Treatment of Iliotibial Band Syndrome in Athletes
For an athlete with IT band syndrome, initiate conservative management with complete rest from running for 2-6 weeks, combined with hip abductor strengthening exercises, ITB stretching, and activity modification, which produces a 44% complete cure rate at 8 weeks and 91.7% cure rate at 6 months. 1
Initial Management Phase (First 2-6 Weeks)
Complete cessation of running and aggravating activities is mandatory during the acute phase. 1, 2 This is not negotiable—continuing to run through IT band pain leads to chronic symptoms and treatment failure.
Pain and Inflammation Control
- Apply ice to the lateral knee region during the acute phase 2
- Use NSAIDs for pain management and inflammation reduction 2
- Consider corticosteroid injection only for severe pain or swelling that doesn't respond to initial conservative measures 2
- Osteopathic manipulative treatment (counterstrain technique) targeting the tender point 0-3 cm proximal to the lateral femoral epicondyle may provide symptom relief 3
Key Clinical Pitfall
The most common mistake is athletes attempting to "run through" IT band pain or returning to running too quickly. ITBS has high recurrence rates when athletes resume training prematurely, so strict adherence to the rest period is critical. 1, 4
Subacute Phase: Addressing Mechanical Factors
Hip Abductor Strengthening (Primary Intervention)
Hip abductor weakness is the most consistent underlying factor in runners with ITBS, and strengthening these muscles is the cornerstone of rehabilitation. 2 However, there's an important caveat: hip abductor strengthening may initially increase ITB strain since these muscles insert into the ITB, so progression must be gradual. 4
- Focus on gluteus medius and gluteus minimus strengthening exercises 2
- Progress from non-weight bearing to weight bearing exercises 2
- Integrate functional movement patterns that improve hip stability during running 2
ITB Stretching and Soft Tissue Work
While the evidence for ITB stretching is mixed (the ITB has limited capacity to lengthen due to its dense fascial structure), stretching is commonly included in multimodal treatment and shows no negative effects. 5, 4
- Perform ITB-specific stretches during the subacute phase 2
- Address myofascial restrictions with soft tissue therapy 2
- Note that intermittent stretching is unlikely to change the ITB's mechanical properties, but may provide symptomatic relief 4
Return to Running Protocol
Do not begin running until the athlete has been completely pain-free with walking and daily activities for at least 10-14 consecutive days. 6, 7, 8
Structured Progression
- Start with an every-other-day running program to allow tissue adaptation 6, 7, 2
- Begin with easy-paced running, significantly slower than pre-injury pace 7, 2
- Avoid hill training initially—hills dramatically increase ITB strain and are a common cause of symptom recurrence 2
- Use compliant surfaces (treadmill or soft trails) rather than hard pavement initially 7
- Progress distance before speed, building to 50% of pre-injury distance before introducing any speed work 7, 8
Running Retraining Considerations
Running biomechanics modification is a promising but understudied intervention for ITBS. 4 Consider gait analysis to identify excessive hip adduction during stance phase, which increases ITB compression forces at the lateral knee. 4, 2
When Conservative Treatment Fails
If symptoms persist despite 6 months of appropriate conservative management, surgical intervention should be considered. 1
Surgical options include:
- Excision or release of the pathologic distal ITB portion, which shows 100% return to sport rates at 7 weeks to 3 months post-surgery 1
- Bursectomy in select cases 1
Surgery is reserved for refractory cases only, as conservative management is successful in the vast majority of athletes when properly implemented. 1
Critical Success Factors
The athlete must address the underlying biomechanical cause—typically hip abductor weakness and overtraining—or recurrence is nearly guaranteed. 2 ITBS is fundamentally an overuse injury occurring in the context of inadequate hip stability, so simply resting and returning to the same training patterns will result in symptom recurrence. 4, 2