Treatment Options
Acute
| Patient group |
Treatment line
| Treatmentshow all |
|
pain and inflammation
| 1st |
- non-steroidal anti-inflammatory drugs (NSAIDs)
-
Primary Options
diclofenac
:
50 mg orally three times daily when required
OR
ibuprofen
:
400-600 mg orally every 4-6 hours when required, maximum 2400 mg/day
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- activity modification
-
-
The aggravating activity must be avoided in the acute phase. It can be replaced with alternative activity, such as swimming using arms only.
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Ice is also used on the affected area.
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severe pain and swelling or refractory to non-steroidal anti-inflammatory drugs (NSAIDs)/activity modification
|
|
- combination local anaesthetic and corticosteroid injection
-
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Combination local anaesthetic and corticosteroid injection are used if patient's pain and swelling persists after analgesia/anti-inflammatory treatment.
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Inject in the area where the iliotibial band (ITB) crosses the lateral femoral condyle.
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Corticosteroid injections are recommended in the acute phase for patients with severe pain or swelling and as a means to progress the rehabilitation.
Primary Options
methylprednisolone acetate
:
40 mg by injection as a single dose
and
lidocaine
:
10 mg by injection as a single dose
|
Ongoing
| Patient group |
Treatment line
| Treatmentshow all |
|
resolved pain and inflammation
| 1st |
- stretching exercises
-
-
Stretching exercises are given for early return to activity following resolution of pain and inflammation.
-
The patient stands and stretches the iliotibial band (ITB), with an overhead arm extension. A more transverse plane stretch is made by bending downwards and diagonally, while reaching out and extending the arms with clasped hands.
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- foam roll mobilisation
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Foam roll mobilisation is used to improve myofascial restrictions along the lateral hip and thigh. While supporting the upper body with the hands on the floor, the patient reclines on a 3 to 6 inch foam roll placed under the side of the involved leg, which is held straight. The patient crosses the uninvolved leg over the involved leg and rolls along the outer thigh from the bottom of the hip bone to just above the knee, emphasising tight or tender areas.
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- hip abductor strengthening
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Once range-of-motion and myofascial restrictions have been resolved, recovery and strengthening can be started. These involve open-chain, side-lying leg lifts, closed-chain, single-leg balance step-downs, pelvic drop exercises, eccentric muscle contractions, triplanar motions, and integrated movement patterns. Examples of 3 of these exercises are the modified matrix, wallbanger, and frontal plane lunge. For all exercises, it is advisable to start with 5 to 8 repetitions and gradually build up to 2 to 3 sets of 15 repetitions and repeat the exercise in both legs, even if only 1 side is symptomatic.
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Electromyography (EMG) studies suggest that contractions above 60% of the maximal voluntary isometric contraction (MVIC) are needed for strengthening. This intensity is achieved with progression into single leg squat exercises and use of resistance (e.g., 2.3 kg [5 lb] ankle weight with side-lying hip abduction).
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refractory to conservative treatment
| 1st |
- elective surgery
-
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Surgery is used in rare cases to decrease impingement of the iliotibial band (ITB) on the lateral femoral epicondyle. The surgery involves resection, when the leg is in a 30° flexed position, of a triangular piece of the ITB from the area overlying the lateral epicondyle. Alternatively, the ITB can be Z-lengthened.
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Last updated: Apr 22, 2013
