Iliotibial Band Syndrome
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IT band syndrome is a painful condition of the outside of the knee, learn more here: Iliotibial Band Syndrome. The initial phase needed to fix iliotibial band syndrome is RICE, rest, ice, compression and elevate. The rest component is essential. It doesn’t mean complete rest but it means reduction or complete halt to any activities that aggravate the symptoms of iliotibial band syndrome. This may include stopping or significantly reducing running, or walking in more severe cases. It may be avoiding stairs and taking a lift when possible. Or not lying on your side, and avoiding sitting with crossed legs, or on low chairs. All of these activities will put the IT band under more tension and the irritated fat pad under more compression, so can make the pain worse.
The next phase needed to fix iliotibial band syndrome is addressing what the cause was. We covered common causes in another article in more depth. Common causes are training error, such as increasing training volume to quickly, and biomechanical factors. Biomechanical factors may include a range of running styles, poor strength in stability muscle of the hip and pelvis, and tight glutes, quadriceps and hamstring muscles. Additionally, iliotibial band pain is relatively common in pregnancy, as well as in the elderly and those who are overweight or obese. By addressing these issues you will prevent the issue from reoccurring.
Iliotibial band syndrome exercises will vary from person to person. A good assessment is key to knowing the main cause and the contributing factors for your specific case. A physical therapist is well placed to provide this thorough assessment, discuss this with you and formulate a plan for your rehab. The specific exercises that they prescribe should work on your flexibility by stretching and foam rolling areas where you are tight and, strengthening exercises for areas that are weak. You can read more about common exercises that are helpful for the recovery and prevention of iliotibial band syndrome in the IT Band Exercises article.
Massage is hugely beneficial in the early stages of iliotibial band syndrome recovery and, when used regularly more long-term for it prevention of occurring or re-occurring. Massage therapies can help to relax tight muscles. There are different massage treatments that can be used. Deep tissue massage is when strong pressure is used in various directions through the muscle, it can also include the pressure and release of trigger points. Trigger points are tight specific points within a muscle, they often feel tender to touch and may be felt as a burning sensation. Sometimes these points can refer pain in a repeatable pattern when pressed. Sports massage uses deep tissue massage techniques but also utilises stretching as part of the treatment. Many people find they are significant pain relief after massage, for a short period of time.
Whether you should or should not foam roll is a big point of discussion between different therapists and personal trainers. There are two sides to this argument. One side argues that foam roller exercises are helpful to relax the surrounding muscles and IT band. And while it is painful over the IT band it will feel less painful after foam rolling.
The other side of the argument is that the IT band is dense connective tissue that is more similar to a ligament and therefore foam rolling it will not reduce any tension through it. It will be painful and ineffective, and at worse could worsen symptoms due to the compression of the fat pad under the IT band.
With the anatomical knowledge of the iliotibial band (read more about this here Iliotibial Band Syndrome), it is compression of the fat pad under the band on the outside of the knee that causes pain. Repeated compression of the fat pad causes it to become inflamed and therefore painful. Therefore, if you were to lie on your side on a foam roller you would be applying compression to the iliotibial band which would also compress this fat pad.
In conclusion we suggest that you do not foam roll the IT band. But you can foam rolling the surrounding muscles: quadriceps, hamstrings, calf, gluteals and tensor fascia lata. This will help to relax the muscles, while avoiding the pain felt over the IT band which may be at best ineffective and, at worse aggravate symptoms.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are medication that are used to reduce pain and swelling in muscle and joints. These are effective medications for treating iliotibial band pain when it persists. It is generally recommended to avoid NSAIDs for the initial 48hours after an acute injury as it may slow down healing. The initial inflammatory response is necessary for the healing process.
While these are effective pain medications, NSAIDs will not fix the injury or address the cause. Therefore, assessing what the contributing factors were that resulted in IT band pain is still necessary.
With any medication, you should consult your doctor or pharmacist first, as all medications have side effects and should be taken with caution. For example, many NSAIDs can trigger symptoms of allergies and asthma.
Elasticated sports tapes such as Kinesio tape are used for many sports and soft tissue injuries. Anecdotally, many people report that iliotibial band pain is significantly reduced with the application of this type of taping. This pain reduction, which feeling better, can also facilitate the completion of rehab exercises to help fix the issue.
The way KT tape works according to KT tape UK is, “It is believed that when applied correctly, KT Tape lifts the skin, decompressing the layers of fascia, allowing for greater movement of lymphatic fluid which transports white blood cells throughout the body and removes waste products, cellular debris, and bacteria.”
To see how they recommend taping the outside of the knee for iliotibial band pain click here.
Acupuncture and dry needling are a type of treatment that has been used for thousands of years for reducing pain and inflammation, and to promote the healing of many different injuries. Originating from the Far East, acupuncture and dry needling is now common in Weston medicine with an increasing body of research to support it safety and efficacy.
There is evidence that acupuncture can help relax muscles, and inflammation can reduce as a result of acupuncture. Pain reduction is also a common reported outcome in several studies (Maghroori et al, 2021).
Surgery should be a last resort and is rarely necessary. While IT band syndrome can persist for a long time, it is important to evaluate the progress. If it isn’t improving with standard treatment and self-care, and following the advice of a physiotherapist for appropriate rehabilitation it may be necessary to have more medical management such as surgery or injections.
Injections, such as corticosteroids are used to reduce inflammation and can be directed specifically into the fat pad, using ultra sound guidance. This method of delivery is preferred as it will reduce the harmful effects of steroids on the surrounding tissues. Cortisone injections are often used as a last resort, but there is a good argument to having it early on. Long lasting pain and inflammation can cause scar tissue to develop and this can make recovery more complex. As well as cortisone, some sports doctors will inject Botox into especially tight muscles, such as the tensor fascia lata, to cause them to relax. This can dramatically speed up the recovery process.
Typically, iliotibial band syndrome lasts 6-8 weeks if proactive treatment is started as soon as pain develops. If the pain is ignored and persists for a long time before treatment commences, then it can take a lot longer to resolve. The development of scar tissue, from long-lasting inflammation, can make treatment come complicated and recovery times and overall outcomes will be worse. There are many cases of IT band pain that has persisted for years due to repeated aggravation, inadequate rest, and if the cause has not been found or fixed.