Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

pain and inflammation

1st line – non-steroidal anti-inflammatory drugs (NSAIDs)

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ACUTE
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pain and inflammation
1st line – 

non-steroidal anti-inflammatory drugs (NSAIDs)

In the acute phase, goals of treatment include reducing local inflammation and providing effective pain relief with NSAIDs.

Primary options

diclofenac potassium: 50 mg orally (immediate-release) three times daily when required

OR

ibuprofen: 400-600 mg orally every 4-6 hours when required, maximum 2400 mg/day

Plus – activity modification

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ACUTE
|
pain and inflammation
Plus – 

activity modification

Treatment recommended for ALL patients in selected patient group

Patients should be advised regarding activity modification. In mild iliotibial band syndrome (ITBS), this involves limiting physical activity up to the point (time or distance) at which symptoms begin. In severe ITBS, patients should avoid aggravating activities but can consider alternative forms of physical activity that don’t engage the affected limb. Any activity that requires repeated knee flexion and extension is prohibited. Ice should be used on the affected area.

Plus – combination local anaesthetic and corticosteroid injection

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ACUTE
|
pain and inflammation
|
severe pain or swelling or refractory to non-steroidal anti-inflammatory drugs (NSAIDs)/activity modification
Plus – 

combination local anaesthetic and corticosteroid injection

Treatment recommended for ALL patients in selected patient group

Recommended for patients with severe pain or swelling and in refractory cases.[39]

Inject in the area where the iliotibial band crosses the lateral femoral condyle.

[Figure caption and citation for the preceding image starts]: Injection site for iliotibial bandFrom the personal collection of Dr J.C. Mak [Citation ends].com.bmj.content.model.Caption@4ef15e9b

Primary options

methylprednisolone acetate: 40 mg by injection as a single dose

and

lidocaine: 10 mg by injection as a single dose

ONGOING

resolved pain and inflammation

1st line – stretching exercises

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ONGOING
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resolved pain and inflammation
1st line – 

stretching exercises

The subacute phase is characterised by subsiding inflammation and pain. During this phase, emphasis is on stretching of the iliotibial band and soft-tissue therapy for any myofascial restrictions (e.g., trigger points, muscle contractures, fascial adhesions) which supports muscle strengthening and re-education.[Figure caption and citation for the preceding image starts]: Standing stretch exerciseFrom the personal collection of Dr J.C. Mak [Citation ends].com.bmj.content.model.Caption@5bfdd510

Plus – foam roll mobilisation

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ONGOING
|
resolved pain and inflammation
Plus – 

foam roll mobilisation

Treatment recommended for ALL patients in selected patient group

Foam roll mobilisation can be combined with stretching exercises to improve myofascial restrictions along the lateral hip and thigh.[41][Figure caption and citation for the preceding image starts]: Foam roll exerciseFrom the personal collection of Dr J.C. Mak [Citation ends].com.bmj.content.model.Caption@4c51a9e6

Plus – recovery and strengthening

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ONGOING
|
resolved pain and inflammation
Plus – 

recovery and strengthening

Treatment recommended for ALL patients in selected patient group

Once range-of-motion and myofascial restrictions have been resolved with stretching exercises and foam roll mobilisation, recovery and strengthening can begin with exercises to promote movement patterns and improve hip abductor strength.

Electromyography studies suggest that contractions above 60% of the maximal voluntary isometric contraction are needed for strengthening.[42][43] This intensity is achieved with progression into single leg squat exercises and use of resistance (e.g., 2.3 kg [5 lb] ankle weight with side-lying hip abduction).[42][Figure caption and citation for the preceding image starts]: Demonstration of pelvic dropFrom the personal collection of Dr J.C. Mak [Citation ends].com.bmj.content.model.Caption@48a11789

Plus – return to running

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ONGOING
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resolved pain and inflammation
Plus – 

return to running

Treatment recommended for ALL patients in selected patient group

Following recovery and strengthening, patients are gradually reintroduced to running once open-chain and closed-chain exercises can be performed pain free.

refractory to conservative treatment

1st line – elective surgery

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ONGOING
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refractory to conservative treatment
1st line – 

elective surgery

Most patients will respond to a conservative treatment approach.[38]​ However, surgery may occasionally be required to decrease impingement of the ITB on the lateral femoral epicondyle. The surgery involves resection, when the leg is in a 30° flexed position, of a triangular piece of the ITB from the area overlying the lateral epicondyle. Additionally, the PLAR technique (which combines percutaneous lengthening of the ITB and arthroscopic debridement of the lateral synovial recess) may be effective in allowing a return to previous sports performance levels.[40]

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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