Both stretching and strengthening exercises are an important part of any ITB rehabilitation program. Exercises should be done regularly, at least twice a day whilst recovering from injury.
- This static stretch can be done by the athlete themselves. Place the leg you want to stretch behind the other one.
- Keep the foot on the floor and push your hips out to the other side until a stretch is felt in the outer hip.
- You may also feel a stretch down the outside of the thigh. Hold for 30 seconds, repeat 5 times and do this at least three times a day.
- It is important not to bounce when stretching, always ease into it gently and try to relax. If you need to, lean forwards on to a table to help with balance or to increase the stretch.
This is probably the most effective stretch for the iliotibial band and tensor fascia latae muscle but it does require some assistance. Lie on your back and let the partner or therapist lift the non-stretching leg out of the way then pull the stretching leg across to feel a deep stretch on the outside of the hip. This stretch can be performed statically by taking the stretch as far as possible and holding for 30 seconds.
Stretching can also be done in the form of a muscle energy technique. The patient attempts to push the bottom leg against resistance contracting the muscles being stretched at approximately 25% of maximum effort for 10 seconds. They then relax and the therapist increases the stretch as far as it will go before the contraction is repeated. This is continued for 4 or 5 times or until no further gains are achieved.
Tensor fascia latae stretch
This stretch lengthens the tensor fascia latae muscle which is found on the outside of the hip. The IT band is almost like a long tendon which extends from this muscle, down to the knee. The athlete sits on the floor with one leg out straight. The leg to be stretched is bent and the foot placed on the outside of the other knee as shown. They then use their hands to apply pressure as if trying to pull the bent knee across the other one. Hold for 30 seconds and relax. Repeat 3 to 5 times.
Gluteal muscle stretch
Lay on your back with one leg flat on the floor. Pull the other knee up to your chest. Then pull it across your body until you feel a stretch in the buttock and outer hip. Hold for 30 seconds.
Strengthening exercises for Iliotibial band friction syndrome
Strengthening exercises for the muscles on the outside of the hip which abduct the leg will help prevent the knee turning inwards when running or walking and therefore help reduce the friction on the ITB tendon at the knee.
In particular, strengthening exercises for the tensor fascia latae muscle and gluteus medius, such as heel drops, clam exercise, and hip abduction is important.
- The heel drop exercise strengthens the muscles that stabilize the hips.
- Stand on one leg and slowly squat down on the affected leg as if you are going to step off the step.
- Don’t let either side of the pelvis dropdown. This should only be done if the knee is free of pain and inflammation.
- Perform two sets of as many as you can comfortably manage. Try to get the number in each set equal. Have a minutes rest in-between sets.
- Gradually increase the number you perform, up to 3 sets of 15-20. Repeat the exercises every day.
- Lay on your side with the knees together and bent with the feet in line with your spine.
- Keep the feet together as you lift the top knee up as far as comfortable.
- Ensure you keep your back still and do not rotate backward to increase the range.
- It may only be a small movement initially but this will improve as your strength increases.
- Start with 2 sets of 10 if you can, and gradually increase to 3 sets of 15-20.
Hip abduction exercises for Iliotibial band friction syndrome
- Use a resistance band wrapped around the ankle. Pull the leg out to the side, keeping the knee straight.
- Slowly return to the start position and repeat.
- Start with 2 sets of 10 and gradually increase to 3 sets of 15-20. Make sure the iliotibial band is stretched after performing these exercises.
- Doing too much of this exercise and not stretching out may actually shorten the tfl muscle.