From the Research
Treatment for iliotibial band syndrome should prioritize conservative management, including rest, ice, NSAIDs, stretching, foam rolling, and strengthening exercises, as these interventions have been shown to effectively reduce pain and improve function in runners, with hip abductor strengthening exercises emerging as a particularly effective strategy 1.
Overview of Treatment Options
Treatment options for iliotibial band (ITB) syndrome include both conservative and interventional approaches. The goal of treatment is to reduce pain and inflammation, improve function, and prevent recurrence.
Conservative Management
Conservative management is the first line of treatment and includes:
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily to reduce inflammation
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (220-440mg twice daily) to manage pain and inflammation for short periods
- Stretching exercises targeting the ITB, hip abductors, and quadriceps, performed 2-3 times daily, holding each stretch for 30 seconds and repeating 3-5 times
- Foam rolling the lateral thigh for 1-2 minutes daily to release tension
- Strengthening exercises for hip abductors (particularly gluteus medius) and core muscles, incorporated 3 times weekly
Additional Considerations
- Proper footwear with adequate support is essential, and runners should replace shoes every 300-500 miles
- Biomechanical issues may require gait analysis and possibly custom orthotics
- For persistent cases, physical therapy for 6-8 weeks is recommended
- Corticosteroid injections may provide temporary relief in recalcitrant cases
- Surgery is rarely needed but may be considered after 6-12 months of failed conservative treatment
Recent Evidence
A recent systematic review found that conservative treatment strategies, including hip abductor strengthening exercises, can effectively reduce pain and improve function in runners with ITB syndrome, with intervention effects on pain reduction ranging from 27% to 100%, and functional improvement from 10% to 57%, over 2 to 8 weeks 1.
Recommendation
Based on the most recent and highest quality evidence, conservative management, including hip abductor strengthening exercises, should be the primary treatment approach for iliotibial band syndrome, with a focus on reducing pain and improving function in runners 1.