Some conditions in sports medicine are relatively easy to diagnose but are challenging to manage. A good example is a condition often seen in runners called IT Band syndrome or iliotibial band friction syndrome. Primarily, this common condition affects the outside of the knee. Does a cortisone injection for IT band syndrome help?

First, we need to understand the iliotibial band and the concept of IT Band syndrome.

What is the iliotibial band? 

IT band

The iliotibial band begins above the hip joint from the tensor fascia lata muscle. Then, it passes from the outside of the thigh to the outer side of the shin (tibia). The IT band functions as one of several essential stabilisers for the outside of the knee. As it passes over a bony bump outside the knee, it is prone to inflammation and swelling.

What causes IT band syndrome?

ITB syndrome is caused by pressure or friction of the Iliotibial band against the outside of the knee joint. Recent research suggests that pressure is a more critical factor in causing ITB syndrome and occurs maximally at 30 degrees of knee flexion. Similar to the runner’s knee, critical contributing factors to ITB syndrome found in one study include biomechanical issues such as tightness in the quadriceps muscles and weakness in the buttock muscles.

IT band syndrome symptoms

Generally, most people with IT band syndrome present with pain at the outside of the knee triggered by running and improves with rest.   Runners are usually fine for the first 5-10 minutes but quickly develop sharp pain outside the knee. Pain is generally so intense that it is hard to run through. Less commonly, other activities such as hiking, walking, and cycling pain cause pain.

It is essential not to miss other causes of pain outside the knee. Other injuries include a torn meniscus, biceps femoris tendonitis, or pain from the back or hip. MRI or ultrasound scan is often helpful to confirm fluid under the ITB and exclude other causes.

What treatments are available for IT Band syndrome?

Firstly, we start with treatments to treat pain and inflammation. These treatments include tablets such as ibuprofen or a cortisone injection.

Secondly, working with a therapist to correct biomechanics such as pelvis strength and leg flexibility is crucial. In particular, strengthening the buttock muscles is essential. Changes in your running style, such as an increasing step rate and reducing the crossing of legs, may also help.

Finally, a return to running should occur gradually to avoid a return of pain.

What is the best approach for IT Band syndrome including a cortisone shot?

Most people try to muddle through with bits and pieces, often unsuccessful, leading to months of pain. In addition, long-term pain often leads to scar tissue.

Our approach is more aggressive. Overall, we think the best results come from complete rest from running, anti-inflammatory tablets, and a rehab program to treat biomechanics. Cortisone shot for IT Band syndrome is a great idea early to reduce swelling and help rehab. Dr Masci refers people for botox injections directed to the side buttock muscles for complex cases. Generally, the days of muddling through are long gone.

More on cortisone shot for IT Band syndrome

ultrasound-guided cortisone injection

Cortisone is a potent anti-inflammatory that reduces inflammation and pain. IT Band syndrome produces inflammation as it passes over the bony prominence on the outside of the knee. By directing cortisone at the IT band at the level of this bony prominence, inflammation and pain are reduced. Moreover, it is essential to use ultrasound to direct a cortisone shot for IT Band to increase the effectiveness and minimise side effects.

Dr Masci has written a paper that summarises the results of cortisone injeciton in conditions such as IT band syndrome.

Botox vs cortisone injection for IT Band syndrome

Recently, some practitioners have been using botox directed to the muscle outside the hip to help with chronic ITB syndrome cases. Overall, we suspect the TFL or tensor fascia lata muscle is too tight in chronic cases of IT band syndrome. Relaxing this muscle with botox leads to a change in the tightness of the IT band and less pain. This treatment is an exciting advance in treating chronic IT Band syndrome and may help people who have exhausted all other non-surgical options.

What about iliotibial band surgery?

Usually, surgery involves the release of the IT band at the level of the outside of the knee.

Generally, we strongly suggest runners avoid surgery in almost all cases. The iliotibial band friction surgery results are unpredictable and may lead to a worse outcome. Therefore, we recommend at least 12 months of conservative treatment before surgery.

Other frequently asked questions about cortisone injection for IT band syndrome.

Should you rest after a cortisone shot for IT Band? 

Yes. Generally, we recommend rest from running for a week. This rest prevents a flare, which usually presents 24-48 hours after an injeciton.

Are there side effects from a cortisone injection for IT band syndrome?

Although side effects are low, you must know that a cortisone shot for the IT band may not work. Other risks include skin changes, infection, and a steroid flare.

Can you run with IT band syndrome? 

It depends on how bad your symptoms are. For example, most people with IT band syndrome can’t run because of pain. However, in mild cases, you might be able to manage your symptoms with intensive physiotherapy.

What cardio can I do with IT band syndrome? 

Generally, we recommend you avoid running until the inflammation settles and you see a physiotherapist. However, people with this condition can walk, cycle, swim, and cross-train in most cases.

Does stretching help IT band syndrome? 

Yes. Most people with IT band syndrome are tight in their ITB, hamstring, and tensor fascia lata. We suggest you focus on relaxing the tendon in these muscles. Stretching, Yoga and foam roller massage are all effective.

Are there other injection options for ITB friction syndrome besides cortisone injections? 

Yes. Some practitioners use Botox to relax one of the hip muscles called the tensor fascia lata for TFL. I explain the use of Botox above.

Final word from Sportdoctorlondon about cortisone injection for IT band syndrome

IT Band syndrome is a complex condition to treat in runners. We suggest aggressive treatment early, including an ITB injection if the pain is severe. In general, rehab is significant. The bottom line is this: Ignore IT Band syndrome at your peril.

Other knee conditions:

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.