eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Iliotibial Band Syndrome: Treatment & Medication

Author: John M Martinez, MD, Medical Director, Primary Care Sports Medicine, Coastal Sports and Wellness Medical Center
Coauthor(s): Kenneth Honsik, MD, Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente; Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Contributor Information and Disclosures

Updated: Apr 17, 2009

Treatment

Rehabilitation Program

Physical Therapy

Physical therapy is one of the mainstays of treatment for ITBS, in addition to reducing the amount of inflammation and irritation.^1,2,5 The physical therapist can advise the athlete about ways to modify his/her training program so that faster results are seen with therapy. Running and cycling should be decreased or avoided to prevent further repetitive stress to the ITB. Wearing proper shoes also is very important in individuals with ITBS. Frequently, patients with ITBS demonstrate excessive pronation of their feet. The physical therapist should evaluate the patient's biomechanics during walking and running and should assist him/her in obtaining custom-made orthotics to correct faulty mechanics that may be causing the ITBS.

Physical therapy treatment in the acute stage may include modalities such as phonophoresis or iontophoresis in addition to cryotherapy to decrease the inflammation. Since some cases of ITBS are caused by excessive tension on the ITB, physical therapy can help to incorporate proper stretching techniques into the patient's exercise routine. These exercises concentrate on increasing flexibility of the ITB and of the gluteus muscles. Other muscles that commonly need attention for flexibility include the hamstrings, quadriceps, gastrocnemius, and soleus. (See images below and Images 7, 8.)

As the patient's symptoms improve, the physical therapy can progress toward strength development and maintenance. The physical therapist should instruct the patient in a home exercise program that continues to improve the strength and endurance of the hip and knee, as well as the back and abdominals. Strengthening of the hip abductors and knee flexors and extensors is an important component of rehabilitation. Once the patient is able to complete all strengthening exercises without discomfort, he/she may gradually return to the previous training regimen.

Occupational Therapy

Occupational therapy usually is not indicated in the treatment of individuals with iliotibial band syndrome.

Surgical Intervention

Reports of surgical intervention exist for recurrent iliotibial band syndrome (ITBS) that has not been responsive to previous conservative treatment. The operation may involve (1) releasing the posterior portion of the ITB, (2) performing an osteotomy of the lateral femoral epicondyle, or (3) performing a bursectomy.^7,8

A Belgian study investigated the effectiveness of arthroscopic treatment for ITBS, specifically, resection of the lateral synovial recess, in 33 patients.⁹ The authors reported that all of the patients returned to sports after 3 months. At follow-up (a mean period of 2 years and 4 months), good to excellent results were found in 32 of the patients, and a fair result in 1 of them. 

Consultations

Patients with iliotibial band syndrome that is recurrent and difficult to treat may be referred to a sports medicine specialist.

Other Treatment

Local injections with corticosteroids may be indicated for symptoms of iliotibial band syndrome that do not respond to nonsteroidal anti-inflammatory drugs (NSAIDs), relative rest, stretching, and physical therapy.⁵

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Nonsteroidal anti-inflammatory drugs

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Advil, Motrin)

DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprelan, Naprosyn, Anaprox)

For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.

Ketoprofen (Oruvail, Orudis, Actron)

For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease.
Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.

Cyclooxygenase-2 Inhibitors

COX-2 inhibitors are a new class of NSAIDs that report a lower incidence of GI side effects, such as gastritis and ulcers. COX-2 inhibitors may be indicated in patients who require anti-inflammatory medications but who have a history of gastric ulcers.

Celecoxib (Celebrex)

For relief of mild to moderate pain. Primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and with inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID-related GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

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