IT Band Syndrome Treatment

Recovery from IT band syndrome usually involves rest, stretching and strengthening exercises, and a gradual return to activity. Nearly 1 in every 2 people with IT band syndrome are able to return to a regular workout routine within 8 weeks of beginning treatment. After 6 months, that ratio increases to 9 in 10 people.¹Pegrum J, Self A, Hall N. Iliotibial band syndrome. BMJ. 2019;364:l980. doi:10.1136/bmj.l980

Without adequate rest and treatment, however, IT band syndrome symptoms may get worse. For example, a person who first feels IT band pain only when running might eventually experience pain during everyday activities, such as going down stairs or walking.

A medical professional who has training in biomechanics, such as an orthopedist or physiatrist, can create a treatment plan for IT band syndrome. Treatment plans can vary depending on factors such as the:

• Suspected cause of the IT band syndrome
• Severity of symptoms
• Patient’s sport or activity

Once a treatment plan is made, mild to moderate IT band syndrome can often be managed without medical supervision. 

Rest the IT Band

The first step in treating IT band syndrome is rest. Avoid the exercise or repetitive activity that causes pain. Take a couple of weeks off from exercise or consider changing routines:

• Ease up on workouts. Shorter and less frequent workouts for about 6 weeks are suggested.¹Pegrum J, Self A, Hall N. Iliotibial band syndrome. BMJ. 2019;364:l980. doi:10.1136/bmj.l980 Athletes with moderate to severe IT band pain may need to take time off from their sport. 
• Cross-train. Doing exercises that do not trigger pain is usually considered okay. Activities such as yoga, swimming, and walking usually do not cause pain.¹Pegrum J, Self A, Hall N. Iliotibial band syndrome. BMJ. 2019;364:l980. doi:10.1136/bmj.l980

While it can be frustrating to change a training schedule, rest is necessary. It allows inflammation to go down and tissues to heal.

Change IT Band Biomechanics

The IT band supports knee movement by working together with the knee’s bones, muscles, and other soft tissues. How these parts move in relation to each other is called biomechanics. Changing biomechanics can help prevent the irritation and friction between tissues that is causing IT band syndrome.

Consider these ideas to correct or alter biomechanics in the knee joint.

• Vary exercise form or technique. For example, runners are sometimes advised to increase the length of their strides or change their cadence (the number of steps they take per minute).²Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The Iliotibial Band: A Complex     Structure with Versatile Functions. Sports Med. 2022;52(5):995-1008. doi:10.1007/s40279-021-01634-3 Cyclists might adjust saddle position and pedal clips.
• Try new footwear. Wearing different shoes or orthotic inserts is another way to change biomechanics. Footwear affects how weight is distributed to joints when the foot hits the ground.
  
  Using a shoe insert to raise heel height while running may ease IT band pain in some people.³Orchard JW, Fricker PA, Abud AT, Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996;24(3):375-379. doi:10.1177/036354659602400321^,4Balachandar V, Hampton M, Riaz O, Woods S. Iliotibial Band Friction Syndrome: A Systematic Review and Meta-analysis to evaluate lower-limb biomechanics and conservative treatment. Muscle Ligaments and Tendons Journal. 2019;09:181. doi:10.32098/mltj.02.2019.05  This type of insert is called a heel lift or wedge. Keep in mind, no single shoe or insert works for everyone.⁵Horst F, Hoitz F, Slijepcevic D, et al. Identification of subject-specific responses to footwear during running. Sci Rep. 2023;13(1):11284. doi:10.1038/s41598-023-38090-0
• Do strengthening exercises. IT band syndrome has been linked to muscle weakness, particularly weakness in the hip abductor muscles located at the outer hip.⁶ These muscles help move the leg out and away from the body. Exercises that strengthen the hip abductor muscles might help reduce symptoms.

Hip strengthening exercise with a resistance band

Place an elastic exercise band around the ankles and lift the leg sideways, up and away from the body. Repeat this motion 10 times, 3 to 4 times a day. 

If this motion is too difficult or puts uncomfortable strain on the knee, consider raising the elastic band to thigh level. After a couple of weeks, as strength improves, the band may be moved down to calf or ankle level. 

Knee biomechanics vary from person to person. A healthcare professional with sports medicine training can suggest strategies that address a person’s unique anatomy and needs. 

Reduce IT Band Inflammation

While several treatments try to prevent inflammation from happening, these treatments aim to lower existing inflammation:

• Ice the knee.¹Pegrum J, Self A, Hall N. Iliotibial band syndrome. BMJ. 2019;364:l980. doi:10.1136/bmj.l980 Cold will help ease inflammation in and around the IT band. Apply a cool compress to the painful area of the knee for 10 to 15 minutes. Try this treatment on and off throughout the day, particularly after a workout. 
  • See The P.R.I.C.E. Protocol Principles
• Take an anti-inflammatory medication.⁶Mellinger S, Neurohr GA. Evidence based treatment options for common knee injuries in runners. Ann Transl Med. 2019;7(Suppl 7):S249. doi:10.21037/atm.2019.04.08^,7Hadeed A, Tapscott DC. Iliotibial Band Friction Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed September 21, 2023. http://www.ncbi.nlm.nih.gov/books/NBK542185/  Over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs) helps reduce IT band inflammation and pain. Examples of NSAIDs include ibuprofen, naproxen, and aspirin. Consult a health care provider before taking NSAIDs every day for longer than 2 weeks.
• Get a cortisone injection.⁷Hadeed A, Tapscott DC. Iliotibial Band Friction Syndrome. In: StatPearls. StatPearls Publishing; 2023. Accessed September 21, 2023. http://www.ncbi.nlm.nih.gov/books/NBK542185/  A steroid injection lowers inflammation and usually reduces pain. However, they also tend to weaken soft tissues and slow down healing.Barnett J, Bernacki MN, Kainer JL, Smith HN, Zaharoff AM, Subramanian SK. The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis. Arch Physiother. 2019;9(1):12. doi: 10.1186/s40945-019-0063-6^,9Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: A review. JAMA. 2021;325(6):568-578. doi: 10.1001/jama.2020.22171
  Cortisone injections are sometimes used to relieve pain if other IT band syndrome treatments, such as rest and hip strengthening exercises, do not work. A doctor might also suggest an injection if symptoms appear suddenly and are moderate to severe.⁶Mellinger S, Neurohr GA. Evidence based treatment options for common knee injuries in runners. Ann Transl Med. 2019;7(Suppl 7):S249. doi:10.21037/atm.2019.04.08 

Because of cortisone’s effects on healing, a doctor may advise against getting more than one or two injections within a year. After getting a steroid injection, ease back into training slowly to avoid an injury. 

Promote Tissue Healing

Researchers continue to research ways to speed up soft tissue healing. The treatments described below are still being studied but generally considered safe. 

Low intensity ultrasound.¹⁰Best TM, Wilk KE, Moorman CT, Draper DO. Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology. Intern Med Rev (Wash D C). 2016;2(11):271. doi: 10.18103/imr.v2i11.271 Physicians, physical therapists, athletic trainers, and others may use low-intensity ultrasound to increase heat and blood flow to the injured area. The increased blood flow is believed to stimulate healing. 

Low intensity ultrasound is generally recommended daily for about 20 minutes. It is noninvasive and painless.

Regenerative medicine. Promising new treatments, such as platelet rich plasma (PRP) injections, may boost the body’s ability to heal and encourage new cell growth.⁸Barnett J, Bernacki MN, Kainer JL, Smith HN, Zaharoff AM, Subramanian SK. The effects of regenerative injection therapy compared to corticosteroids for the treatment of lateral Epicondylitis: a systematic review and meta-analysis. Arch Physiother. 2019;9(1):12. doi: 10.1186/s40945-019-0063-6 Some regenerative medicine treatments are called orthobiologics. 

See Regenerative Medicine for Sports Injuries

Other examples of regenerative medicine treatments used in sports medicine include stem cell injections and prolotherapy. Experts debate how well regenerative medicine treatments work. Even proponents of these treatments debate exactly how they can be designed to deliver the most benefit.

See Whether to Choose Regenerative Medicine Treatment

Try Non-surgical IT Band Release Strategies

Iliotibial band syndrome has been linked to a tight IT band.¹Pegrum J, Self A, Hall N. Iliotibial band syndrome. BMJ. 2019;364:l980. doi:10.1136/bmj.l980 Stretches, foam rolling, and massage are frequently recommended to help release tension in the IT band. 

Keep in mind that experts are not sure a tight IT band causes iliotibial band syndrome.²Hutchinson LA, Lichtwark GA, Willy RW, Kelly LA. The Iliotibial Band: A Complex     Structure with Versatile Functions. Sports Med. 2022;52(5):995-1008. doi:10.1007/s40279-021-01634-3 Some doctors do not recommend IT band release treatments, saying they do not help or only provide short-term pain relief.⁶Mellinger S, Neurohr GA. Evidence based treatment options for common knee injuries in runners. Ann Transl Med. 2019;7(Suppl 7):S249. doi:10.21037/atm.2019.04.08^,11Geisler PR. Current Clinical Concepts: Synthesizing the Available Evidence for Improved Clinical Outcomes in Iliotibial Band Impingement Syndrome. Journal of Athletic Training. 2020;56(8):805-815. doi:10.4085/1062-6050-548-19 The subject is controversial.

Stretching the IT band

Try this stretch to relieve IT band tension:

• Stand with the affected leg crossed behind the unaffected leg. 
• With arms raised overhead, bend away from the affected leg. 
• Continue bending until a stretch is felt at the side of the thigh.
• Hold this position for about 30 seconds, relax, and repeat 2 or 3 more times. 

Experts suggest doing this stretch a few times a day. 

Watch IT Band Stretch for Hip Pain Relief Video

Using a foam roller to release the IT band 

Like stretching, using a foam roller is believed to reduce tightness in the IT band. A foam roller is a hard foam cylinder that is typically about 3’ long and 6” inches in diameter. They are found in many gyms and are available for sale at some doctor and physical therapy offices, sporting goods stores, and online. 

How to use a foam roller:

• Lie on the floor, turned onto the painful side
• Place the foam roller underneath and perpendicular to the upper thigh. The foam roller should be about 5 inches below where the knobby bone that sticks out at the top of the thighbone, called the greater trochanter (often where the hips are widest). 
• Using hands and arm strength, slowly move the body forward a couple of inches, so the roller rotates and moves down the thigh. 
• Rest in this position and count to 10
• Repeat until the roller is a few inches above the side of the knee.  

This exercise can be quite painful for people with a tight IT band. It is believed to stretch the fibrous tissue, release tender points, and improve circulation, leading to reduced pain.

Although the foam roller exercise helps many patients, it does not work for everyone. Some experts suspect that it works for people who have a temporarily tight IT band, but not for people whose pain is rooted in other problems, such as inflammation or poor biomechanics. 

Massage

While not a standard treatment for IT band syndrome, a massage that relaxes muscles in the hip and thigh may feel good and temporarily relieve tension. 

Consider IT Band Release Surgery

If symptoms do not get better after 6 to 12 months of treatment, a doctor may suggest IT band release surgery. While the surgical steps can vary, the main goal is to lengthen the IT band. The hope is that adding length will help relieve tension. 

What happens during surgery

During this procedure a surgeon makes a small incision at the side of the knee and makes strategic cuts to the IT band, perhaps removing tissue that rubs against the thighbone (the lateral femoral epicondyle). 

The surgeon might also remove the nearby bursa—a small fluid-filled sac that normally reduces friction between the IT band and bone—if it is a source of inflammation and pain. 

IT band release surgery is not common and is an outpatient procedure. Patients typically receive general anesthesia and the surgery itself takes less than an hour. Complete recovery may take 4 to 6 weeks, though patients can usually perform everyday tasks without crutches within one week.

Recovery from IT Band Syndrome

Once treatment is complete and the knee pain is gone, an athlete can gradually return to a more challenging training schedule. For example, a person who successfully jogs 3 miles one week would be advised to run no more than 3.25 to 3.5 miles the next week. A gradual return to activity will help prevent IT band problems from returning.