Noble's test: Difference between revisions

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'''Original Editors ''' - [[User:Merlin Roggeman|Merlin Roggeman]]  
'''Original Editors ''' - [[User:Merlin Roggeman|Merlin Roggeman]]  


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== Search Strategy  ==
Use the PubMed database. Use keywords “Noble AND iliotibial band”, and set limits: “link to free full text”. You’ll have two article results: “Changes in low back pain in a long distance runner after stretching the iliotibial band” and “The treatment of iliotibial band friction syndrome”.<br>
To find more articles you can use “google scholar” for scientific articles. Use the keywords “Noble test AND iliotibial band AND evidence based”. You’ll come up with those articles: “Evidence Based Treatment for Iliotibial Band Friction Syndrome” and “Clinical testing for extra-articular lateral knee pain. A modification and combination of traditional tests”.<br>
== Definition/Description  ==
== Definition/Description  ==


The Noble’s test (also known as Noble's Compression test) is a provocative test of the iliotibial band, developed by Clive Noble. It is commonly used as an indication for [[Iliotibial Band Syndrome|iliotibial band syndrome]]; however no evidence-based research has been done yet to control the validity of this test. Other tests that could be used are the modified [[Ober's Test|Ober’s test]] and the [[Renne test|Renne Creak test]].&nbsp;<ref name="Kasunich 2003">Kasunich NJ. Changes in low back pain in a long distance runner after stretching the iliotibial band. Journal of Chiropractic Medicine 2003; number 1, volume 2; 37-40. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646955/pdf/main.pdf (accessed 20/05/2011) LEVEL OF EVIDENCE: B</ref><ref name="Noble 1979">Noble CA. The Treatment of Iliotibial Band Friction Syndrome. Brit. J. Sports Med. 1979; 13; 51-54. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1859686/pdf/brjsmed00261-0005.pdf (accessed 20/05/2011) LEVEL OF EVIDENCE: A2</ref><ref name="Rosenthal 2008">Rosenthal MD. Clinical Testing for Extra-Articular Lateral Knee Pain. A Modification and Combination of Traditional Tests. North American Journal of Sports Physical Therapy 2008; volume 3, number 2; 107-109. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953323/pdf/najspt-03-107.pdf (accessed 20/05/2011) LEVEL OF EVIDENCE: B</ref>  
The Noble’s test (Noble's Compression test) is a provocative test of the iliotibial band, developed by Clive Noble. It is commonly used as an indication for [[Iliotibial Band Syndrome|iliotibial band syndrome]]; however, no evidence-based research has been done yet to control the validity of this test. Other tests that could be used are the modified [[Ober's Test|Ober’s test]] and the [[Renne test|Renne Creak test]].&nbsp;<ref name="Kasunich 2003">Kasunich NJ. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646955/pdf/main.pdf Changes in low back pain in a long distance runner after stretching the iliotibial band.] Journal of Chiropractic Medicine 2003; number 1, volume 2; 37-40. Level of Evidence: B</ref><ref name="Noble 1979">Noble CA. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1859686/pdf/brjsmed00261-0005.pdf The Treatment of Iliotibial Band Friction Syndrome]. Brit. J. Sports Med 1979;13;51-54 </ref><ref name="Rosenthal 2008">Rosenthal MD. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953323/pdf/najspt-03-107.pdf Clinical Testing for Extra-Articular Lateral Knee Pain. A Modification and Combination of Traditional Tests]. North American Journal of Sports Physical Therapy 2008; volume 3, number 2:107-109 LEVEL OF EVIDENCE: B</ref><br>  
 
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== Clinically Relevant Anatomy  ==
== Clinically Relevant Anatomy  ==


Relevant anatomy related to the test is knowledge of the iliotibial band. It starts as the iliotibial tract, which is a thickening of the fascia lata, originating from the iliac crest. The iliotibial tract continues downward, laterally from the femur. At the greater trochanter, fibers of the tensor fascia lata muscle and gluteus maximus muscle inserts in the iliotibial tract. When approaching the [[Knee|knee]] joint, the iliotibial tract passes the lateral epicondyle of the femur and splits into two structures: the iliopatellar band, and a distal extension inserting at the Gerdy tubercle (Figure 1).<ref name="Dubin 2005">Dubin J. Evidence Based Treatment for Iliotibial Band Friction Syndrome: Review of Literature. BioMechanics, August 2005. http://dubinchiro.com/iliotibial_band.pdf (accessed 22/05/2011) LEVEL OF EVIDENCE: A1</ref>
[[File:Iliotibial Band Syndrome.jpg|Iliotibial band|alt=|right|frameless]]Relevant anatomy related to the test is knowledge of the iliotibial band. It starts as the [https://www.physio-pedia.com/Iliotibial_Tract iliotibial tract], which is a thickening of the fascia lata, originating from the iliac crest. The iliotibial tract continues downward, laterally from the femur. At the greater trochanter, fibres of the tensor fascia lata muscle and gluteus maximus muscle inserts in the iliotibial tract. When approaching the knee joint, the iliotibial tract passes the lateral epicondyle of the [[femur]] and splits into two structures: the iliopatellar band, and a distal extension inserting at the Gerdy tubercle (Figure 1).<ref name="Dubin 2005">Dubin J. [http://dubinchiro.com/iliotibial_band.pdf Evidence Based Treatment for Iliotibial Band Friction Syndrome: Review of Literature.]Biomechanics August 2005 </ref>  
 
[[Image:Fig 1 for nobles test.png|center|410x266px|ITB Anatomy]]<br>
<center>'''Figure 1. '''Anatomy of the ITB and other relevant structures.<ref name="Dubin 2005">Dubin J. Evidence Based Treatment for Iliotibial Band Friction Syndrome: Review of Literature. BioMechanics, August 2005. http://dubinchiro.com/iliotibial_band.pdf (accessed 22/05/2011) LEVEL OF EVIDENCE: A1</ref> </center>
<br>  


During walking and running, the Iliotibial band is subjected to frictional and compressive forces over the lateral epicondyle. Repetitive strain, improper footwear, lower extremity mal-alignments and muscle imbalance cause increased friction.<ref>SieunNarine-McKay J[https://open.library.ubc.ca/cIRcle/collections/ubctheses/24/items/1.0306928 . Evaluation of outcomes in assessment of iliotibial band syndrome rehabilitation programs] (Doctoral dissertation, University of British Columbia.)</ref> Iliotibial band (ITB) friction syndrome is an overuse injury common in runners, cyclists, weightlifters, skiers, and soccer players. It is characterized by pain over the lateral femoral epicondyle.
== Purpose  ==
== Purpose  ==


The purpose of this test is to detect pain, abnormalities, tightness of the iliotibial tract, which can be indicative for the iliotibial band syndrome. It helps to differentiate [[Iliotibial Band Syndrome|iliotibial band syndrome]] from other common causes of lateral knee pain.<ref name="Noble 1979" /><ref name="Dubin 2005" />  
The purpose of this test is to detect pain, abnormalities, tightness of the iliotibial tract, which can be indicative for the iliotibial band syndrome. It helps to differentiate [[Iliotibial Band Syndrome|iliotibial band syndrome]] from other common causes of lateral knee pain.<ref name="Noble 1979" /><ref name="Dubin 2005" />  


== Technique  ==
== Technique<ref name=":0" /> ==


Put the patient in a supine position. Next bring the affected knee up to a 90 degree knee flexion and apply pressure with your thumb to the lateral femoral epicondyle. The leg is then extended slowly. When it is extended to approximately 30 degrees, the iliotibial band translates anteriorly over the lateral femoral epicondyle under the examiners thumb.  
=== Procedure ===
The patient is supine or side-lying with the injured side up. Grasp just above the ankle and slowly bend the knee back and forth several times from 0-90° while palpating and applying firm pressure on the lateral epicondyle of the femur for crepitus with the thumb of the other hand.


If the patient indicates pain at this 30 degree angle, which is similar to when the patient is active, the test is considered positive and it suggests the presence of iliotibial band syndrome.  
=== Interpretation ===
Palpable snapping, rubbing or “squeaky hinge-like” crepitus or localized pain that increases with pressure at or above the epicondyle (often at 30° of flexion) indicates ITB syndrome.  


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| {{#ev:youtube|eLAU6Xhs2ms|300}}<ref>Noble's Compression test. The student physical therapist. Available from https://www.youtube.com/watch?v=eLAU6Xhs2ms</ref>
 
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<ref name="Noble's Test">Online video, http://www.youtube.com/watch?v=IIJVbf_t_2A (last accessed 24/05/2011)</ref><br>
== Evidence  ==
 
Reliability & Validity: Unknown<ref name=":0">Knee Orthopaedic Test - A Strategic Approach to Assessing the Knee; University of Western States, College of Chiropractic, Clinic Protocol; Renne; Page No.34; Adopted 12/12. (accessed on 21.07.18 from Knee_Orthopedic_Tests.pdf)</ref>
== Key Research  ==
 
add links and reviews of high quality evidence here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
 
== Resources <br>  ==
 
add appropriate resources here <br>
 
== Clinical Bottom Line  ==
== Clinical Bottom Line  ==


This test is indicative of iliotibial band syndrome, but again it must be stated that there have been no studies to indicate the validity of this test.<ref name="Noble 1979" /><ref name="Dubin 2005" />  
This test is indicative of iliotibial band syndrome, but again it must be stated that there have been no studies to indicate the validity of this test.<ref name="Noble 1979" /><ref name="Dubin 2005" /><br>
 
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
 
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
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== References  ==


see [[Adding References|adding references tutorial]]. <references />  
== References ==
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[[Category:Vrije_Universiteit_Brussel_Project|Template:VUBTest]]
[[Category:Musculoskeletal/Orthopaedics|Orthopaedics]]
[[Category:Special_Tests]]
[[Category:Knee]]
[[Category:Assessment]]
[[Category:Knee - Assessment and Examination]]
[[Category:Sports Medicine]]
[[Category:Athlete Assessment]]
[[Category:Knee - Special Tests]]

Latest revision as of 11:02, 2 October 2022

Original Editors - Merlin Roggeman

Top Contributors - Evan Thomas, Vidya Acharya, Merlin Roggeman, Admin, Kim Jackson, Chelsea Mclene, Rachael Lowe, Oyemi Sillo, Kai A. Sigel, WikiSysop, 127.0.0.1, Demol Yves and Wanda van Niekerk

Definition/Description[edit | edit source]

The Noble’s test (Noble's Compression test) is a provocative test of the iliotibial band, developed by Clive Noble. It is commonly used as an indication for iliotibial band syndrome; however, no evidence-based research has been done yet to control the validity of this test. Other tests that could be used are the modified Ober’s test and the Renne Creak test. [1][2][3]

Clinically Relevant Anatomy[edit | edit source]

Relevant anatomy related to the test is knowledge of the iliotibial band. It starts as the iliotibial tract, which is a thickening of the fascia lata, originating from the iliac crest. The iliotibial tract continues downward, laterally from the femur. At the greater trochanter, fibres of the tensor fascia lata muscle and gluteus maximus muscle inserts in the iliotibial tract. When approaching the knee joint, the iliotibial tract passes the lateral epicondyle of the femur and splits into two structures: the iliopatellar band, and a distal extension inserting at the Gerdy tubercle (Figure 1).[4]

During walking and running, the Iliotibial band is subjected to frictional and compressive forces over the lateral epicondyle. Repetitive strain, improper footwear, lower extremity mal-alignments and muscle imbalance cause increased friction.[5] Iliotibial band (ITB) friction syndrome is an overuse injury common in runners, cyclists, weightlifters, skiers, and soccer players. It is characterized by pain over the lateral femoral epicondyle.

Purpose[edit | edit source]

The purpose of this test is to detect pain, abnormalities, tightness of the iliotibial tract, which can be indicative for the iliotibial band syndrome. It helps to differentiate iliotibial band syndrome from other common causes of lateral knee pain.[2][4]

Technique[6][edit | edit source]

Procedure[edit | edit source]

The patient is supine or side-lying with the injured side up. Grasp just above the ankle and slowly bend the knee back and forth several times from 0-90° while palpating and applying firm pressure on the lateral epicondyle of the femur for crepitus with the thumb of the other hand.

Interpretation[edit | edit source]

Palpable snapping, rubbing or “squeaky hinge-like” crepitus or localized pain that increases with pressure at or above the epicondyle (often at 30° of flexion) indicates ITB syndrome.

[7]

Evidence[edit | edit source]

Reliability & Validity: Unknown[6]

Clinical Bottom Line[edit | edit source]

This test is indicative of iliotibial band syndrome, but again it must be stated that there have been no studies to indicate the validity of this test.[2][4]

References[edit | edit source]

  1. ↑ Kasunich NJ. Changes in low back pain in a long distance runner after stretching the iliotibial band. Journal of Chiropractic Medicine 2003; number 1, volume 2; 37-40. Level of Evidence: B
  2. ↑ 2.0 2.1 2.2 Noble CA. The Treatment of Iliotibial Band Friction Syndrome. Brit. J. Sports Med 1979;13;51-54
  3. ↑ Rosenthal MD. Clinical Testing for Extra-Articular Lateral Knee Pain. A Modification and Combination of Traditional Tests. North American Journal of Sports Physical Therapy 2008; volume 3, number 2:107-109 LEVEL OF EVIDENCE: B
  4. ↑ 4.0 4.1 4.2 Dubin J. Evidence Based Treatment for Iliotibial Band Friction Syndrome: Review of Literature.Biomechanics August 2005
  5. ↑ SieunNarine-McKay J. Evaluation of outcomes in assessment of iliotibial band syndrome rehabilitation programs (Doctoral dissertation, University of British Columbia.)
  6. ↑ 6.0 6.1 Knee Orthopaedic Test - A Strategic Approach to Assessing the Knee; University of Western States, College of Chiropractic, Clinic Protocol; Renne; Page No.34; Adopted 12/12. (accessed on 21.07.18 from Knee_Orthopedic_Tests.pdf)
  7. ↑ Noble's Compression test. The student physical therapist. Available from https://www.youtube.com/watch?v=eLAU6Xhs2ms
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