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Iliotibial band syndrome - aftercare

The iliotibial band (ITB) is a tendon that runs along the outside of your leg. It connects from the top of your pelvic bone to just below your knee. A tendon is thick elastic tissue that connects muscle to bone.

Iliotibial band syndrome occurs when the ITB becomes swollen and irritated from rubbing against the bone on the outside of your knee.

Alternate Names

IT band syndrome - aftercare; Iliotibial band friction syndrome - aftercare

More about your injury

There is a water-filled sac, called a bursa, between the bone and the tendon at side of the knee. The rubbing of the tendon can cause pain and swelling of the bursa, the tendon, or both.

This injury often affects runners and cyclists. Bending the knee over and over during these activities can create irritation and swelling of the tendon.

Other causes include:

  • Being in poor physical condition
  • Having a tight ITB
  • Not warming up before exercising
  • Having bowed legs
  • Changes in activity levels

What to expect

If you have iliotibial band syndrome you may notice:

  • Mild pain on the outside of your knee when you begin to exercise, which goes away as you warm up.
  • Over time the pain feels worse and doesn't go away during exercise.
  • Running down hills or sitting for a long time with your knee bent may make pain worse.

Your doctor will examine your knee and move your leg in different positions to see if your ITB is tight. Iliotibial band syndrome can be treated with pain relievers and ice for pain. You will also do stretching and strengthening exercises.

In some cases, your doctor may give you a shot of a medicine called cortisone. The shot goes into the area that hurts the most. This can help decrease pain and swelling.

Most people don't need surgery. But if other treatments don't work, you may. During surgery, your doctor may remove part of your ITB, or the bursa, or both. This prevents the ITB from rubbing against the bone at the side of your knee.

Symptom relief

Follow these steps to help reduce pain and swelling:

  • Apply ice to the painful area for 15 minutes every two to three hours. Do not apply ice directly to your skin.
  • Apply heat before stretching or doing strengthening exercises.
  • Take pain medicine if you need to.

For pain, you can use ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), or acetaminophen (Tylenol). You can buy these pain medicines at the store.

  • Talk with your doctor before using any pain medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past.
  • Do not take more than the amount recommended on the bottle or by your doctor.

Activity

Try running or cycling shorter distances than you usually do. If you still have pain, avoid these activities completely. You may need to do other exercises that do not irritate your ITB, such as swimming.

Try wearing a bandage or knee sleeve to keep the bursa and ITB warm while you exercise. 

Your doctor may recommend a physical therapist (PT).  This is a special therapist that will work with your specific injury so you can return to normal activity as soon as possible.

Your PT may recommend ways to change the way you exercise to prevent problems. You may also be fitted for arch supports (orthotics) to wear in your shoes.

Once you can do stretching and strengthening exercises without pain, you can gradually begin running or cycling again. Slowly build up distance and speed.

Self-care at home

Your PT may give you exercises to do to help stretch your ITB and strengthen your leg muscles. Before and after activity:

  • Use a heating pad on your knee to warm the area up.
  • Ice your knee and take pain medication after activity if you feel pain.

The best way for the tendons to heal is to stick to a care plan.  The more you rest and practice physical therapy, the quicker and better your injury will heal.

When to call the doctor

Call your doctor if pain gets worse or doesn't get better in a few weeks.

References

Akuthota V, Stilp SK, Lento P, Gonzalez P. Iliotibial band syndrome. In: Frontera W, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation, 2nd ed. St. Louis, MO: W.B. Saunders Elsevier; 2008:chap 60.

Kernan M, Raja B, Matuszak J. The collegiate/professional male athlete. In: Heidelbaugh JJ, ed. Clinical Men's Health: Evidence in Practice, 1st ed. St. Louis, MO: W.B. Saunders Elsevier; 2007: chap 26.

Khaund R, Flynn S. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005;71(8):1545-1550.

Updated: 5/15/2013

C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.


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