How to Treat Iliotibial Band Syndrome: 5 Possible Approaches

1- Make sure it’s indeed Iliotibial Band Syndrome

Firstly, know that all these names are synonymous and refer to the same issue:

• Iliotibial Band Syndrome
• Iliotibial Band Friction Syndrome
• Tensor Fasciae Latae Tendinitis
• Iliotibial Tract Syndrome

It’s one of the most common causes of knee pain in running (especially on the side of the knee), or in other contexts.

When you have troublesome knee pain and you consult, your healthcare professional performs what’s called a differential diagnosis.

The idea is to rule out another cause behind your knee pain, which would require different management and have a different course.

Here are the main conditions that Iliotibial Band Syndrome can be confused with [Hadeed 2023]:

• Stress fracture of the tibia
• External meniscus tear*
• Osteoarthritis of the lateral compartment of the knee: femorotibial osteoarthritis*
• Sprain of the external ligament of the knee*
• Referred pain from a hip pathology
• Patellofemoral syndrome*
• Tendinopathy*

Note that some of these conditions (marked with *) are managed and evolve very similarly to iliotibial band syndrome.

🚨 Getting an X-ray or other imaging exams (MRI, CT scan) may not be necessary to rule out other causes. These exams are not without risks, so it’s often preferable to avoid them if possible!

➡️ In practice: if you have doubts about the diagnosis of your pain, you can schedule an appointment with your doctor or physiotherapist to discuss it.

2- Identify what bothers you the most today

This syndrome can manifest in various ways.

Some people may experience very specific pains, for example only after hiking or trail running for 6 hours with a positive and negative elevation gain of more than 1200 meters.

Others have such intense knee pain that even walking a few meters is difficult.

And between these extremes, there are many other possible scenarios.

That’s why it’s important to identify precisely what bothers you in your case. Considering your lifestyle, preferences, and professional and personal activities.

The treatment of iliotibial band syndrome adapts based on your discomfort and primary goals.

🗣️ Here are two concrete examples from my patients to make it clearer.

👩 Example 1: A thirty-year-old who cycles in summer and skates on weekends in winter. She commutes by bike to work and spends hours behind a computer.

She occasionally goes jogging to maintain her fitness during the off-season, but she often has to stop due to pain on the side of her knee: iliotibial band syndrome diagnosed by her sports doctor.

Her goal: to be able to go jogging at least once a week without having to stop due to pain during or after.

What she will do: identify at what point during jogging the pain starts (e.g., 15 minutes), and start with shorter jogs (e.g., 10 minutes), possibly complemented by walking.

She will gradually increase the duration of her runs (at a rate of 1 or 2 minutes maximum per week). If this isn’t sufficient, she may consider incorporating sessions of knee muscle strengthening exercises.

She does not experience pain outside of running sessions (or it doesn’t bother her), so she won’t seek treatment to relieve pain.

👨 Example 2: A fifty-year-old who has recently started running for weight loss. After a few weeks, iliotibial band syndrome has developed to the point where it limits even walking.

The pain is continuous and sometimes even affects sleep.

His goal: to reduce pain at rest initially for better sleep, and ultimately to resume running without pain.

What he will do: try different methods to relieve pain according to what appeals to him most: apply cold packs, use TENS therapy, massage, take pain-relieving medication, find more comfortable positions, etc.

Only once the pain at rest subsides will he consider resuming running.

➡️ In practice: identify as precisely as possible the symptoms that bother you the most and when they occur.

3 – Explore different treatment options

At this point in the article, you should have understood that the treatment to implement will depend on the specific problems you are experiencing and the priority goals you set for yourself (alone or with your physiotherapist!).

With this important clarification made, here are some insights from scientific publications synthesizing current knowledge on treatments and recovery for iliotibial band syndrome.

There are many publications on the subject, as shown in the graph below.

I have selected those which, in my opinion, are both the most rigorous and enlightening for patients and professionals involved in rehabilitation.

Reference	Subject & Method	Result
Nguyen 2023	Synthesis of 98 publications on conservative treatment of this syndrome	There is a lack of objective research in the literature regarding conservative management of iliotibial band syndrome. Recommendations are primarily based on expert opinions and review articles.
Friede 2022	Review of publications on preventive and curative treatments used by physiotherapists	Based on biomechanical considerations, iliotibial band syndrome may be favored by anatomical predisposition, joint misalignments, excessive activation of lateral knee muscles, and excessive stiffness of the iliotibial band. Intermittent stretching interventions are unlikely to alter the intensity or mechanical properties of the syndrome significantly. Rehabilitation of running mechanics shows promise but remains under-researched.
Opara 2023	Narrative review on the effects of stretching interventions	Long-term interventions typically include iliotibial band stretching; however, it remains uncertain to what extent stretching actually contributes to symptom resolution. At the same time, there is no direct evidence suggesting that stretching has negative effects.
Foch 2023	Literature review of 17 articles and meta-analysis of 10 cross-sectional studies on biomechanical causes of the syndrome	While biomechanical evidence is limited, risk factors differ between female and male runners and may vary depending on injury status. Specifically, hip movement in the transverse plane and weakness in hip abductor strength may be biomechanical risk factors among female runners.
Bolia 2020	Literature review comparing the effectiveness of conservative vs surgical treatments	According to current literature with a maximum follow-up of 6 months, conservative therapy can effectively reduce symptoms of iliotibial band syndrome in athletes. Several surgical options exist for athletes who do not respond to non-operative measures, with reported return-to-sport rates between 81% and 100%.

What to remember? There is no strong evidence in favor of one conservative treatment over another, and it is uncertain whether implementing treatment versus letting time pass is truly more effective.

And what does conservative treatment entail? There are many techniques or devices from which one must choose, in the absence of strong evidence favoring one over another [Bolia 2020]:

• Complete or partial rest and gradual resumption of activity;
• Muscle strengthening exercises;
• Tensor fasciae latae (TFL) stretching (another name for the iliotibial band);
• Massages;
• Shockwave therapy;
• Therapeutic ultrasound;
• Corticosteroid injections into the knee;
• Oral anti-inflammatories or other pain-relieving medications;
• Applying ice;
• Immobilizing the knee (using a knee brace, etc.);
• Iontophoresis with anti-inflammatories;
• Shoe or insole adjustments;
• Manual therapy;
• Laser therapy, etc.

Here are personally the criteria I use to help me choose among these different treatments.

If you do not share these same criteria with me, then your therapeutic choice may be different, and there’s nothing wrong with that 🙂!

☑️ Maximum effectiveness (theoretical / empirical)
☑️ Minimum side effects
☑️ Minimum cost (in terms of time, energy, money)
☑️ Minimum reliance on third parties or equipment

In the case of iliotibial band syndrome (which I have never had, unlike shin splints and patellofemoral syndrome, other well-known ailments among athletes), here is my action plan:

• Identify activities that trigger or worsen the pain. For example: running, stair climbing.
• Stop these activities until the knee is nearly pain-free or (my preferred approach) reduce their frequency, intensity, or duration to find the “right balance” for you! This balance fluctuates over time.
• Very gradually reintroduce activities in terms of frequency, intensity, and duration.
• Be confident and aware that pain is not necessarily a sign of a problem and that it is possible to manage it.
• (Possibly: not relevant for everyone) Engage in exercises or activities involving contraction of the muscles around the knee and hip. This is known as muscle strengthening, regardless of the specific exercises performed!

If you don’t feel comfortable doing this alone, which is completely understandable, you can get prescribed physical therapy sessions to be supervised or discuss the best approach in your case.

➡️ In practice: there are dozens of possible therapeutic options to treat iliotibial band syndrome, but none stand out significantly in terms of effectiveness. It’s up to you to identify the therapeutic approaches that resonate most with you!

4 – Adjust your level of physical activity

Regardless of the type of treatment you choose, adapting your level of physical activity based on your pain and sensations seems essential.

Often, overuse of your body is one of the triggering factors of the syndrome: you may have increased one type of physical activity too quickly compared to what your body was ready to handle.

Complete cessation of triggering or aggravating activities (running, cycling, hiking, etc.) is not always necessary: reducing the frequency, intensity, or duration may be sufficient.

➡️ In practice: identify the physical activities or sports that trigger or aggravate the pain and adjust them accordingly.

5 – Be realistic about healing time

There is limited very reliable data on the progression of these syndromes, whether treatments are implemented or not.

However, here are some insights:

• Over an 8-week follow-up, 4 out of 10 individuals treated with physiotherapy were reported as cured of their iliotibial band syndrome [Beals 2013].
• 5 to 9 out of 10 individuals see their symptoms decrease within 4 to 8 weeks after symptom onset [Hadeed 2023].

➡️ In practice: remain optimistic: some people have no more pain within a few weeks after the onset of this syndrome. If the pain persists for several months, it may not necessarily indicate a complication or another problem, as some individuals experience fluctuating pain over months or years.