Table 1.

Studies Reporting Nonoperative Treatment for ITBS and the Associated Clinical Outcomes

Study, Year, Journal Type of Study, Level of Evidence	Study Population (Participants, Age)	ITBS Treatment Protocol	Follow-Up Assessment Tool and Timeline	Clinical Outcome	Complications
Weckstrom et al.,21 2016 Journal of Back and Musculoskeletal Rehabilitation RCT, II	24 recreational runners (14 male, 10 female) with unilateral ITBS Age in years (mean, SD): SWT group: 33 (10) ManT group: 34 (6)	SWT group (n = 11): shockwave therapy + standardized exercise program ManT group (n = 9): manual therapy + standardized program	4 weeks: changes in pain (11-point scale) during treadmill running 8 weeks: changes in pain (11-point scale) during treadmill running 6 months: patients were only assessed (by telephone) for symptoms based on the current activity level	Baseline to week 4: Similar reduction in pain between SWT and ManT groups Baseline–week 8: Similar reduction in pain between SWT and ManT groups 6 months: All pain-free subjects at week 8 remained pain-free at 6 months	SWT group: transient reddening of skin (all subjects) ManT group: transient bruising on the lateral thigh following trigger point therapy (small but unspecified number of subjects)
Beers et al.,23 Physiotherapie Canada OS, II	16 athletes (5 male, 11 female) Mean age in years: 33.7 (range: 20-53)	6-week rehabilitation program to strengthen the hip abductors	Comparison of hip abductor strength between injured and uninjured side + AMI Evaluation at baseline Follow-up time points: 2, 4, 6 weeks	Hip abductor strength was significantly different between injured and uninjured sides at baseline, but the difference disappeared at 6 weeks Hip abductor moments were related to physical function domain of AMI at weeks 2, 4, 6, indicating improvement in function as the injured lower extremity was becoming stronger	none
Gunter et al.,22 2004 British Journal of Sports Medicine RCT, II	18 runners with unilateral gat least grade 2 ITBS Age in years (mean, SD): 28.9 (5)	EXP group (n = 9): ITB injection 40 mg methylprednisolone acetate + with short acting local anesthetic CON group (n = 9): ITB injection with short acting local anesthetic	Total pain during running (calculated as area under the pain versus time graph), using 11-point pain scale every minute during treadmill running Follow-up time: Day 0 (preinjection), day 7, day 14	Preinjection day 7: no significant difference in total pain between EXP and CON groups Day 7–Day 14: EXP group had greater decrease in total pain compared with CON none	None
Bischoff et al.,24 1995 Research in Sports Medicine: An International Journal RCT, II	25 students (26 ITBS cases) at Navy basic underwater demolition training class Age in years (mean) group P: 23 group I: 22	Group I (n = 13) forced rest+ three panel knee immobilizer + 800 mg ibuprofen daily + 5-7 minutes ice massage daily Group P (n = 13): daily phonophoresis with 10% hydrocortisone cream 800 mg ibuprofen daily + 5-7 minutes ice massage daily	Daily examination for pain Endpoint: when pain free, running 1 mile on treadmill without pain or stiffness	Group P achieved pain free examination sooner than group 1 (2 days vs 8 days) A greater proportion of subjects from group P (100%) recovered in less than 10 days than from group I (62%). One subject from group P and three from group I experienced pain during the 1-mile run	Not reported
Schwellnus et al.,25 1992 Physiotherapy RCT, II	17 athletes with unilateral ITBS Age in years (mean, SD): Group A: 25 (6) Group B: 29 (5)	Both groups: 0-14 days: rest, daily stretching and twice daily ice therapy 3-14 days: ultrasound treatment Group A: day 3-14 addition of deep transverse frictions Group B: no transverse frictions	Total pain during running (calculated as area under the pain versus time graph), using 11-point pain scale every minute during treadmill running Follow-up time points: day 0, 3, 7, 14 treadmill running	Total pain experienced during treadmill not significantly different between the groups on any of the days Significant decrease in pain in both groups over the treatment period Significant reduction in percentage of maximum pain experienced during running in both groups over the treatment period	Not reported
Schwellnus et al.,26 1991 South African Medical Journal RCT, II	43 athletes with unilateral ITBS Age (mean, SD): Group 1: 22(5) Group 2: 24(6) Group 3: 22(2)	All 3 groups common baseline protocol: day 0-7: rest day 3-7: identical physical therapy Group 1 (n = 13): common baseline protocol + placebo Group 2 (n = 14): common baseline protocol+ anti-inflammatory medication (Voltaren, Geigy) Group 3 (N = 16): common baseline protocol+ combined anti-inflammatory/analgesic medication (myprodol, Rio ethical)	Daily 24-hour recall pain Treadmill running test with pain scoring every minute (calculation for the area under the curve) Total running distance Total running time Day 0, 3, 7	24-hour recall pain scores: decreased for all the groups over the treatment period Running test: Group 3: improved their total running time and distance from day 0 to day 7 Group 1 + 2: improved total running time and running distance from day 3 to day 7 All groups: pain decreased from day 0 to day 7 All 3 treatment modalities are effective against ITBS but physiotherapy + analgesic + anti-inflammatory medication is superior. Functional running test is more sensitive for the evaluation of the therapy progress compared with 24 recall pain scores	Group 1: nausea, headache, fatigue, abdominal pain, dizziness Group 2: nausea, headache Group 3: nausea, headache, sore throat

Level of evidence was reported based on the American Academy of Orthopaedic Surgeons accepted criteria.²⁰

AMI, Allan McGavin Health Status Index; CON, control; EXP: experimental group; I, knee immobilizer; ITBS, iliotibial band syndrome; ManT, manual therapy; OS, observational study, P, phonophoresis 10% hydrocortisone; RCT, randomized clinical trial; SD, standard deviation; SWT, shockwave therapy.