Management of Iliotibial Band Friction Syndrome During Return-to-Sport Rehabilitation Following Left Knee Osteotomy Using Winback TECAR Therapy: A Case Report

Provider Name & Treatment Location:

Dr. Brock Labelle, PT, DPT
Competitive Edge Performance Physical Therapy – Tampa, FL

Key Words:

• Iliotibial Band Friction Syndrome (ITBFS)
• Winback TECAR Therapy
• Return to Sport
• Running Injury
• Cycling Rehabilitation

Summary (Testimonial):

This case report describes the successful management of iliotibial band friction syndrome in a high-level runner and cyclist during postoperative rehabilitation following a left knee osteotomy and arthroscopic lateral knee procedure after a previous lateral meniscus repair. Despite progressing appropriately through a comprehensive rehabilitation program consisting of neuromuscular re-education, strengthening, movement retraining, and edema management, the patient developed progressive lateral knee pain as running and cycling mileage increased.

Clinical findings included increased lateral knee pressure, pain and resistance during deep knee flexion, impaired terminal knee extension mechanics, reduced hip rotational mobility, localized edema, and inflammation.

A Winback TECAR intervention utilizing the Tendon Elasticity Enhancement protocol followed by RET Dynamic HI-TENS treatment was performed to improve tissue extensibility, reduce fascial restrictions, and restore lower-extremity mobility.

Immediately following treatment, the patient reported reduced lateral knee pressure, improved deep flexion, restoration of smooth terminal extension, improved hip mobility, decreased edema, and significant pain reduction. The patient ultimately returned to unrestricted running and cycling without recurrence of symptoms.

This case demonstrates the potential value of TECAR therapy as an adjunct to traditional rehabilitation for athletes recovering from knee surgery who develop secondary iliotibial band friction syndrome.

Introduction:

Iliotibial band friction syndrome is among the most common overuse injuries affecting endurance athletes. It frequently develops in runners and cyclists during periods of increased training volume and may be exacerbated by postoperative movement compensations, altered biomechanics, weakness, and reduced hip mobility.

While rehabilitation traditionally emphasizes strengthening, neuromuscular re-education, mobility, and progressive loading, adjunctive therapies that improve tissue extensibility and decrease pain may accelerate restoration of normal movement mechanics.

This case highlights the integration of Winback TECAR therapy into a comprehensive rehabilitation program for a high-level endurance athlete recovering from knee surgery who developed secondary iliotibial band friction syndrome during return-to-sport progression.

Patient Information/Diagnosis:

Patient Profile

• 47-year-old male
• High-level runner and cyclist
• Status post left knee osteotomy with arthroscopic lateral knee procedure following previous lateral meniscus repair
• Initially ambulated with bilateral axillary crutches
• Postoperative DVT managed medically with anticoagulation for one month
• Cleared by surgeon to begin progressive rehabilitation and independent exercise

Chief Complaint

Progressive lateral knee pain during return to running and cycling.

Medical History

• Previous lateral meniscus repair
• Left knee osteotomy
• Arthroscopic lateral knee procedure
• Medicated postoperative DVT

Relevant Past Interventions

• Progressive postoperative rehabilitation
• Independent strengthening program
• Neuromuscular re-education
• Functional strengthening

Clinical Findings:

The patient demonstrated:

• Increased pressure over the lateral knee
• Pain during deep knee flexion
• Mechanical resistance into deep flexion
• Difficulty achieving full terminal knee extension during triple-extension mechanics
• Reduced femur-on-pelvis and pelvis-on-femur rotational mobility
• Localized inflammation
• Mild lateral knee edema
• Decreased movement efficiency during sport-specific mechanics

Detailed Treatment, Timeline, and Outcome:

Diagnostic Assessment:

Examination Findings:

• Pain with deep knee flexion
• Reduced hip rotational mobility
• Impaired triple-extension mechanics
• Lateral knee tenderness
• Edema
• Functional movement dysfunction during athletic activities

Diagnosis: Secondary Iliotibial Band Friction Syndrome during postoperative return-to-sport rehabilitation

Therapeutic Intervention:

Previous Rehabilitation:

Neubie Neuromuscular Re-education

Neubie Frequency Specific Microcurrent (FSM)

• Acute Cartilage Swelling Protocol (40/157)

Winback TECAR Intervention

• Care+ Program

Tissue: Tendon

Protocol: Elasticity Enhancement

Electrode Placement – Ground electrode placed over the lateral hip encompassing the TFL and gluteal complex.

Treatment applied continuously along the iliotibial band to the distal insertion.

Second Treatment Phase

• RET Mode
• Bilateral Bracelets
• RET Intensity: 60%
• Dynamic HI-TENS enabled
• Same ground electrode placement maintained

Treatment emphasized prolonged application over palpable restriction points to improve fascial mobility throughout the iliotibial band.’

Treatment Protocol and Follow Ups:

Follow-Up Treatment – Continued progressive strengthening, running progression, cycling progression, hip mobility restoration, neuromuscular retraining, sport-specific movement training

Session Frequency: 2/week

Techniques used in follow-up sessions: Postoperative rehabilitation, Winback TECAR integrated as symptoms developed during return-to-running progression

Clinician and patient assessed outcomes: reduced lateral knee pressure, elimination of resistance during deep flexion, improved terminal extension mechanics, improved hip rotational mobility, reduced edema, improved movement efficiency. “Freedom” within the knee.

Intervention adherence and tolerability (how was this assessed): Patient demonstrated excellent compliance with rehabilitation and home exercise recommendations. All interventions were well tolerated without adverse reactions.

Results after all treatment completed (or current results if still being treated): Immediate

• Reduced pain
• Reduced edema
• Improved hip mobility
• Improved deep knee flexion
• Improved triple-extension mechanics

Long-Term

Patient successfully returned to:

• Unrestricted cycling
• Full running progression
• Pain-free athletic participation
• Pre-injury training volume without symptom recurrence

Discussion: This case demonstrates the successful integration of Winback TECAR therapy into a comprehensive rehabilitation program for a high-level endurance athlete recovering from knee surgery. Despite progressing appropriately with strengthening, neuromuscular re-education, and functional exercise, the patient developed secondary iliotibial band friction syndrome as training volume increased.

The addition of TECAR therapy produced immediate improvements in tissue mobility, pain, edema, and movement quality, facilitating continued progression through rehabilitation. Ultimately, the patient returned to unrestricted running and cycling without recurrence of symptoms.

Although this report describes a single patient, the observed outcomes suggest TECAR therapy may serve as a valuable adjunctive intervention for postoperative athletes experiencing soft tissue overload during return-to-sport progression. Future studies examining objective performance measures, longer-term follow-up, and larger patient populations would further clarify its role in rehabilitation.

Patient Perspective: “I’ve had the most pain-free run I’ve experienced in a long time, and I even woke up the next morning without the usual pressure behind my knee. After each PT session, I notice immediate relief, and although my knee is still a little irritated after running, it’s definitely better than it was before treatment. I really feel like we’re headed in the right direction, especially with the aggressive work on my IT band. Overall, I’m starting to feel like I can run again, which is something I haven’t felt in a long time.”