Treatment course6 min read
Treating iliotibial band syndrome and returning to running
For many years treatment of iliotibial band syndrome focused on stretching the band. The current approach differs: the band is already resistant to stretching, and the problem is increased load on it from inadequate hip control.
Load management
Running is not stopped entirely but reduced to a distance below the pain threshold. As the distance at which pain starts is known, this adjustment is practical.
Downhill running and descending stairs are temporarily removed. These two create the highest loads on the band.
Cycling and swimming maintain fitness while running load is reduced. Saddle height is checked in cycling; a low saddle can trigger this picture.
Hip strengthening
The lateral hip group is central to the programme. When these muscles are weak the pelvis drops to the opposite side with every step and tension on the band rises.
Side-lying leg raises, banded lateral steps and single-leg bridges are the core exercises, with load increased progressively.
The aim is the knee not drifting inward during a single-leg squat. As that control improves, load on the band falls markedly.
Running technique and return
Increasing step rate by around five per cent reduces load on the knee with each step. This simple change makes a clear difference for many patients.
Steps crossing very close to the body's midline tension the band. Widening the step slightly reduces that tension.
On return, weekly distance increases should not exceed ten per cent. Downhill running is added last and built up gradually.
Key points
- Strengthening the hip rather than stretching the band is best evidenced.
- Running is not stopped but reduced below the pain threshold.
- Downhill running and stair descent are temporarily removed.
- Increasing step rate by five per cent reduces knee load.
- Weekly distance increases should not exceed ten per cent.
Frequently asked questions
Does a foam roller help?
Applied to the outer thigh it can give temporary relief. It does not lengthen the band; its effect is on the surrounding muscle tissue and pain perception.
Is a steroid injection needed?
Usually not. In stubborn cases it can give short-term relief and open a window for exercise; it is not a lasting solution alone.
Should I change my shoes?
Worn soles alter load and can trigger the picture. There is no strong evidence a particular shoe type resolves it, however; the hip programme takes priority.
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This content is for information only and does not replace medical diagnosis or treatment. Response to treatment varies between individuals. Please consult a healthcare professional about your symptoms.