Iliotibial Band Friction Syndrome - Procedures, Side effects, Recovery time, Costs and alternatives

Iliotibial band friction syndrome is a condition wherein an overuse injury of the large band of connective tissue running along the length of thighs and knees. The occurrence of this condition in a person is characterized by pain, inflammation, and tenderness of the concerned area which is mainly above the knee joint. This condition is mostly experienced by bicyclists and long-distance runners. It is can also be experienced by other athletes that squat repeatedly. The occurrence of this condition can be due to a combination of several issues. These issues include poor flexibility of the muscles, mechanical imbalances in the body which involve knees, hip, lower back and pelvis, and poor training habits. There may also be some anatomical issues that may cause the occurrence of this condition. These issues may be an abnormal tilt to the pelvis and leg length discrepancy. Error in training develops iliotibial band friction syndrome. Usually, the roads are banked and the center of the road is always higher than the outside edge. When the runner runs on the same side of the road then the effect on the body is similar to the effect of leg length inconsistency. When an athlete is running down the hill the stress on the IT band gets increased.

A bicyclist can experience this condition if his/her posture while bicycling is not correct. A physical examination by the doctor may prove to be helpful in diagnosing this condition. During the physical examination, the doctor may look for an imbalance of the muscles, stiffness or tightness of the back or legs, and inconsistent leg length. Simple x-ray is not sufficient to diagnose the inflammation however MRI scans can reveal inflammation both beneath and surrounding the iliotibial band. The treatment for the condition of iliotibial band friction syndrome includes the use of RICE therapy, medications, physical therapy, and surgery.

The treatment available are as follows:

• RICE: The first line of treatment that is given to patients suffering iliotibial band friction syndrome is RICE therapy which involves rest, ice, compression, and elevation. If a patient does not get any relief from the pain and inflammation then a doctor may prescribe some pain killers.
• Medications: Usually, the doctors prescribe non-steroidal anti-inflammatory drugs to the patients. Use of these medications is preferred as it has proven track record of not only providing relief in pain but also reducing the inflammation. Sometimes a doctor may also prescribe the use of corticosteroid for the treatment. Corticosteroids are usually injected at the inflamed site.

If the first line of treatment through RICE and pain-relieving medications do not show any improvement in the condition of the patient then physical therapy is advised by the doctor. The treatments in the physical therapy would concentrate on stretching and flexibility. The occurrence of friction rubbing at the Iliotibial band may help in reducing the scarring and inflammation. The underlying cause of the problem may also be evaluated by the physical therapist. The physical therapist may observe the gait, balance, flexibility, and strength of the muscles.

A doctor can prescribe therapeutic ultrasound techniques like iontophoresis and phonophoresis. In iontophoresis, electrical impulses are used to assist in the reduction of the inflammation while in phonophoresis the ultrasound propagates the pain relieving medicines through to the inflamed tissue by passing through the skin.

It may be a very rare case where a conservative non-surgical method fails to provide relief to the patient suffering from the condition. If this case arises a doctor may advise orthopedic surgery to the patient. The most common surgical procedure that can be used is Arthroscopy. In this surgical procedure, the area having an inflammation is recognized and cut off. The inflammation is usually found in the lateral recess of the knee. Other options may be inclusive of removing a small triangular portion of the Iliotibial band so that the band may be lengthened and more room is provided to it for sliding.

A patient becomes eligible for the treatment of Iliotibial band friction syndrome if he/she is exhibiting the following conditions

• When a patient is experiencing pain, burning sensation or tenderness outside the knee.
• When a sound of click or pop can be heard outside the knee while running or cycling.
• A patient is having redness on the outside part of the knee.
• The pain is radiating both upwards and downwards in the leg.

Also, a doctor may consider a patient eligible for the treat of Iliotibial band friction syndrome if the MRI scans of the patient reveal inflammation both below and around the iliotibial band.

Whether a patient is eligible for the treatment of a specific condition is decided by the doctor. Sometimes a doctor may misdiagnose a patient with iliotibial band friction syndrome with other conditions that may be causing pain in the knee like a sprained lateral collateral ligament, torn cartilage, and inflammation of the muscle tendon. Such patients are not eligible for the treatment of this condition. Since there are several lines of treatment available for correcting the IT band syndrome a patient may be eligible for one line of treatment but might be not eligible for another line of treatment. For instance, if a patient is allergic to corticosteroid or non-steroidal anti- inflammatory drugs then that patient is not eligible for this line of treatment.

Whenever any treatment is given to a patient be it oral, injectable, or surgical there are some minor or major side effects associated with it. The possibilities of a patient experience a minor or a major side effect is variable in each patient. The minor side effects of the treatment usually vanish after some time. However, if a patient is experiencing any major side effects then a prompt action of informing the doctor must be done.

When a patient suffering from iliotibial band friction syndrome undergoes RICE methodology for the treatment no side effects are experienced by the patient. It is one of the safest procedure for reducing pain and inflammation. The side effects associated with the use of pain-relieving medications like non-steroidal anti-inflammatory drugs are flatulence, nausea, loose stool, pain in the abdomen, and allergic reaction. The use of corticosteroids in the treatment may cause side effects like increased blood pressure, glaucoma, weight gain, allergic reaction, and insomnia.

A patient undergoing treatment with physical therapy may experience side effects like excruciating pain, fatigue, muscle soreness, and bruising. In patients that undergo arthroscopy for the treatment as do not get relief from non-surgical procedures, the side effects experienced are :

• Surgical site infection
• Artery damage
• Feeling numbness at the site of the incision.
• Pain
• Nerve damage
• Thrombophlebitis. In case any of these side effects persists or there any other health issues arising during or after treatment, it is advised to kindly consult the health specialist immediately.

The post-treatment guidelines help the patient in recovering from the disease for which he/she has undergone treatment. The post-treatment guidelines not only help in recovering but it also helps in preventing the disease from occurring in the future. Some post-treatment guidelines for patients after the treatment of Iliotibial band friction syndrome are given below

• Plenty of time must be given for cool up proper stretching, warm up.
• The runner should run with smaller strides.
• The running shoes must be replaced regularly.
• Running should be done on a flat surface or the runner must decide on which side of the road he/she wants to run and stick to that side of the road.
• For loosening of the Iliotibial band, a foam roller must be used.
• Hamstrings, thigh muscles, hip muscles, and Iliotibial band must be stretched regularly.
• Ample time must be given to the body to recover from the events or workouts.

The recovery of the patient from Iliotibial band friction syndrome depends on the length of time a patient has been injured and the treatment that a patient is undergoing. Usually, it takes nearly 6 weeks for a patient to recover completely but in some severe cases, it may take months to completely recover from the condition.

In India, the pain relieving medicines such as non-steroidal anti-inflammatory drugs would cost around 50 to 200 rupees. The cost of physical therapy varies in different cities. In metro cities, the cost of physical therapy ranges between 800 to 2000 rupees per session depending upon the experience of the therapist. In smaller cities, the cost ranges from 300 to 600 rupees per session. In India, an arthroscopic surgery would cost around 1.5 lakh rupees. This cost may increase or decrease based on the condition and location of surgery.

The results of the treatment for Iliotibial band friction syndrome are permanent. however, there are chances that this condition may reappear if proper precautions are not followed by the patient after completion of the treatment.

Apart from the treatment described above a patient suffering from Iliotibial band friction syndrome can opt for alternative treatments like deep tissue massaging, lacrosse ball massaging. These treatments can be preferred as they can be slightly less painful than other physical therapy exercises.