Band Friction Syndrome >
Preparing for Surgery
If iliotibial band (ITB) friction syndrome does not
respond to rest and physical therapy, a surgical release,
in which the surgeon cuts into the ITB to relieve pressure,
may be recommended. While you are preparing to undergo
knee surgery, the decisions you make and the actions
you take can be as important as the procedure itself
in ensuring a healthy recovery. Most insurance companies
require a second opinion before agreeing to reimburse
a patient for a surgical procedure. Getting a second
opinion from a surgeon who is as qualified as the surgeon
who gave the initial diagnosis is advisable in any case.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
the use of any anti-inflammatory medicine a week prior
to surgery, to prevent excessive bleeding during the
reduce the risk of infection, try to refrain from smoking
for at least a week prior to surgery.
possible, practice walking with your crutches in case
you need to use them after surgery.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your iliotibial band (ITB) surgical release. If your
surgery is going to be inpatient, there may be a separate
department, so be sure to ask your physician. After
you have checked in to the hospital or clinic, you will
go to a holding area where the final preparations are
made. The paperwork is completed and your knee area
may be shaved (this is not always necessary). You will
wear a hospital gown and remove all of your jewelry.
You will meet the anesthesiologist or anesthetist (a
nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
anesthesia, which can lead to pneumonia.
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Surgical release of the iliotibial
band (ITB) involves cutting out a small portion of the
back inside part of the band that rubs against the leg
bone (lateral femoral epicondyle) when the knee is flexed.
This surgery takes about 30 to 45 minutes and is outpatient.
anesthesia is typically used for this type of surgery,
though in some cases a spinal or epidural anesthetic
is used. The anesthesiologist will administer the anesthesia
once you are in the operating room.
small incision is made over the outside part of your
knee. Only a small section of the ITB is released to
relieve the pressure.
are usually closed with stitches and the patient is
taken to the recovery room.
After your iliotibial band (ITB) surgical
release, you will remain in the recovery room until
you have recovered from the effects of anesthesia, which
may include drowsiness. It normally takes about an hour
for a general anesthetic to wear off, and about two
hours for a spinal anesthetic. Depending on the degree
of your pain, you may be given a narcotic pain reliever
such as vicodin or codeine. Your knee will be bandaged
and wrapped, usually with an ace bandage wrapped over
layers of gauze and cotton, and your knee will be elevated.
Ice may be used to reduce swelling, and a brace may
be used to keep the knee stabilized. Your surgeon may
suggest you use crutches or a cane initially, though
you probably will be able to walk without them. Physicians
may recommend that older patients continue using crutches
or a cane for a longer period of time. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse who, with the assistance of the doctor, will determine
when you can prepare to go home. You will normally be
able to leave the hospital or clinic within a few hours
after surgery. Make sure to have someone available to
drive you home, as you may not be able to drive a car.
Surgical release of an iliotibial band (ITB) is outpatient,
and does not require an overnight stay in the hospital
Following surgical release of your
iliotibial band (ITB), you will follow a course of rest,
anti-inflammatories, physical therapy, and stretching
and strengthening exercises. The severity of your symptoms
will dictate the course of action your physician recommends.
ITB friction syndrome is a chronic condition, and usually
is not severe enough that you will need to immobilize
your knee or use crutches. However, you should probably
try to avoid squatting, or walking or running up hills
or stairs, since these movements place added stress
on your knees. You will most likely have to curtail
your exercising routine if you participate in activities
that place strain on the ITB, like running or cycling.
to call the doctor after surgery
You usually are able to begin rehab
exercises soon after your iliotibial band (ITB) surgical
release, possibly as soon as the following day. Physical
therapy for ITB friction syndrome includes stretching
the ITB and strengthening exercises for the muscles
around the knee. You probably will begin with mild stretching
and slow movements to restore range of motion, and gradually
work your way up to strengthening exercises focusing
on the quadriceps and hamstrings. Strengthening exercises
require dedication because results often take weeks
and pain may recur. Heat applied to the affected area
of your knee can aid in loosening up the muscles and
tendons before you stretch. Depending on the severity
of the irritation, pain from ITB friction syndrome usually
subsides over a period of four to six weeks.
The ITB rubs against the outside of
the knee as part of the knee's normal motion. The goal
is to prevent this motion from causing irritation and
pain. Following are some steps you can take to prevent
ITB friction syndrome:
sure to stretch and strengthen the muscles around your
knees, particularly the quadriceps and hamstrings.
and warm up before you exercise, and stretch after you
your physician check to see if your feet turn inward
excessively (over-pronation), and if they do, make sure
to wear running shoes with proper support and cushioning.
you do a lot of cycling, adjust your seat height so
that you are not stretching too far at the bottom of
the down stroke.
you run frequently at a track, alternate direction (clockwise
and counter-clockwise) to avoid excessive ITB strain
on your outside leg.
not suddenly increase your training duration or intensity;
try to progress in small increments.