Van Emmerik R.E.
        • Hamill J.
        Variability in kinematic coupling assessed by vector coding and continuous relative phase.
        J. Biomech. 2010; 43: 2554-2560
        • Newell K.
        Coordination, control and skill.
        in: Goodman D. Wilberg R.B. Advances in Psychology. Elsevier, Amsterdam1985: 295-317
        • Noehren B.
        • Davis I.
        • Hamill J.
        ASB clinical biomechanics award winner 2006 prospective study of the biomechanical factors associated with iliotibial band syndrome.
        Clin. Biomech. 2007; 22: 951-956
        • Schwartz M.H.
        • Rozumalski A.
        A new method for estimating joint parameters from motion data.
        J. Biomech. 2005; 38: 107-116
        • Seay J.F.
        • Van Emmerik R.E.
        • Hamill J.
        Low back pain status affects pelvis-trunk coordination and variability during walking and running.
        Clin. Biomech. 2011; 26: 572-578
        • Taunton J.E.
        • Ryan M.B.
        • Clement D.B.
        • McKenzie D.C.
        • Lloyd-Smith D.R.
        • Zumbo B.D.
        A retrospective case-control analysis of 2002 running injuries.
        Br. J. Sports Med. 2002; 36: 95-101
        • Voloshin A.S.
        • Mizrahi J.
        • Verbitsky O.
        • Isakov E.
        Dynamic loading on the human musculoskeletal system — effect of fatigue.
        Clin. Biomech. 1998; 13: 515-520