The knowledge of this condition has evolved over the last several years.
It’s interesting to understand how this condition was initially understood and how the evolution of our understanding has changed treatment options to improve our results.
Here’s the revised version:
A Historical and Evidence-Based Perspective on Iliotibial Band Syndrome (ITBS)
Iliotibial Band Syndrome (ITBS), a common overuse injury, is frequently seen in runners and athletes. Historically, treatments focused on stretching the iliotibial band (ITB) and addressing localized symptoms at the lateral knee. However, evolving evidence suggests the need for a paradigm shift toward addressing underlying biomechanical contributors and utilizing advanced therapeutic modalities.
Our Current Understanding of ITBS: Etiology and Biomechanics
ITBS occurs due to repetitive friction or compression of the ITB over the lateral femoral condyle, often exacerbated by poor biomechanics. Historically, the “slipping band” model attributed ITBS to the ITB’s movement over the condyle during knee flexion and extension. The updated “compression model,” however, identifies localized inflammation and impingement caused by excessive valgus knee forces, dynamic hip instability, and weak hip musculature.
Key biomechanical contributors include:
• Weakness in the hip abductors and external rotators, leading to increased hip adduction and internal rotation.
• Poor neuromuscular control during gait or running.
Evidence-Based Treatments for ITBS
Recent research underscores the importance of addressing proximal factors, particularly hip strength and control, while reevaluating traditional interventions like corticosteroid injections and stretching.
1. Manual Therapy and Hip Strengthening
Evidence strongly supports hip-targeted interventions as a cornerstone of ITBS treatment. Studies indicate that strengthening the gluteus medius and other hip stabilizers significantly reduces pain and improves function (Zemadinis & Betzos, 2017; Balachandar et al., 2019). Effective exercises include:
• Side-lying hip abduction (activated gluteus medius by 40% more than clamshells).
• Step-ups and lateral band walks.
• Single-leg squats to enhance gluteal activation and neuromuscular control.
2. Extracorporeal Shockwave Therapy (ESWT)
Extracorporeal shockwave therapy has emerged as a promising adjunct treatment. By stimulating tissue healing and modulating pain pathways, ESWT provides relief for soft tissue injuries, including ITBS. Studies comparing ESWT with manual therapy found both effective at reducing pain, making shockwave therapy a viable option for patients needing additional pain management (PubMed, 2015).
4. Corticosteroid Injections and Stretching: No Longer Recommended
Corticosteroid injections and stretching the ITB were once commonly prescribed but are no longer recommended. Research shows that these approaches do not address underlying biomechanical dysfunctions(Schwellnus et al., 1992).
A Comprehensive Approach to ITBS Management
Modern ITBS management emphasizes the following:
1. Hip-Strengthening and Neuromuscular Re-Education
Focus on correcting dynamic valgus and improving hip stability during functional activities.
2. Manual Therapy
Directed at the hip and adjacent areas.
3. Adjunct Modalities
Utilize shockwave or laser therapy to support healing and provide symptom relief.
4. Activity Modification
Avoid overloading activities and progressively return to sport with biomechanical retraining.
As our understanding of ITBS evolves, treatment strategies have shifted from focusing on the ITB itself to addressing the proximal hip and neuromuscular contributors. Advanced modalities like shockwave therapy complement this approach, helping patients recover faster and with less pain. By adopting evidence-based practices, clinicians can achieve better outcomes for athletes and active individuals.
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