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Iliotibial band syndrome (ITB syndrome) is an overuse injury that affects the outer thigh and knee. According to multiple studies [6], approximately 4–15% of runners experience ITB syndrome. While this injury can be difficult to manage, TENS machines are safe and effectively assist with pain relief. This guide will cover all that you need to know about using a TENS unit for ITB syndrome.

What is IT Band Syndrome? 

Iliotibial band syndrome (or ITB syndrome) is a common overuse condition that is caused by excessive tightness, swelling, and rubbing of the iliotibial band against the end of the femur (also known as the thigh bone). The ITB is a long-spanning structure that travels from the outside of the hip to the knee. As a result, this condition is characterised by pain around the outer (lateral) part of the knee, which can radiate along the outer part of the thigh. 


What causes IT band syndrome? 

IT Band Syndrome is considered an overuse injury that occurs through microtrauma to the tissue due to overly repetitive lower body movements. According to the Royal Australian College of General Practitioners [1], ITB syndrome is the second most common cause of outer knee pain in runners.

While too much running and jogging are frequent causes of IT band syndrome, other potentially responsible activities include hiking, cycling, and power walking. Weekend warriors or those who overtrain are particularly likely to develop symptoms due to sudden spikes in activity (where the body has yet to fully tolerate the load). More often than not, these suboptimal training habits are more influential in causing this condition than the activity itself.

Range of IT Band Symptoms 

ITB syndrome symptoms can vary from person to person. Many people will experience ITB syndromes after physical activity, such as jogging and running. This is considered an overuse injury that will progressively worsen with continued activity. 

Symptoms associated with ITB syndrome include: 

  • Front/side hip pain
  • Pain along the outside of the knee
  • Clicking sensation around the hip and thigh.
  • Tightness around the outside of the thigh. 

Traditional Therapies for IT Band Syndrome 

Typically, traditional therapies have been used to treat IT band syndrome to varying degrees of success. Usually, surgery is only resolved for severe and chronic conditions [2]. Examples of these therapies include: 

  • Physiotherapy
  • Exercise and rehabilitation (particularly for the hip abductors)
  • Physical activity modification
  • Heat
  • Ice
  • Medications (e.g., non-steroidal anti-inflammatory drugs)


What is a TENS machine, and how can it help IT band syndrome?

A TENS machine is a portable device that is used to help relieve pain. This device delivers electrical current into the body in order to reduce pain in specific areas along the body [3]. People safely and effectively use TENS to assist with immediate pain relief and long-term pain management. This innovative piece of technology has been based on the fundamental pain principles of the human body. As a result, it can be used to treat a multitude of physical conditions, including IT band syndrome. A TENS machine is commonly used to provide pain relief after symptoms appear from aggravating activities, such as jogging and running.


What's the best way to use a TENS machine for IT band syndrome?

There are several ways you can use a TENS machine, depending on your unique circumstances and desired outcome. You can adjust your settings and where you place your electrode pads with varying results.


Here are the best practices for using a TENS unit:

Optimal pain relief for a TENS unit will depend on the ideal placement of the electrode pads. For ITB syndrome, the location of the pain can vary, particularly on the side of the thigh or more locally around the knee's outer knee cap. When using the TENS machine, 2 channels (or 4 electrode pads) should be used for larger areas, such as the ITB region [3]. The area between the electrode pads will experience the greatest pain relief treatment.An example of the electrode pad positioning is detailed below. However, there may be other channel placements that could be more optimal for you.

 

A conductive TENS knee sleeve brace can be used as an alternative to electrode pads, especially if your ITB syndrome symptoms are mostly present around the kneecap. For those with ITB syndrome pain more along the upper thigh and hip, this garment may not reach these areas.

  • Setting the TENS Mode for the IT Band 

Currently, there is no substantial research on optimal TENS machine settings for treating ITB syndrome. There are fundamental settings on the TENS unit that can be used to help with pain relief from ITB syndrome.

  • Setting the Pulse Rate for the IT Band 

The frequency of the ITB syndrome is typically measured in hertz (Hz) and describes how many electrical impulses are delivered at any given time. Higher frequencies (90–130 Hz) help with immediate pain relief. Whereas, lower frequencies (2–5 Hz) assist with sustained and longer-term pain relief [3]. Those who experience ITB syndrome may consider trialling both higher and/or lower frequencies to see what could be the most effective.

  • Setting the Pulse Width for the IT Band 

Insufficient research is required to determine the importance of pulse in ITB syndrome. Typically, the pulse width µs ranges between 50 and 250 µs [3]. It's the opinion of the author that the pulse width does not significantly influence treatment outcomes. 

  • How Often Should You Use Your TENS Machine for IT Bands? 

Currently, there is mixed research about how often a TENS machine is the most effective for ITB syndrome. Studies have shown that TENS machines are applied for 20 minutes over twice a week to four hourly sessions daily, depending on the conditions being targeted [4]. Experts have suggested that 15–30 minute sessions are required to help ease pain.

 

Using Caremax TENS machine for IT Band Pain Mangement


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Other Home Remedies to Relieve IT Band Syndrome 

Home remedies can be used or performed with varying success. These include, 

  • Massage
  • Heat packs
  • Using creams and ointments
  • Stretching and exercise
  • Physical therapy
  • Foam rolling


Where and when to not use TENS machines 

Using a TENS (transcutaneous electrical nerve stimulation) machine can help reduce unpleasant or painful sensations, but it's crucial to follow safety guidelines to ensure it’s used safely and effectively [5]. Here are some important precautions: 

Avoid applying the TENS machine to:

  • Damaged skin, such as wounds or cuts.
  • Areas with reduced sensation or numbness.
  • Swollen areas.
  • Near tumours or blood clots.
  • Areas treated with radiotherapy or radiation.

Special considerations: 

  • People with implanted devices like pacemakers or neurostimulators should avoid or speak to their doctors about using TENS machines.
  • Those with cognitive or mental impairments should be cautious.
  • Individuals who cannot consent to the use of TENS machines should not use them.
  • For specific issues, such as nerve pain, consult a healthcare professional before using a TENS machine. 

Do not use the TENS machine if:

  • You have reduced sensation or numbness in the area.
  • You experience severe pins and needles or tingling.
  • Your symptoms worsen after using the machine.
  • You’re pregnant.



If you have any doubts or questions, please contact your local doctor or physiotherapist who is experienced with electrotherapy.


Are there any risks of side effects when using a TENS machine? 

Using a TENS machine is generally safe when used correctly, but it's important to be aware of potential side effects [5]. Most side effects are mild and can be avoided with careful use. If you notice any negative symptoms, stop using the TENS machine immediately. While severe side effects are rare, they also need prompt attention. 

Common side effects: 

  • Skin irritation
  • Unusual sensations around the treatment area
  • Sensations that mimic or worsen neuropathy pain 

If you experience any of these, stop using the TENS machine and consult a healthcare professional, such as a physiotherapist. 

Severe side effects (usually due to improper use or in high-risk individuals): 

  • Rashes
  • Increased pain
  • Seizures
  • Interference with implanted medical devices
  • Strokes
  • Blood clots
  • Skin damage
  • Burns


References

  1. RACGP. (2020). Overuse injuries in the athlete.
  2. Lavine, R. (2011). Iliotibial band syndrome: Evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 19(12), 728-736.
  3. Watson, T. (n.d.). Transcutaneous Electrical Nerve Stimulation (TENS).
  4. Osiri, M., Welch, V., Brosseau, L., Shea, B., McGowan, J., Tugwell, P., & Wells, G. (2003). Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database of Systematic Reviews.
  5. University of Iowa Health Care. (2018). Pain medicine: Contraindications and precautions.
  6. Van der Worp, M. P., van der Horst, N., de Wijer, A., Backx, F. J., & Nijhuis-van der Sanden, M. W. (2012). Iliotibial band syndrome in runners: a systematic review. Sports medicine, 42, 969-992.