What is the treatment for iliotibial (IT) band pain syndrome?

Treatment of Iliotibial Band Pain Syndrome

Conservative treatment is the first-line approach for iliotibial band pain syndrome, focusing on stretching, strengthening, and activity modification before considering more invasive options. 1

First-Line Treatment Options

Rest and Activity Modification

• Reduce or temporarily cease activities that exacerbate symptoms
• Modify training regimens to decrease repetitive knee flexion and extension
• Avoid running on banked surfaces or always in the same direction on a track

Physical Therapy Interventions

• Stretching exercises:

  • Standing IT band stretch: Cross affected leg behind unaffected leg and lean toward unaffected side
  • Side-lying IT band stretch (modified Ober test position)
  • Hip flexion, adduction and external rotation with knee flexion (produces greater strain than straight leg raise) 2

• Strengthening exercises:

  • Focus on gluteus medius strengthening (side-lying leg raises, clamshells)
  • Hip abductor strengthening
  • Core stabilization exercises

Pain Management

• Ice application to the lateral knee for 15-20 minutes several times daily
• NSAIDs for pain and inflammation control
• Local heat application may benefit some patients

Second-Line Treatment Options

Therapeutic Modalities

• Foam roller myofascial release along the lateral thigh
• Deep tissue massage targeting the IT band and TFL
• Ultrasound therapy to the point of maximum tenderness

Biomechanical Corrections

• Gait analysis to identify and correct running mechanics
• Proper footwear assessment and recommendations
• Consider orthotics for those with excessive pronation

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 maximum tenderness, typically 0-3 cm proximal to the lateral femoral epicondyle 3
• Limit to 1-2 injections to avoid tissue weakening

Third-Line Treatment Options

Osteopathic Manipulative Treatment

• Counterstrain technique targeting tender points 0-3 cm proximal to the lateral femoral epicondyle 3
• Helps reduce proprioceptor activity and relieve pain

Surgical Intervention

• Consider only after 6+ months of failed conservative management
• Surgical options include:
  1. Partial resection of the posterior half of the IT band where it passes over the lateral femoral epicondyle 4
  2. Mesh technique: multiple small incisions across the IT band fibers to release tension 5
• Success rates: 75-85% of surgical patients report good to excellent outcomes 4

Return to Activity Protocol

1. Begin with pain-free cross-training (swimming, cycling with adjusted seat height)
2. Gradually reintroduce running on flat surfaces
3. Slowly increase distance before increasing intensity
4. Continue maintenance stretching and strengthening program

Common Pitfalls to Avoid

• Returning to full activity too quickly before adequate healing
• Focusing only on IT band stretching without addressing hip abductor weakness
• Neglecting to correct training errors or biomechanical issues
• Overreliance on passive treatments without active rehabilitation
• Failing to recognize that the IT band is a thickening of fascia firmly attached to the femur, making traditional stretching less effective than commonly believed 2

Remember that most patients respond well to conservative treatment, with only a small percentage requiring surgical intervention. Consistent adherence to the rehabilitation program is crucial for successful outcomes.