Sport injury series: Iliotibial band syndrome Q&A

Richard Hughes With summer on our doorstep, we are becoming more active and prone to sports injuries. Our Q&A series will cover the more common sports injuries, how to prevent them or treat them.

Mr Richard Hughes, Consultant Radiologist at BMI The Chiltern Hospital, BMI The Clementine Churchill Hospital and BMI Bishops Wood Hospital, offers his insights on a rather common sports injury: the Iliotibial band syndrome. Mr Hughes explains how we can injur this area, what are the treatment options and the recovery. 

Mr Richard Hughes
Friction between the tendon that runs along the lateral aspect (the outer side) of the knee. The iliotibial tract (tendon of the tensor fascia lata muscle) extends from the hip to the top of the shin bone and is vulnerable to rub against the outside of the femoral bone at the knee as it crosses the bone. It is an injury pattern which we very commonly see in long distance runners, cyclists, tennis players and footballers.

Mr Richard Hughes
Pain and tenderness on the outer aspect of the knee which gets worse on activity. When severe, it can ache at rest and cause pain when lying on the affected side or on pressure.

Mr Richard Hughes
A physiotherapist or knee/ sports injury specialist will be able to diagnose this condition based on the history of the injury and the examination. In difficult or atypical cases, MRI and ultrasound are useful tests to confirm the diagnosis and the severity of the inflammation within the iliotibial tendon and adjacent soft tissues.

Mr Richard Hughes
When symptoms are acute, ice treatment and anti-inflammatories can help with the symptoms and are useful after exercise. Alteration of activities which exacerbate the pain and periods of rest from sport may be required. A sports physiotherapist can guide treatment and activity levels and will work on stretching the tendon and strengthening the hip/ buttock muscles. Analysis of running style/ gait and running shoes may be useful, in cyclists with ITB friction, adjustment of pedals and clip-ons can help offload the area.

When these measures fail, ultrasound-guided injections of corticosteroids (cortisone) around the tendon are an option to help relieve symptoms and provide a pain-free window for rehabilitation. There are some promising results from use of low-dose Botox injections in severe resistant cases into the tensor fascia lata muscle at the top of the thigh. This treatment stops the muscle from contracting for a period of weeks and allows the tendon/ tissues to heal.

Rarely surgery is required for intractable cases and involves releasing and/ or lengthening the tendon.

Mr Richard Hughes
Most people improve without need for invasive treatments. Corticosteroid injections are relatively safe and low-risk procedures. However, there are low risks of causing skin thinning and lightening at the injection site and very low risk of infection and allergy as with any injection. Multiple cortisone injections can weaken tendons and most specialists recommend no more than 2-3 injections into the one area, however in most cases only a single injection is required. Botox injections are a new but promising treatment and require careful supervision under direction of a specialist.

Mr Richard Hughes
Recovery is very variable, however, the majority of cases will improve over a few weeks with appropriate management. A minority of patients will struggle longer term and will benefit from specialist input.