Further Outpatient Care
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The patient should continue physical therapy until the symptoms of iliotibial band syndrome improve or he/she can continue the exercises independently. See Physical Therapy for treatment recommendations.
Inpatient & Outpatient Medications
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The patient with iliotibial band syndrome is treated as an outpatient with medications that include NSAIDs or corticosteroid injections, as discussed above (see Medication).
Transfer
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Transfer of care (referral) is warranted if the patient's symptoms do not improve with conservative management.
Deterrence
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The key to preventing iliotibial band syndrome (ITBS) is having a well-balanced approach to training. Runners need to limit their uphill/downhill training and to run on level surfaces as much as possible. When training on a track, it is important to alternate the direction of running from clockwise to counterclockwise regularly to avoid repetitive stress to 1 leg. Preventative stretching of the ITB and gluteals also is important. Individuals with known subtalar joint hyperpronation may occasionally avoid developing ITBS by wearing proper shoes and orthotics to correct faulty biomechanics.
Complications
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Complications of iliotibial band syndrome (ITBS) can include continued pain and an inability to maintain a training program. Some patients may demonstrate significant biomechanical abnormalities of the lower extremity as they attempt to compensate for ITBS-related pain.
Prognosis
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Prognosis for iliotibial band syndrome is very good with the appropriate treatment.
Patient Education
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Education is important in preventing recurrence of iliotibial band syndrome (ITBS).
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Education should focus on instructing the patient in proper stretching techniques, as well as on educating patients about the use of ice and NSAIDs for minor irritation or inflammation of the ITB.
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More importantly, the patient should learn to recognize symptoms that indicate when training volume should be decreased and when training surfaces should be changed.
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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.
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Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
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Iliotibial band noted prominently along the lateral thigh.
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Lateral hip stabilizers.
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The Thomas test can be used to evaluate restriction in the iliotibial band and hip flexors.
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The Ober test.
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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.
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This illustration demonstrates iliotibial band syndrome stretching performed in a side-lying position.
