Iliotibial band syndrome surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Surgery

Rarely, and only in extreme cases, surgery is used to correct the injury. Typically, unless one is still suffering from symptoms in 6-12 months, surgery is not performed. It involves the release-excision of the iliotibial band, performed after an arthroscopic evaluation of the knee, which rules out other causes for the symptoms. Only patients unwilling to adapt their exercise because of this injury undergo surgery; it should only be performed after all other treatments have failed.

Rehabilitation

After the Pain is Gone

• Continue stretching, as well as strengthening of the leg muscles.
• The patient should start running only after treatment.
  • Restart running with small distances, building slowly.
  • If the patient feels pain, he or she should stop.
    • Even better, the patient should try to stop running before the pain starts.

Some Rehabilitation Options

• Deep-tissue massage or Rolfing may help break up scar tissue that forms.
• Non-steroidal anti-inflammatory drugs (aka NSAIDs), in high doses for a period of weeks, can help reduce the inflammation.
• Strengthening exercises for the quadriceps femoris and gluteus medius muscles can help support the leg, thus lessening the load on the ITB.
• Glucosamine Sulfate and Chondroitin Sulfate may help.

Example Physical Therapy Regimen

For successful rehabilitation, it is essential to restore the flexibility of the iliotibial band, and the strength and flexibility of the muscles which act upon it. Stretching the band is a complicated task; before the band can stretch, the hip flexors must stretch.

To prepare for ITB stretching, one may heat the lateral thigh with hydrocollator packs for a period of time, typically twenty minutes. This is followed by ultrasonic heating (1.5-2.0 watts/cm²) to the length of the ITB tract for 5-7 minutes. After one stabilizes the pelvis while another person (qualified therapist) stretches the leg to maximally tolerated adduction. This may be repeated using three 1-minute stretches. Cryotherapy of the painful and inflamed tissue for ten minutes in the stretched position is also effective. (Gose, 1989)