Iliotibial Band Syndrome Treatment & Management

Rehabilitation Program

Physical Therapy

Modalities to decrease inflammation include ultrasonography, phonophoresis, iontophoresis, and icing. After the acute inflammation has resolved, the patient should begin a stretching program, which should include active stretching of the hamstrings, gluteal musculature, and hip adductors to improve the flexibility of the ITB. (See images below.) ^[18]

Medical Issues/Complications

The acute phase of treatment focuses on control of inflammation, correction of poor training habits, as well as accommodation made for any anatomic structural variants.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to control pain and inflammation

• To reduce stress on the knee, ideally, the athlete should avoid participating in the activity that incited the injury. Pragmatically, it is often helpful for the physician to work with the athlete to develop a training program that allows athletes to participate in their sports to the extent that they are not experiencing discomfort.

  • Swimming, using only the arms, is a way for athletes to maintain cardiovascular fitness during this period. Once the inflammation is reduced, the athlete's activity level can be gradually increased as he/she moves to the next phase of recovery.

  • Runners

    • Inspect the athlete's running shoes for uneven or excessive wear.

    • Evaluate and identify anatomic factors that may contribute to ITBS. If a leg-length discrepancy is present, consider prescription of a heel lift. Many runners have a tendency toward foot pronation or supination. If either condition is present, orthotic devices may be helpful.

    • Runners should modify their training routine to avoid running on banked surfaces and/or hills or running in the same direction on a track.

  • Cyclists

    • Often, cyclists who are diagnosed with ITBS have their cleats positioned in internal rotation. This position increases tension on the ITB. To eliminate stress on the ITB, the cleats should be adjusted to reflect the cyclist's anatomic alignment, or the cleats can be externally rotated to reduce stretch on the ITB. If the cyclist is riding with fixed, clipless pedals, a switch to floating pedals is often beneficial.

    • Evaluate the cyclist’s saddle or seat position. A saddle that is too high should be adjusted so that 30-35° of flexion is present at the bottom of the pedaling stroke. Consider reducing stress on the ITB by widening the cyclist’s bike stance and by improving both the hip and foot alignment. This correction can be accomplished by placing spacers between the pedal and the crank arm.

Surgical Intervention

Surgical intervention is not indicated for ITBS except in rare cases in which prolonged conservative treatment has failed to either alleviate the patient's symptoms or resolve the ITBS. ^{[3, 12, 19]}

Before considering surgery, the physician should investigate other possible sources of lateral knee pain. Lateral meniscus tears and chondromalacia can also cause lateral knee pain. Diagnostic arthroscopy should accompany any surgical procedure for ITBS.

Several procedures have been reported to be effective, most of which involve removing a portion of the ITB where it comes into contact with the lateral femoral epicondyle. Z-lengthening of the ITB at the level of the lateral epicondyle has also been proposed. ^[12]

Consultations

The following consultants may be of assistance in managing ITBS:

• Primary care sports medicine specialist (pediatrician, family practitioner, or internal medicine specialist with a certificate of added qualification [CAQ] in sports medicine)

• Orthopedic surgeon

• Physiatrist with fellowship training in sports medicine

Other Treatment

See the list below:

• Local corticosteroid injection has been shown to be beneficial in managing acute inflammation for those who do not respond to analgesia and rest. ^{[1, 3, 12, 20, 21]}

  • Place the patient in a lateral recumbent position with the affected knee flexed to approximately 30 º.

  • Direct the injection into the deep space at the point of maximal tenderness just lateral to the lateral femoral condyle.

Rehabilitation Program

Physical Therapy

Once the pain of ITBS has resolved and the athlete has achieved adequate ITB flexibility, the patient should begin strengthening exercises. The strengthening program focuses on the proximal hip musculature. Examples of exercises that are used at this stage include side-lying leg lifts, pelvic drops, and step-down exercises.

Medical Issues/Complications

If the preceding management of the injury is not successful, consider a period of total rest (4-6 weeks).

Surgical Intervention

Surgical treatment of ITBS is rarely required because most cases respond to conservative treatment (see Acute Phase, Surgical Intervention, above).

Rehabilitation Program

Physical Therapy

Integrate active ITB stretching and strengthening of the hip musculature into the athlete’s training program.