Iliotibial band syndrome medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
As with any injury or ailment, one should see one's physician, physical therapist or athletic trainer for diagnosis and treatment.
For a runner with acute ITBS, reduce weekly distance training to 50% for 2 weeks, and only run on flat ground. After, in the absence of ITBS pain, slowly begin to build distance again. If ITBS pain remains or is chronic, one should stop running immediately for two weeks (minimum). If the pain and inflammation are still present, another month of rest may be needed. Once the injury begins to improve, resuming activity can be possible, doing low distance, low speed jogging on flat terrain. Also, changing one's route may help counteract re-injury, as running a common route may put increased stress on the iliotibial band of one leg.
To prevent, or cure chronic ITBS there are some essential exercises:
- Strength building of the proximal hip musculature for controlling ITB tightness; especially the straight leg raising motion and hip adduction
- Performing specific stretches; Iliotibial band stretch, stretching the gluteal muscles, and other leg based static stretching
To create a good treatment program, proper assessment of injury severity is critical. Once the injury has been properly assessed, a treatment program (usually consisting of three steps) can be planned. The length of time spent on each phase varies depending on the athlete, the reasons for the initial injury, and the severity of the injury.
Immediate Treatment
After noticing symptoms, the important task is controlling pain and inflammation. For these symptoms, RICE works well. Stretching is second in importance, to make sure that the iliotibial band does not become taut. Next, examining what may have caused ITBS is important. Issues range from poor training habits to structural abnormalities, but the shoes a runner uses are another consideration. For example, after 500 miles most shoes retain less than 60% of their initial shock absorption capacity, increasing the chance of ITBS injury. Lastly, anti-inflammatories or ultrasound may be helpful to relieve symptoms.
Short Term Treatment
If the pain and inflammation do not subside, all painful activity should stop while continuing immediate treatment. A regular stretching regimen is important. A video analysis of running movements may provide insight into problematic running mechanics. To retain fitness, a number of options will work at this stage, as long as they do not promote pain. Altering these exercises will minimize overtraining:
- Swimming, though abstain from the breaststroke as it may aggravate symptoms
- Optionally, wearing a life jacket, one may run in the pool (depth allowing)
- Cycling, though with care, as it may aggravate symptoms
- Speed walking, especially straight-legged to discourage pain
- Cross-country skiing
- Yoga, or similar low-impact aerobics
At this stage, Steroid injections may be helpful, though some risks are involved.
Long Term Treatment
The last phase is only started once pain and inflammation are gone. Often, this phase involves returning to a normal state, even competitive sports. Though, at least these criteria must be satisfied:
- The injured knee has regained full range of motion without pain
- The injured knee has regained normal strength compared to the uninjured knee
- Cardiovascular endurance has normalized
Most importantly, one must ensure that old symptoms do not recur. Thus, any pain or inflammation must be treated cautiously, especially if the ITBS was serious and involved a lengthy downtime. The return process must be gradual and treated with extreme care, structurally specific stretching during this time is essential and must be done extensively, before and after activity. Returning to activity should be done while correcting, or significantly reducing, any factors that were thought to have caused ITBS. If no factors are identified and corrected, the chance of the re-injury is much higher.