Conservative managment of Iliotibial band friction syndrome
Date First Published:
December 18, 2013
Last Updated:
April 30, 2014
Report by:
Amy Davis, Band 6 Musculoskeletal Physiotherapist (Imperial College NHS Healthcare Trust)
Search checked by:
Carol Waugh; Aldo Russell de Boer, Amy Davis, Imperial College NHS Healthcare Trust
Three-Part Question:
In patients diagnosed with [iliotibial band syndrome (ITBS)] is [manual therapy or exercise therapy] more effective in [the conservative management of these patients]? (ITBS)
Clinical Scenario:
A female patient aged 30 has recently returned to running after a 5 year break. She has developed pain on the lateral aspect of her knee whilst she is running, and she has been diagnosed with iliotibal band syndrome (ITBS). You wonder, given the limited treatment time available, which conservative technique to use in order to get the best results.
Search Strategy:
The following search terms : (iliotibial AND band AND syndrome AND physiotherapy); (iliotibial AND band AND friction AND syndrome; (iliotibial AND band AND syndrome), were used to find articles from the following data-bases: AMED, EMBASE, HMIC, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE.
Search Details:
In total 268 articles were found, after removal of duplicates. The results were then searched manually for articles relating to the 3 part question.
Outcome:
Two major reviews were identified as being systematic, and the quality of these reviews was assessed by 3 researchers using the Critical Appraisal Skills Program (CASP) tool. The results were discussed in a group setting and any discrepancy discussed and resolved between the 3 researchers.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Iliotibial Band Friction Syndrome- A systematic Review Richard Ellis, Wayne Hing, Duncan Reid 2007 New Zealand | studies included with patients over 18 yeras of age, either gender, with clinical diagnosis of Iliotibial band syndromeof greater than 14 days | Iliotibial Band Friction Syndrome- A systematic Review; Manual Therapy; 12; 200-208 | 4 Randomised controlled trials were critique as part of the review. 3 of the RCT’s were rated to have moderate quality, and 1 RCT rated to have limited quality. Inadequate blinding was the most common reason for low quality. The PEDro 11 point score and Internal Validity Scores were used to evaluate the quality of the studies. The main studies looked at injection therapy, phonophoresis, medications and physiotherapy, medications and physiotherapy, and deep transverse friction with physiotherapy. Physiotherapy plus medication (NSAIDS, paracetamol and codeine) appears to reduce pain on running in people with ITBS within the acute phases of the condition. However,due to the quality of the studies and lack of homogenous data the review was unable to support or refute the effectiveness of conservative management in the tretament of ilio-tibail band syndrome |
||
| Iliotibial Band Syndrome in Runners, A systematic Review Maarten van der Worp, Nick van der Horst, Anton de Wijer, Frank J.G Backx, Maria W.G Nijhuis-van der Sandern 2012 Netherlands | Studies involving adult runners (over 18 years old)which focussed on aetiology, diagnosis and treatment of iliotibial band syndrome | A systematic Review | 36 trials met the inclusion criteria. Methodological quality was assessed using the Cochrane Collaboration Criteria, and only studies with a quality score of >60% were included in the review. An observational study provides some evidence to support advice on running technique and footwear in the treatment of ITBS, however, due to low quality studies and lack of homogenous data there is a paucity of the evidence informing the effectiveness of conservative managements including exercise and manual therapy for ITBS |
Author Commentary:
There appears to be a limited amount of high quality Randomised Controlled Trials in investigating conservative management for iliotibial band syndrome (ITBS). Two recent systematic reviews have evaluated the literature. However, due to a lack of quality and homogenous data, there continues to be a lack of certainty as to which treatment approach to use once a diagnosis of ITBS has been made.
There is some evidence to dispute the use of Deep Transverse Friction massage when used in addition to ‘conventional physiotherapy’ (Stretches, Ice, Ultrasound). ‘Conventional physiotherapy’ was seen to reduce pain levels whilst running in patients with ITBS, but was less effective than the use of NSAIDs in combination with paracetamol and codeine. An observational study provides some evidence to support advice on running technique and footwear in the treatment of ITBS.
Further research should aim to look at different interventions in isolation, and in combination.
There is some evidence to dispute the use of Deep Transverse Friction massage when used in addition to ‘conventional physiotherapy’ (Stretches, Ice, Ultrasound). ‘Conventional physiotherapy’ was seen to reduce pain levels whilst running in patients with ITBS, but was less effective than the use of NSAIDs in combination with paracetamol and codeine. An observational study provides some evidence to support advice on running technique and footwear in the treatment of ITBS.
Further research should aim to look at different interventions in isolation, and in combination.
Bottom Line:
There is a paucity of the evidence informing the effectiveness of conservative managements including exercise and manual therapy for ITBS. Physiotherapy plus medication (NSAIDS, paracetamol and codeine) appears to reduce pain on running in people with ITBS within the acute phases of the condition.
References:
- Richard Ellis, Wayne Hing, Duncan Reid. Iliotibial Band Friction Syndrome- A systematic Review
- Maarten van der Worp, Nick van der Horst, Anton de Wijer, Frank J.G Backx, Maria W.G Nijhuis-van der Sandern . Iliotibial Band Syndrome in Runners, A systematic Review