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.