Treatment of Iliotibial (IT) Band Syndrome
The treatment of iliotibial band syndrome should focus on conservative management with stretching of the iliotibial band, strengthening of the hip muscles, and activity modification as first-line therapy. 1
Diagnosis and Clinical Presentation
- Characterized by lateral knee pain caused by inflammation of the distal portion of the iliotibial band
- Pain typically occurs with repetitive knee flexion and extension activities (running, cycling)
- Physical examination may reveal:
- Tenderness over the lateral femoral epicondyle
- Positive Noble test (pain with knee flexion at 30° while applying pressure to lateral femoral epicondyle)
- Pain with resisted hip abduction
Conservative Management (First-Line Treatment)
1. Activity Modification
- Reduce or temporarily cease aggravating activities
- Avoid running on banked surfaces or exclusively in one direction on a track
- Decrease training intensity, duration, and frequency
- Cross-train with low-impact activities (swimming, cycling if not painful)
2. Stretching Protocol
- Focus on stretching the iliotibial band:
- Standing IT band stretch: Cross affected leg behind unaffected leg and lean toward unaffected side
- Side-lying IT band stretch: Affected leg extended, bottom leg flexed, pull top leg toward floor
- Hold stretches for 30 seconds, repeat 3-5 times, 2-3 times daily
3. Strengthening Exercises
- Target hip abductors (particularly gluteus medius) and external rotators:
- Side-lying hip abduction
- Clamshell exercises
- Single-leg squats with proper alignment
- Hip hikes
- Perform 3 sets of 10-15 repetitions daily
4. Physical Therapy Modalities
- Ice massage to lateral knee for 10-15 minutes after activity
- Foam roller self-massage along the lateral thigh
- Deep tissue massage targeting IT band and associated muscles
Advanced Interventions (For Persistent Cases)
1. Corticosteroid Injections
- Consider if visible swelling or pain with ambulation persists for more than three days after initiating conservative treatment 1
- Target the area of maximal tenderness at the lateral femoral epicondyle
- Limit to 2-3 injections with at least 6 weeks between injections
2. Biomechanical Assessment and Correction
- Evaluate for foot pronation, leg length discrepancy, or gait abnormalities
- Consider custom orthotics if biomechanical issues are identified
- Proper footwear selection for runners
3. Surgical Intervention
- Reserved for cases refractory to 6+ months of conservative management
- Surgical options include:
- IT band release at the lateral femoral epicondyle
- Arthroscopic debridement of inflamed tissue
- Z-plasty lengthening of the IT band
Treatment Efficacy and Considerations
Recent research challenges traditional understanding of IT band syndrome. Ultrasound shear wave elastography studies suggest that IT band tension may not actually be increased in affected individuals compared to healthy controls 2. Additionally, anatomical studies indicate that the IT band does not actually "roll over" the lateral femoral epicondyle as previously thought, but is anchored to the distal femur by fibrous strands 3.
Despite these findings, clinical experience shows that conservative management focusing on stretching and strengthening remains effective for most patients. The mechanism may involve addressing compression of the fat pad deep to the IT band rather than reducing friction 3.
Return to Activity Protocol
- Begin with pain-free low-impact activities
- Gradually reintroduce previous activities at 50% of pre-injury level
- Increase activity by no more than 10% per week
- Continue stretching and strengthening exercises even after symptoms resolve
- Consider gait analysis for runners to identify and correct biomechanical issues
Most patients with IT band syndrome respond well to conservative management when implemented consistently. Only a small percentage require surgical intervention 1.