Iliotibial band syndrome PRACTITIONER PROMPT

IMMEDIATE TREATMENT (INFLAMMATORY PHASE)

P R

I C E

PRICE PROTOCOL ■ P - protect from repeated bent knee positions. ■ Unload gluteus medius with taping if painful.

■ R - (functional rest). Avoid all lower limb activities if irritable. ■ Reduce activities to sub-pain threshold if sub-acute. ■ Maintain fitness with upper limb and trunk activities.

■ I - avoid prolonged static ice exposure over femoral epicondyle or greater trochanter as they are both superfical bony prominences. ■ Use ice massage or wet ice only.

■ C - compression may be used during treatment but avoid long term compression as this may increase friction forces of ITB over bony prominences.

■ E - not required unless swelling is marked. ■ Anti-inflammatory modalities such as ultrasound may be useful.

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TREATMENT DURING RECOVERY PHASE Stretching ■ Stretch ITB/TFL in Ober test position ■ Teach pelvic control to eliminate false hip adduction

■ Maintain neutral pelvis and emphasise prolonged stretch

■ Stretch after heat application ■ Where pain is limited to upper insertion consider crook lying adduction instead.

Manual therapy ■ Release TFL and gluteus medius trigger points. ■ Use a massage tool to save your hands! ■ Consider deep massage to ITB.

Muscle control ■ Postural endurance using inner range holding of gluteus medius in side lying

■ Progress to abduction/lateral rotation maintaining pelvic alignment

■ Kneeling and then standing pelvic weight shift

actions avoiding ‘hip dip’

■ Build endurance of single leg standing with pelvis neutral

■ Leg alignment ■ Teach lower limb alignment ■ Central foot (avoid pronation) ■ Centre of patella over 4th metatarsal ■ Maintain optimal alignment for 20-30 seconds, build to 8-10 reps

■ Use mini squat movement on block emphasising alignment

■ Consider orthotic prescription.

Sport preparation ■ Build lower limb alignment endurance ■ Step down activities ■ Slope running (emphasise downward action) ■ Side slope run ■ Build running progressively, increasing time of run and using rest pause (day on-day off)

■ Encourage maintenance of flexibility and gluteus medius endurance.

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

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