Treatment of Iliotibial Band Syndrome
The cornerstone of IT band syndrome treatment is modifying training regimens combined with hip abductor strengthening exercises, particularly targeting the gluteus medius, rather than focusing on IT band stretching alone. 1
First-Line Conservative Management
Training Modification (Essential Component)
- Reduce running volume and intensity during acute phases 1
- Avoid hills in initial stages post-injury 1
- Implement gradual return-to-running protocols with attention to biomechanical factors 1
- Reduce stride length or increase cadence to decrease tibial stresses and potentially reduce IT band tension 1
Hip Abductor Strengthening (Primary Exercise Focus)
- Perform hip abductor strengthening exercises to correct excessive hip adduction during running gait, with specific focus on gluteus medius strengthening 1, 2
- Address core and proximal strength to optimize lower extremity biomechanics and control knee alignment 1
- Screen for and address excessive peak hip adduction and rearfoot eversion angles, particularly in female runners 1
Important caveat: Hip abductor strengthening may paradoxically increase IT band strain while correcting hip adduction, so monitor symptoms carefully during strengthening programs 3
Stretching Protocol (If Incorporated)
- Perform stretching 2-3 days per week with proper technique 1
- Hold static stretches for 10-30 seconds for most adults 1
- Repeat each flexibility exercise 2-4 times, targeting 60 seconds total stretching time per exercise 1
Critical limitation: Anatomical studies demonstrate that intermittent stretching interventions are unlikely to change the IT band's length or mechanical properties, as the IT band is firmly attached along the linea aspera and shows minimal lengthening (<0.5%) with typical stretching maneuvers 4. Therefore, stretching should target the muscular component of the IT band/tensor fasciae latae complex rather than the IT band itself 4.
Range of Motion Assessment
- Perform baseline goniometry to identify muscle hypoextensibility and joint contractures, assessing hip, knee, ankle joints, IT band, hamstrings, and gastrocnemius 1
- Monitor range of motion every 6 months in patients with persistent symptoms to identify need for additional therapeutic intervention 1
Adjunctive Therapies
Anti-inflammatory Measures
Corticosteroid Injections (Second-Line)
- Consider corticosteroid injections if visible swelling or pain with ambulation persists for more than three days after initiating conservative treatment 2
Biomechanical Adjustments for Cyclists
- Make bicycle adjustments including seat height and cleat positioning 5
- Implement training modifications specific to cycling mechanics 5
Manual Therapy Techniques
- Osteopathic manipulative treatment using counterstrain technique may provide symptom relief, with the tender point located 0-3 cm (most commonly 2 cm) proximal to the lateral femoral epicondyle 6
Surgical Intervention (Refractory Cases)
- A small percentage of patients refractory to conservative treatment may require surgical release of the IT band 2
- Surgical technique involves excision of an elliptical piece of the distal posterior band off the lateral femoral epicondyle 5
- Reserve surgery only after exhausting conservative measures for at least 3-6 months 2
Common Pitfalls to Avoid
- Do not focus exclusively on IT band stretching, as the IT band's anatomical properties make it resistant to lengthening 4
- Avoid standard stretching protocols that fail to address the underlying biomechanical causes (excessive hip adduction, weak hip abductors) 1, 3
- Do not allow patients to continue high-intensity training or hill running during acute phases, as this perpetuates the injury cycle 1
- Recognize that treatment requires active patient participation and compliance with activity modification 2