There are some conditions in sports medicine that are relatively easy to diagnose but are difficult 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 what is 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 muscle called the tensor fascia lata. Then, it passes on the outside of the thigh to the outer side of the shin (tibia). The IT band functions as one of a number of important stabilisers for the outside of the knee. As it passes over a bony bump on the outside of 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 important factor in causing ITB syndrome and occurs maximally at 30 degrees of knee flexion.  Similar to the runner’s knee, important 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 improved with rest.   Runners are usually fine for the first 5-10 minutes but quickly develop severe sharp pain on the outside of the knee. Pain is usually so intense that it is hard to run through. Less commonly, other activities such as hiking, walking, and cycling pain cause pain.

It is important not to miss other causes of pain at the outside of the knee. Other injuries include a torn meniscus, biceps femoris tendonitis or pain from the back or hip. Often, MRI or ultrasound scan is useful 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, it is important to work with a therapist to correct biomechanics such as pelvis strength and leg flexibility. In particular, strengthening the buttock muscles is important. Changes in your running style such as an increasing step rate and reducing 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?

In general, most people try to muddle through with bits and pieces and are often unsuccessful leading to months of pain.  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 injection for IT Band syndrome is a great idea early to reduce swelling and help rehab. For difficult cases, Dr Masci uses botox injections directed to the. side buttock muscles. Generally, the days of muddling through are long gone.

More on ITB injection 

ultrasound-guided cortisone injection

Cortisone is a powerful 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 important to use ultrasound to direct an ITB injection in the exact spot to increase the effectiveness and reduce side effects.

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

Botox vs cortisone injection for IT Band syndrome

Recently, some practitioners are using botox directed to the muscle on the outside of the hip to help with chronic ITB syndrome cases. Overall, we suspect the muscle called the TFL or tensor fascia lata 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 the treatment of chronic IT Band syndrome and may help people that have exhausted all other non-surgical options.

What about iliotibial band surgery?

Usually, surgery involves the release of part 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 results of iliotibial band friction surgery are unpredictable and may lead to a worse outcome. We suggest at least 12 months of conservative treatment before surgery is considered.

Final word from Sportdoctorlondon about cortisone injection for IT Band syndrome

IT Band syndrome is a difficult condition to treat in runners. We suggest aggressive treatment early including an ITB injection if the pain is severe. In general, rehab is extremely important.  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.

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