Treatment of Iliotibial Band Tendinitis
Begin with conservative management consisting of relative rest, ice therapy, iliotibial band stretching, gluteus medius strengthening, and training modification for 2-6 weeks, with most patients responding within this timeframe. 1
Initial Conservative Treatment (First-Line)
The cornerstone of management involves active patient participation with activity modification and targeted rehabilitation 1:
Relative rest by reducing or temporarily stopping the aggravating activity (running, cycling) to prevent ongoing irritation of the distal iliotibial band over the lateral femoral epicondyle 1, 2
Ice therapy applied to the lateral knee to reduce inflammation and provide pain relief 1
Iliotibial band stretching exercises performed daily, as this is the most commonly recommended intervention despite limited direct evidence for its isolated benefit 1, 3
Gluteus medius strengthening to address biomechanical factors contributing to excessive iliotibial band tension 1
Training regimen modification including reducing mileage, avoiding hills and cambered surfaces, and correcting running mechanics 1, 2
Conservative management produces a 44% complete cure rate with return to sport at 8 weeks, and a 91.7% cure rate with return to sport at 6 months 2. This is notably different from other tendinopathies where 80% recover within 3-6 months 4.
Second-Line Conservative Options
If symptoms persist beyond 3 days with visible swelling or pain with ambulation:
Corticosteroid injection into the area of maximal tenderness over the lateral femoral epicondyle should be considered 1, 5
NSAIDs (oral or topical) for acute pain relief, though evidence specific to ITBS is limited 6
The evidence for other modalities like deep friction massage and phonophoresis in ITBS is weak and inconsistent 6.
Surgical Management
Reserve surgical intervention for patients who fail 2-6 months of well-executed conservative treatment. 2, 5
Surgical options include:
Excision or release of the pathologic distal portion of the iliotibial band over the lateral femoral epicondyle, which shows 100% return to sport rates at both 7 weeks and 3 months post-operatively 2
Release of posterior fibers of the iliotibial band at the site of friction 5
Only a small percentage of patients require surgery, but when indicated, outcomes are excellent 1, 2.
Diagnostic Confirmation
The diagnosis is clinical, confirmed by:
Point tenderness over the lateral femoral epicondyle approximately 2-3 cm above the lateral joint line 1, 5
Pain at 30 degrees of knee flexion when compressing the iliotibial band against the lateral epicondyle (Noble compression test) 5
Pain reproduction with repetitive knee flexion-extension movements 1
Critical Pitfalls to Avoid
Do not allow patients to "run through the pain" - this leads to chronic symptoms and prolonged recovery 1
Address training errors early - most cases result from sudden increases in mileage, hill running, or running on cambered surfaces 1, 5
Do not rely solely on stretching - multimodal treatment including strengthening and activity modification is essential 1, 2
Recognize refractory cases early - if no improvement after 2-6 weeks of conservative treatment, consider corticosteroid injection rather than prolonging ineffective therapy 1, 2
The literature reveals significant gaps in high-quality evidence for ITBS treatment, with most recommendations based on clinical experience rather than rigorous trials 6. However, the combination of rest, stretching, strengthening, and activity modification remains the accepted standard approach 1, 2.