Practical Management of Iliotibial Band Friction Syndrome in Runners

This article outlines the practical management of iliotibial band friction syndrome (ITBFS) in running athletes. ITBFS is the most common cause of lateral knee pain in runners and is related to repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle. Runners predisposed to this injury are typically in a phase of over training and often have underlying weakness of the hip abductor muscles. The diagnosis of ITBFS is clinical and is based on a thorough patient history and physical exam. In the acute phase, treatment includes activity modification, ice, nonsteroidal anti-inflammatory medication, and corticosteroid injection in cases of severe pain or swelling. During the subacute phase emphasis is on stretching of the iliotibial band and soft tissue therapy for any myofascial restrictions. The recovery phase focuses on a series of exercises to improve hip abductor strength and integrated movement patterns. The final return to running phase is begun with an every other day program, starting with easy sprints and avoidance of hill training with a gradual increase in frequency and intensity. In rare refractory cases that do not respond to conservative treatment, surgery can be considered.