Non-surgical treatments are usually successful in treating IT band syndrome. Treatment recommendations can vary slightly depending on the severity of the pain. The most commonly recommended treatment is the use of a foam roller to reduce IT band tension.
Foam Roller Stretch
A foam roller is a hard foam cylinder that is about 6 inches in diameter and 3 feet long. A patient lies on his or her side with the foam roller positioned perpendicular to and underneath the upper thigh (not at the very top of the thigh, but rather about 5 inches below knobby bone that sticks out at the top of the thighbone, called the greater trochanter).
The patient then uses his or her arms to slowly roll the body forward, allowing the roller to move down the thigh. The patient may move just a couple inches and then stop and count to 10.
This exercise can be quite painful for people with a tight IT band, but it is thought to stretch the fibrous tissue, release tender points, and improve circulation, leading to reduced pain.
Foam rollers are found in many gyms or may be purchased for home use. They are available for sale at some doctor and physical therapy offices, sporting good stores, and online stores.
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.
Other Non-Invasive Treatments for IT Band Syndrome
Whether using a foam roller or not, patients can benefit from making changes in their stretching and exercise routines. Commonly recommended treatments are listed below. An athlete may also need to talk to a doctor, physical therapist, or a knowledgeable trainer about making specific improvements to form that will reduce or eliminate IT band pain.
Rest. People with IT band syndrome may need to cut back on the intensity, duration and frequency of activity that leads to IT band pain (for example, reduce running or cycling mileage). People with moderate to severe IT band pain may need to take time off from their sport. It can be frustrating and difficult for active people to cut back on their training schedules; however, rest is necessary for the injury to heal.
Warm up. Five to 10 minutes of gentle exercise and stretching can literally increase the body’s temperature, helping muscles become more elastic and responsive and reducing the chance of IT band syndrome or other injuries.
Change footwear. Switching out shoes and/or getting orthotic inserts can alter a person’s biomechanics and reduce the risk of IT band pain.
Massage. Much like the foam roller exercise, massage may help relieve tension and improve blood-flow in the IT band, thereby reducing pain.
Stretching. A doctor may recommend stretching or yoga to promote flexible muscles and other soft tissue.
NSAIDs. Over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs) can help reduce inflammation and pain.
Change running biomechanics. Runners may consider shortening their stride1 and running on soft, flat surfaces, such as tracks and even, grassy trails.
Change cycling biomechanics. Cyclists may consider adjusting saddle position and pedal clips. Even a small adjustment can alter the biomechanics of their pedaling and reduce IT band pain.
Ultrasound. Efforts to heal the IT band and reduce pain may get a small boost from ultrasound and electrical muscle stimulation.2
Iontophoresis. Doctors and physical therapists occasionally recommend iontophoresis, which uses a mild electrical current to administer an anti-inflammatory medicine (e.g. dexamethason) through healthy skin and into the sore area.3 This treatment may be appropriate for people who can't tolerate injections or want to avoid injections.
Without adequate rest and treatment, the IT band syndrome may be prolonged or become chronic. For example, a person who began experiencing IT band pain only while running may eventually experience pain during everyday activities, such as going downstairs or even walking.
A cortisone injection works by reducing painful inflammation. However, in addition to reducing inflammation, cortisone injections may weaken soft tissues such as tendons and cartilage (particularly in patients receiving multiple injections per year).6,7 As a result, these injections are reserved for patients who are still in pain after making an earnest effort with non-invasive treatments, such as resting, participating in physical therapy, and adjusting training habits.
IT Band Release Surgery
In unusually stubborn cases of iliotibial band syndrome, a physician may recommend IT band release surgery. During surgery the doctor makes a small incision at the side of the knee and removes the small portion of the IT band that rubs against the thighbone (lateral femoral epicondyle). The doctor may also remove the nearby bursa—a small fluid-filled sac that normally reduces friction between the IT band and bone—that may be a source of inflammation and pain.
IT band release surgery 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.
Once treatment is complete and the knee pain is gone an athlete can gradually return to a more challenging training schedule. Some training experts recommend no more than a 5 or 10% increase each week. For example, a jogger who successfully runs 5 miles one week will run no more than 5.5 miles the next week.