The iliotibial band is a tendon that runs down the outside of the thigh, connecting the tensor fascia lata muscle of the iliac crest to its attachment point on the lower outside of the knee. Iliotibial band friction syndrome, an irritation of the tendon involving pain at the lateral knee, is prevalent among runners and others who engage in vigorous exercise.
RICE Protocol
In the initial phase of injury, up to 72 hours after symptoms appear, the RICE protocol of rest, ice, compression and elevation should be followed to reduce swelling, inflammation and pain, according to the Stretching Institute. During the resting period, avoid activities that involve repetitive flexion and extension of the knee, such as walking up and down stairs, and running. Ice can be applied for 20-minute intervals per hour throughout the day, according to chiropractor Dr. Joshua Dubin. Non-steroidal anti-inflammatory medications may help manage pain in this phase, as well. A properly fitted knee brace will promote improved function at the knee, while providing compressive support to weakened structures. Modalities such as ultrasound and electrical muscle stimulation can be helpful at this stage to reduce tight muscles and speed healing.
Massage
When the inflammation has subsided, massage can be added in. Massage will soften and lengthen the muscles and relieve pressure on the low back, hip and knee joints in preparation for more active rehabilitation and eventual return to sports and daily activities. Deep-tissue massage can reach some of the deeper structures and release longstanding tight areas. Cross-friction massage, perpendicular to the direction of the muscle, helps break up adhesions.
Stretching
A gentle stretching program ensures that the muscles will perform with less risk of injury. Muscles to include are the hip flexors, including the iliopsoas and quadriceps; extensors, including the hamstrings and gluteus maximus; abductors (muscles that bring the leg out to the side), including the TFL and gluteus medius; and adductors (muscles that bring the leg in toward the body), the muscles of the inner thigh. A technique of sustained stretching for 20 to 30 seconds combined with short contractions of the opposing muscle is recommended, according to Dubin.
Manipulation
Dr. Steven J. Karageanes of the Center for Orthopedics and Neuroscience Department of Medical Education at Oakwood Healthcare System recommends manipulation as a means to correct biomechanical imbalances around the low back, hip and knee that allow this condition to occur. Specific areas to address with manipulative therapy include the upper lumbar spine and the fibular head where the iliotibial band attaches.
Strengthening
Building strength back by targeting the weaker muscles and emphasizing safe and proper form for the large muscle groups can begin after the acute phase and before return to full activities. Side leg lifting and stepping down with the affected side on a slightly elevated surface are helpful. Squats and bridges, lying on the back and lifting the hips into the air, can be employed, as well.
Activity Modification
Upon resumption of activity, Stephen M. Pribut recommends shortening your stride and avoiding downhills and side-sloping surfaces. Continue to use targeted stretching and strengthening exercises to prevent return to faulty biomechanics.
Orthotics
Properly fitting athletic shoes and orthotics, preferably customized for your individual foot structure to prevent over-pronation, or flattening of the arch, are highly recommended, according to the Time-to-run.com. Orthotics promote healthy weight-bearing and distribution of forces through the foot, ankle knee, hip and back.
References
- Dubin Chiropractic: Evidence Based Treatment for Iliotibial Band Friction Syndrome
- Stretching Institute: Knee Pain, Knee Injuries and Iliotibial Band Syndrome
- American Family Physician: Iliotibial Band Syndrome: A Common Source of Knee Pain
- Iliotibial Band Friction Syndrome: Treatment
- Dr. Stephen M. Pribut: Iliotibial Band Syndrome
