From the Research
Physical therapy for iliotibial band syndrome (ITBS) should prioritize a comprehensive approach including rest, ice, stretching, strengthening, and running gait analysis, as this multifaceted strategy addresses both symptoms and underlying biomechanical issues, with the most recent and highest quality study 1 suggesting that common physiotherapeutic measures may not be effectively targeting the right goals.
Key Components of Physical Therapy for ITBS
- Rest from aggravating activities to reduce inflammation and pain
- Ice application for 15-20 minutes several times daily to reduce pain and inflammation
- Stretching exercises targeting the IT band, hip abductors, and tensor fasciae latae, holding each stretch for 30 seconds and repeating 3 times, twice daily
- Strengthening exercises focusing on hip abductors, particularly the gluteus medius, with exercises like side-lying leg raises and clamshells
- Core strengthening, including planks and bridges held for 30-60 seconds
- Running gait analysis and correction to address improper mechanics contributing to ITBS
Additional Considerations
- Proper footwear is essential, with shoes typically needing replacement every 300-500 miles
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily with food) can help manage pain and inflammation during the initial recovery phase
- Most patients see improvement within 4-6 weeks of consistent therapy, though complete resolution may take 2-3 months, as noted in studies such as 2 which discussed conservative management options
Underlying Biomechanical Issues
The therapy works by addressing the symptoms and underlying biomechanical issues that cause excessive friction between the IT band and lateral femoral condyle during repetitive knee flexion and extension, with the study 1 highlighting the need for a better understanding of the pathogenic factors contributing to tissue compression beneath the ITB.