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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.
In total 268 articles were found, after removal of duplicates. The results were then searched manually for articles relating to the 3 part question.

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

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.

Editor Comment

KMJ

Clinical 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

1. Richard Ellis, Wayne Hing, Duncan Reid Iliotibial Band Friction Syndrome- A systematic Review Manual Therapy 12 2007; 200-208
2. 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 Sports Medicine; 42 (11) 2012; 969-992