IT Band Friction Syndrome (ITBFS) is one of the most common causes of pain on the outside of the knee, particularly in runners. Generally, we manage this condition with physical therapy and anti-inflammatory treatments, including a cortisone injection. However, in chronic cases resistant to these treatments, some doctors are using Botulinum toxin (Botox) injections, mainly where tightness in the hips is an issue. So, how does Botox work for knee pain and IT band friction syndrome, and what issues should you be aware of?
What is IT Band Friction Syndrome?
Iliotibial Band Friction Syndrome occurs when the iliotibial (IT) band rubs against the lateral femoral condyle during knee flexion and extension. This friction causes inflammation and pain:
Common symptoms include:
- Sharp pain on the outside of the knee during running. Generally, pain starts after 5-10 minutes of running and worsens as running continues.
- Tenderness at the outside of the knee.
How Do We Normally Treat IT Band Friction Syndrome?
Ususally, we start with modifying activity such as running or cycling. Antinflammatory measures are helpful to reduce knee joint swelling. Also, it is critical to reduce friction between the IT band and the knee by strengthening the hip muscles and reducing tightness in the IT Band and hamstrings. Sometimes, we use an ultrasound-guided cortisone injection deep to the IT Band at the knee to help with rehab. However, not all cases settle with this treatment.
How Can Botox Help with Knee Pain?
Botulinum toxin (Botox) is a neurotoxin that temporarily inhibits muscle contraction by blocking the release of hormones. While commonly used to erase wrinkles, Botox can also relax muscles in musculoskeletal conditions.
In the case of IT band friction syndrome, we think Botox injections are supposed to help by relaxing the IT band and reducing the friction at the knee. However, we don’t inject the IT Band directly. Instead, we inject the Tensor Fascia Lata (TFL) muscle with Botox on the outside of the hip. Relaxing the TFL muscle forces the glute muscles to work harder, reducing IT band pressure on the knee.
Step-by-Step Procedure of Botox for Knee Pain
- Your sports doctor will assess you to confirm the diagnosis and exclude other causes of outside knee pain. Ideal patients have tight IT bands and weak glutes.
- The TFL muscle is also visualised on ultrasound.
- The buttock area is cleaned with antiseptic.
- Local anesthetic is applied to reduce pain and make the procedure more comfortable.
- 75 units of Dysport (type of Botox) are injected into the middle of the TFL muscle under ultrasound
What Happens after the Botox Injection?
Patients should avoid activity for 48 hours, but gentle walking and stretching are allowed. Physiotherapy must be recommenced about 3-4 days later to help with the effects of Botox.
When Does Botox Start Working?
Generally, the effects typically begin within a week, with peak benefits at 4 weeks. However, pain relief can last for 3-6 months before
Evidence for Botox in Knee Pain and IT Band Friction Syndrome
A key paper published in 2018 found that 80% of patients injected with Botox reported improved pain and function. About 67% were able to return to running. Minimal side effects were noted, and no long-term complications were observed.
A follow-up paper in 2021 found that Botox reduced runners’ pain by up to 70% and allowed earlier return to running than traditional methods.
Botox offers longer-lasting relief compared to steroid injections, without the risk of soft tissue damage. However, it is best used as a complementary treatment to physiotherapy rather than a standalone solution.
Who Should Use Botox for Knee Pain and IT Band Pain?
The best candidates for Botox for knee pain are:
- IT band pain that has not responded to physiotherapy, NSAIDs, or steroid injections.
- Significant IT band tightness due to an overactive TFL muscle.
- Combine injection with rehabilitation exercises for the best outcome.
Potential Side Effects of Botox Injections
Botox is generally safe, but potential side effects include:
- Temporary muscle weakness, which could alter running mechanics. It is critical to guide the Botox into the right spot with ultrasound to prevent spread to other muscles.
- Bruising or mild pain at the injection site, which settles after a few days.
- Allergic reactions to Botox (rare)
Unlike steroid injections, Botox does not damage soft tissue and can be safely repeated if needed.
Other Frequently Asked Questions about Botox for knee pain:
Can you combine a Botox injection with a cortisone injection?
Yes. We think this combination may work better. However, Botox is injected into the TFL muscle, and cortisone is injected deep into the IT Band at the level of the knee.
Final word from Sportdoctorlondon about Botox for IT Band Friction Syndrome
Botox is a promising treatment for iliotibial band friction syndrome, particularly in athletes with persistent pain despite other treatments. By reducing TFL muscle overactivity, Botox injections may offer long-lasting relief and enhance physiotherapy. However, it should only be used if other treatments have failed.
Dr Masci performs Botox injections for chronic IT Band Friction syndrome. The cost is £650 and includes an ultrasound. In cases of combined Botox and Cortisone, the price is £850.
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