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Physical Medicine and Rehabilitation for Iliotibial Band Syndrome Treatment & Management

  • Author: John M Martinez, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Feb 11, 2016
 

Rehabilitation Program

Physical Therapy

Treatment for iliotibial band syndrome (ITBS) usually is conservative. Conservative treatment consists of (1) relative rest by decreasing the amount of exercise or training, (2) the use of superficial heat and stretching prior to exercise, and (3) the use of ice after the activity. Heat should be applied before and during stretching for at least 5-10 minutes, and ice treatments should be employed using a cold pack applied to the area for 10-15 minutes or using an ice massage, which involves rubbing ice over the inflamed region for 3-5 minutes or until the area is numb.

Physical therapy is one of the mainstays of treatment for ITBS, in addition to reducing the amount of inflammation and irritation.[2, 3, 6] 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 the images below.

This illustration demonstrates active stretching o This illustration demonstrates active stretching of the iliotibial band (ITB). The athlete stands a comfortable distance from a wall and, with the contralateral knee extended, leans the proximal shoulder against the wall to stretch the ipsilateral ITB.
This illustration demonstrates iliotibial band syn This illustration demonstrates iliotibial band syndrome stretching performed in a side-lying position.

Soft-tissue mobilization and massage techniques may be used to assist with lengthening of the sore ITB. Prior to mobilizing the tissues, the physical therapist may perform an ultrasonographic treatment over the ITB to increase blood flow to the area and prepare the tissues to be stretched. Massage should generally be performed with the ITB in a lengthened state.

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.

A study by Noehren et al suggested that in men with ITBS, treatment that addresses hip and knee neuromuscular control may be particularly beneficial. Examining differences between 17 men with ITBS and 17 healthy controls, the investigators found that, although ITB length was somewhat reduced in males with ITBS and hip external rotators were somewhat weaker, the largest differences occurred in internal rotation of the hip and adduction of the knee, both of which were significantly greater in the ITBS subjects.[14]

Occupational Therapy

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

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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.[11, 12]

A Belgian study investigated the effectiveness of arthroscopic treatment for ITBS, specifically, resection of the lateral synovial recess, in 33 patients.[13] 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.

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Consultations

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

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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.[6]

A randomized, controlled trial by Weckström and Söderström found that in runners with ITBS, pain decrease in those treated with radial extracorporeal shockwave therapy (11 patients) was not significantly different from that in runners treated with manual therapy (13 patients), at 4- and 8-week follow-up. The patients underwent an exercise rehabilitation program concurrently with one or the other therapy.[15]

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Contributor Information and Disclosures
Author

John M Martinez, MD Staff Physician, Kaiser Permanente

John M Martinez, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Kenneth Honsik, MD Consulting Staff, Department of Primary Care Sports Medicine, Kaiser Permanente

Disclosure: Nothing to disclose.

References
  1. Baker RL, Souza RB, Fredericson M. Iliotibial band syndrome: soft tissue and biomechanical factors in evaluation and treatment. PM R. 2011 Jun. 3(6):550-61. [Medline].

  2. Fredericson M, Weir A. Practical management of iliotibial band friction syndrome in runners. Clin J Sport Med. 2006 May. 16(3):261-8. [Medline].

  3. Fredericson M, Wolf C. Iliotibial band syndrome in runners: innovations in treatment. Sports Med. 2005. 35(5):451-9. [Medline].

  4. Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon). 2008 Oct. 23(8):1018-25. [Medline].

  5. Grau S, Maiwald C, Krauss I, Axmann D, Horstmann T. The influence of matching populations on kinematic and kinetic variables in runners with iliotibial band syndrome. Res Q Exerc Sport. 2008 Dec. 79(4):450-7. [Medline].

  6. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15. 71(8):1545-50. [Medline]. [Full Text].

  7. Strauss EJ, Kim S, Calcei JG, Park D. Iliotibial band syndrome: evaluation and management. J Am Acad Orthop Surg. 2011 Dec. 19(12):728-36. [Medline].

  8. Sher I, Umans H, Downie SA, Tobin K, Arora R, Olson TR. Proximal iliotibial band syndrome: what is it and where is it?. Skeletal Radiol. 2011 Dec. 40(12):1553-6. [Medline].

  9. Grau S, Krauss I, Maiwald C, et al. Hip abductor weakness is not the cause for iliotibial band syndrome. Int J Sports Med. 2008 Jul. 29(7):579-83. [Medline].

  10. Phinyomark A, Osis S, Hettinga BA, Leigh R, Ferber R. Gender differences in gait kinematics in runners with iliotibial band syndrome. Scand J Med Sci Sports. 2015 Dec. 25 (6):744-53. [Medline].

  11. Ilizaliturri VM Jr, Martinez-Escalante FA, Chaidez PA, et al. Endoscopic iliotibial band release for external snapping hip syndrome. Arthroscopy. 2006 May. 22(5):505-10. [Medline].

  12. Hariri S, Savidge ET, Reinold MM, Zachazewski J, Gill TJ. Treatment of recalcitrant iliotibial band friction syndrome with open iliotibial band bursectomy: indications, technique, and clinical outcomes. Am J Sports Med. 2009 Mar 13. [Medline].

  13. Michels F, Jambou S, Allard M, Bousquet V, Colombet P, de Lavigne C. An arthroscopic technique to treat the iliotibial band syndrome. Knee Surg Sports Traumatol Arthrosc. 2009 Mar. 17(3):233-6. [Medline].

  14. Noehren B, Schmitz A, Hempel R, et al. Assessment of strength, flexibility, and running mechanics in men with iliotibial band syndrome. J Orthop Sports Phys Ther. 2014 Mar. 44(3):217-22. [Medline].

  15. Weckstrom K, Soderstrom J. Radial extracorporeal shockwave therapy compared with manual therapy in runners with iliotibial band syndrome. J Back Musculoskelet Rehabil. 2015 Jul 6. [Medline].

  16. Adams WB. Treatment options in overuse injuries of the knee: patellofemoral syndrome, iliotibial band syndrome, and degenerative meniscal tears. Curr Sports Med Rep. 2004 Oct. 3(5):256-60. [Medline].

 
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In this 27-year-old female marathon runner with anterolateral pain superior to the joint line, a coronal fast spin-echo T2-weighted magnetic resonance imaging scan with fat suppression demonstrates edema between the iliotibial band and the lateral femoral condyle (arrow). The edema's location is consistent with a clinical diagnosis of iliotibial band syndrome.
Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
Iliotibial band noted prominently along the lateral thigh.
Lateral hip stabilizers.
The Thomas test can be used to evaluate restriction in the iliotibial band and hip flexors.
The Ober test.
This illustration demonstrates active stretching of the iliotibial band (ITB). The athlete stands a comfortable distance from a wall and, with the contralateral knee extended, leans the proximal shoulder against the wall to stretch the ipsilateral ITB.
This illustration demonstrates iliotibial band syndrome stretching performed in a side-lying position.
 
 
 
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