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

Treatment of Iliotibial Band Syndrome

Conservative management with activity modification, ITB stretching, and gluteus medius strengthening should be the first-line treatment for IT band syndrome, with corticosteroid injections reserved for cases with persistent swelling or pain beyond 3 days, and surgical intervention considered only for refractory cases after 6 months of failed conservative therapy. 1, 2

Initial Conservative Management (First 2-6 Weeks)

The cornerstone of treatment requires active patient participation and strict adherence to activity modification 1:

• Rest from aggravating activities for 2-6 weeks, particularly running, cycling, and repetitive knee flexion-extension movements 2
• ITB stretching exercises should be performed daily, though evidence suggests focusing on the muscular component (tensor fasciae latae) rather than the band itself, as the ITB demonstrates minimal lengthening capacity (<0.5%) 3
• Gluteus medius strengthening is essential to address biomechanical dysfunction and prevent recurrence 1
• Training modification including reducing mileage, avoiding hills and cambered surfaces, and correcting running mechanics 1
• Pain management with ice application and NSAIDs to control inflammation 2

When to Escalate: Corticosteroid Injections

Corticosteroid injections should be administered if visible swelling or pain with ambulation persists for more than 3 days after initiating conservative treatment 1. The injection targets the area of inflammation between the ITB and lateral femoral epicondyle.

Expected Outcomes with Conservative Treatment

Conservative management produces variable results 2:

• 44% complete cure rate with return to sport at 8 weeks 2
• 91.7% cure rate with return to sport at 6 months after injury 2
• Most patients respond to conservative treatment when compliance with activity modification and stretching is maintained 1

Surgical Intervention for Refractory Cases

Surgery should be considered only after 6 months of failed conservative therapy 2. Surgical options include:

• Excision or release of the pathologic distal ITB at the lateral femoral epicondyle, showing 100% return to sport rates at 7 weeks to 3 months post-operatively 2
• Z-lengthening of the ITB for cases with pain localized to the lateral femoral epicondyle and Gerdy's tubercle 4
• Bursectomy when indicated 2

Critical Pitfalls to Avoid

• Do not rely solely on traditional ITB stretching maneuvers (Ober test, straight leg raise) as these generate minimal strain in the ITB itself; instead, focus on hip flexion with adduction and external rotation combined with knee flexion to target the tensor fasciae latae muscle 3
• Avoid premature return to activity before adequate rest period (minimum 2-6 weeks), as this is the most common cause of treatment failure 2
• Do not proceed to surgery prematurely; a small percentage of patients require surgical intervention, and conservative treatment should be exhausted first 1
• Address biomechanical factors including weak hip abductors, as failure to correct these predisposes to recurrence 1