Women who take up running are twice as likely as men to develop knee pain, yet no one knows exactly how the hip muscles that control the knee actually tug on the joint. The problem is a stiff band of tissue called the iliotibial band, which runs down the outside of the thigh and connects the gluteus maximus and tensor fasciae latae muscles to the knee. While its anatomy is well mapped, researchers do not know which parts of the band tighten when each hip muscle contracts, nor which region of the knee receives that pull. This project will build a cadaver model that can actuate the hip and knee muscles, then measure how tension travels through the band to the knee. The team will also create a computational model to simulate a wider range of movements than the lab can test, and validate both models by measuring strain in the band of healthy volunteers using ultrasound. If successful, the work will give physiotherapists and surgeons precise, muscle-specific targets for rehabilitation exercises and preventative programmes. The ultimate beneficiaries are people who want to stay active but are sidelined by knee injury—a group that aligns directly with NHS initiatives to boost national activity levels.
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To improve activity levels in the UK population, the NHS promotes running through its 'couch to 5k' program. Running is a great exercise, but the downside is the risk of injury which can happen to everyone, from beginners to pro athletes. The most common injury is knee pain and women are twice as likely to experience it than men. Many studies report that exercising two of the hip muscles (the gluteus maximus and tensor fasciae latae) is the most effective way to improve knee pain. This is because these hip muscles are connected to the knee by a stiff band of tissue that runs down the outside of the thigh (the iliotibial band). The anatomy of this band of tissue is well known, but we don't know how it works, we don't know which parts of the band pull tight when either of the hip muscles are tensed, nor which part of the knee is affected by which hip muscle. The aim of the project is to find this out. To give us new understanding on how the hip muscles affect the knee joint we will take a three pronged approach. (1) We will create an experimental cadaver model that can actuate the hip and knee muscles. We can then elucidate how the iliotibial band is tensioned by the hip muscles and how this tension is transferred to the different parts of the knee. (2) We will create a computational model with a new iliotibial band contribution based on the findings from the experimental model and calculate the kinematics for a wider range of simulated activities than is feasible experimentally. (3) We will validate the experiment and computational model by measuring strain in the iliotibial band in healthy volunteers using an ultrasound approach recently developed in our lab. Success in the three methods outlined above will lead to new understanding on how the hip muscles affect the knee joint. This will benefit researchers in the physiotherapy, surgical and musculoskeletal modelling field, it will lead to more precise rehabilitation and preventative exercises for knee pain. The ultimate beneficiary will be people who seek to maintain an active lifestyle and are affected by knee injury. The research is thus timely because this aligns with the current NHS initiatives to increase the health of the nation outlined at the beginning of this summary.
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