Treatment of IT Band Syndrome with Inability to Bear Weight
For IT band syndrome causing inability to bear weight, immediately initiate corticosteroid injection to the lateral femoral epicondyle combined with strict rest and non-weight bearing status, followed by aggressive physical therapy focusing on gluteus medius strengthening and activity modification once pain permits ambulation. 1
Immediate Management for Severe Pain
Corticosteroid injection should be administered within three days when visible swelling or pain with ambulation persists, as this represents severe disease requiring more aggressive intervention than standard conservative measures. 1
Complete rest from aggravating activities is mandatory until the patient can ambulate without significant pain. 1
Ice application to the lateral knee should be performed multiple times daily to reduce acute inflammation. 1
Non-steroidal anti-inflammatory medications should be initiated immediately to address the inflammatory component at the distal iliotibial band. 1
Transition to Active Rehabilitation
Once the patient can bear weight without severe pain (typically after corticosteroid injection and initial rest period):
Stretching of the iliotibial band complex must be initiated, though evidence suggests focusing on the muscular component (tensor fasciae latae) rather than the band itself, as the ITB has limited capacity for elongation. 2, 3
Gluteus medius strengthening is essential and should be prioritized, as weakness in this muscle is a primary contributor to IT band syndrome pathology. 1
Activity modification requires identifying and eliminating the specific training errors that precipitated the syndrome (excessive mileage, hill running, cambered surfaces). 1
Critical Treatment Pitfalls
Do not rely on stretching alone, as the ITB is firmly attached along the linea aspera and demonstrates minimal strain response to typical stretching maneuvers (median microstrain values of only 9.4-44.6με). 2
Active patient participation is non-negotiable—treatment failure most commonly results from inadequate compliance with activity modification and exercise protocols. 1
The inability to bear weight represents a more severe presentation than typical IT band syndrome and warrants earlier consideration of corticosteroid injection rather than prolonged conservative management. 1
Surgical Consideration for Refractory Cases
If the patient remains unable to bear weight or resume activities after 3-6 months of aggressive conservative treatment including corticosteroid injection, surgical release should be considered. 1, 4, 5
Surgical options include Z-lengthening of the iliotibial band or mesh technique with multiple small incisions to release pressure on the lateral femoral epicondyle. 4, 5
Surgery is reserved for the small percentage of patients refractory to all conservative measures. 1