Extreme Diagnostic and Therapeutic Heterogeneity Limits Treatment Conclusions in Iliotibial Band Syndrome: A Systematic Review with Level-of-Evidence Stratification
Abstract
BACKGROUND: Iliotibial band syndrome (ITBS) is a leading cause of lateral knee pain in runners and endurance athletes, yet clinical decision-making remains inconsistent and largely unsupported by high-quality comparative evidence. No comprehensive synthesis has previously integrated all available treatment modalities using a standardized evidence framework, and the evidence base for individual injection-based therapies continues to evolve rapidly.
OBJECTIVE: To evaluate all available treatment strategies for ITBS and stratify their efficacy according to the Oxford Centre for Evidence-Based Medicine (CEBM) levels of evidence.
METHODS: A systematic review was conducted following PRISMA 2020 guidelines. The protocol was registered in PROSPERO (CRD420261374567) on 20 April 2026. PubMed, Embase, and Web of Science were searched from database inception to 29 April 2026. Screening, data extraction, and the subsequent review processes were completed by 21 May 2026. An updated search subsequently identified one further eligible trial, published after the original cut-off. Eligible studies included RCTs, prospective and retrospective cohort studies, and case series reporting outcomes in adults with clinically diagnosed ITBS. Studies were classified into five treatment categories: therapeutic exercise, instrumental physical therapy, manual therapy and minimally invasive techniques, injection-based, pharmacological and biologic treatments, and surgical interventions. The primary…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,012 participants or records.
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