Dry Needling vs Ilio-Tibial Band Syndrome

Dry Needling and Iliotibial Band Syndrome

Dr. Scott A. Jones

Physical Therapist

Are you suffering from iliotibial band syndrome, otherwise known as ITBS?  Here at Peak Health and Performance, we’ve been treating ITBS for athletes at every level.  

As you might guess, having been an Air Force physical therapist for 15 years, I used the dry needling technique thousands of times on military men and women who were suffering from this condition.  In particular, where iliotibial band syndrome is concerned, I have found trigger point dry needling to be a powerful tool in addition to manual therapy techniques, and a holistic corrective exercise approach in the battle against this condition. In this article I will discuss a little bit about the background of ITBS as well as why therapeutic dry needling is an important part of helping athletes return to full function as quickly as possible. 

Iliotibial Band Syndrome: An Overview

If you are reading this article, I’m sure you are aware that ITBS  is a common condition among all athletes. However, it does seem to be particularly troublesome for  long distance athletes who engage in repetitive knee flexion and extension activities without much deviation from midline.  If you are a runner or cycler, yes, I’m talking to you. 

ITBS Generally manifests as an overuse injury that affects the lateral, or outside aspect of the hip, thigh, and knee.  This is, dense, fibrous band that runs from the hip to the top of the shin bone and plays a crucial role in stability.

First, let’s take a look at what the recent research says about ITBS. In 2015 Aderem et al attempted to shed some light on why ITBS so commonly occurs in runners. It turns out that this condition is the second most frequent running injury, and the number of people experiencing this injury seems to be increasing each year due to the growth in popularity of running for fitness purposes. However, as frequent as this injury is, the factors for individual athletes that lead up to such a common overuse injury are poorly understood. This is largely due to the fact that all athletes are individuals, everyone’s biomechanics differ, as well as the compensatory strategies that lead to overuse injury and dysfunction. there simply is no one-size-fits-all way to easily categorize and treat this condition. Researchers continue to look at various factors, including knee flexion angles, differences in leg length, decreased flexibility, and muscle weakness. However, a consistent narrative linking these factors together in a way that suggests a common solution has been elusive.

In 2015, Aderem et. al took a closer look at the potential biomechanical changes that could contribute to ITBS in runners. Indeed, previous Studies have suggested that the biomechanics of runners are altered compared to other athletes who do not suffer from this condition. Aderem  and his colleagues set out to determine the extent of those differences by conducting a systematic study.  While considering the data they took a close look at the measures of the trunk, pelvis, hip, knee, and Ankle risk factors that may be associated with ITBS.

After reviewing 13 studies, they concluded that female runners are more likely to develop ITBS, and had a higher degree of hip adduction, that is, a medial movement of the hip closer to midline, and a higher degree of knee internal rotation during running when the foot is on the ground. The biomechanical review also showed that female runners with ITBS  demonstrated increased trunk ipsilateral flexion when the foot is on the ground (trunk flexion to the same side as the grounded foot), and these similarities led to the conclusion that these risk factors may provide some insight as to why certain runners are more likely to acquire ITBS than others.

The Role of Dry Needling in ITBS:

As you know by now, dry needling is a highly effective treatment that uses small, thin, filament needles. The sterile needle is inserted into specific points, usually areas associated with pain, known as myofascial trigger points. The needle may elicit a localized twitch response, which may feel like a small, brief spasm within the muscle, and results in the relaxation of tension and a reduction in pain. Here are a few examples of how dry needling might work to help relieve the pain of iliotibial band syndrome.

1. Trigger Point Release: ITBS Many times will be associated with tight and painful trigger points in the iliotibial band itself as well as  in the surrounding musculature, including the vastus lateralis, tensor fascia lata, gluteus medius, and hamstrings. As I just mentioned, these sensitive trigger points can be “released” by inserting the filament needle into these trigger point areas which may produce a localized twitch response. These twitch responses are highly associated with a release in muscle tension, decreased pain, and an improvement in joint mobility. 
2. Localized Microtrauma and Healing Response: The insertion of a needle into the muscle will also cause what is known as ” microtrauma”.   this is simply the process of creating a localized healing and pro-inflammatory response that increases blood flow as well as growth factors.The increased blood flow theoretically helps to flush out inflammatory substances and toxins within the area that may be the result of chronic overuse injury, which results in an increase healing response, decreased stiffness, and decreased pain.
3. Neuromodulation: Dry needling can also affect the nervous system in a positive way by creating a mechanical disruption to pain signals. this disruption can lead to a decrease in the sensation of pain, which will further have a relaxing effect on the muscles due to a decrease in the body’s guarding response.
4. Reducing Muscle Tension: A release of the trigger point is usually quickly followed by a decrease in muscle tightness. In this way, dry needling can quickly restore functional movement patterns and decrease faulty joint mechanics. This has the potential to reduce excessive friction of the iliotibial band over the lateral epicondyle at the knee.

So, is this all just theory? Do we have any evidence that dry needling actually works for iliotibial band syndrome? Why yes, yes we do. 

In 2021, Razie et al compared treatments to see if dry needling could be effective, and whether it could significantly improve this chronic overuse condition.

The study compared dry needling and shockwave therapy to see if one or the other was superior in the alleviation of iliotibial band pain.

40 patients with iliotibial band syndrome were selected for the study. they were randomly assigned to either the dry needle group or the shockwave sherapy group. If you are unfamiliar with shockwave therapy, this treatment uses a high energy sound wave to elicit healing. each group received their respective treatments, and the researchers recorded their pain levels and leg function before, after, and 4 weeks after their treatments.

After 4 weeks, the investigators found that both methods of treatment were effective. In fact, both treatments significantly decreased pain and improved joint function. However, the investigators also found that dry needling did reduce pain more effectively and for a longer duration of time than shock wave therapy.

Both groups also demonstrated significant improvement in restoration of functional biomechanics of the leg. Interestingly, there was no observable or measurable difference in iliotibial band length. In other words, even though pain was reduced and function was restored, the iliotibial band structure itself was not physically altered.

The authors concluded this study by pointing out that both dry needle therapy and shockwave therapy are helpful in the fight against iliotibial band syndrome, dry needling did appear to provide more long-term relief. Dry needling is a highly effective therapy, and should be considered for the improvement of both pain and function in the management of ITBS.

Another study demonstrating the efficacy of dry needling for iliotibial band syndrome took a look at people who had previously tried physical therapy, and were experiencing difficulty with such seemingly simple activities as walking, sleeping and other everyday tasks. This brief clinical study compared dry needling to stretching and a variety of strengthening exercises in order to determine which treatments might be most effective.

The subjects in this study had been experiencing chronic pain and stiffness for at least 90 days. They had also previously tried a variety of treatments to include stretching, strengthening, and even cortisone injections, but the subjects never received anything other than short-term relief.  The subjects agreed to participate in a more holistic approach which included targeted physical therapy strengthening and stretching, as well as dry needle treatments, with each therapeutic session lasting approximately 1 hour. The goal was to see if the addition of dry needling to traditional physical therapy would provide additional and longer term benefit.

At the end of each treatment, each of the subjects reported less pain and improved function. In addition, all functional scores and measurements improved. However, beyond that, the results after one year were highly encouraging. The improvement in pain and functional scoring increased by an average of 16 points on the functional scale measurement, and a year later, the improvements remained. This demonstrates that simply with the addition of dry needling alone, long-term results may be more likely than with physical therapy alone. The subjects of the study reported improved function in day-to-day activities such as walking, sleeping, stair climbing, and other daily activities.

Hopefully this answers some of your questions about whether trigger points. Dry needling can be effective in the treatment and management of pain due to iliotibial band syndrome. Dry needling’s ability to improve pain, decrease muscle stiffness and tightness, and improve joint function make it a powerful tool for helping athletes of all stripes return to their favorite activities, whether running, cycling, hiking, or just enjoying an afternoon out with the family.

References:

Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review. BMC Musculoskelet Disord. 2015;1(16):1–16.

Pavkovich R. Effectiveness of dry needling, stretching, and strengthening to reduce pain and improve function in subjects with chronic lateral hip and thigh pain: a retrospective case series. Int J Sports Phys Ther. 2015 Aug;10(4):540-51. PMID: 26347305; PMCID: PMC4527201.

Walsh R. The effects of dry needling and radial extracorporeal shockwave therapy on the sensitivity of trigger points in the quadriceps and jump performance: A randomised control trial. Institute of Technology Carlow. 2017

As always, our physical therapy clinic does participate in most insurance plans, including Tricare Select, Tricare Prime, and Tricare For Life for military active duty, military retirees, and their dependents. As a United States Air Force retiree myself, I am excited to continue to serve our nation’s guardians and their families.