The iliotibial band (ITB) is sort of like the long snapper on a football team. If you don’t already know, the job of the long snapper is hike the football to the place holder, who holds the ball for the kicker. If you know the name of the long snapper for your respective NFL team, it’s either because he’s your cousin, or he made a big mistake because the best long snappers do their job well without anyone noticing.
The ITB does its job every day without being noticed, until it starts to cause pain!
I’ll admit, ITB pain can be nasty. But the ITB is misunderstood! The ITB has a very important role in stabilizing the knee joint, and often gets blamed for the work of other muscles.
The ITB, or iliotibial band is named for its attachment points: the ileum (pelvis) and the tibia (shin bone). There are also two muscles that attach to the ITB, which are the tensor fascia latae, and the glute max. The ITB is a thick band of connective tissue that allows some force to be transmitted from these two muscles to the knee joint. Functionally, the role of the ITB is basically to be a helper. It can flex the knee in some positions, and extend it in others. It can help extend and abduct the hip (1). And there is some research to suggest that it may even provide stability to the knee joint that can help support the ACL (2).
Some research suggests that the ITB may provide stability to the knee joint that can help support the ACL.
Why and How ITB Syndrome Occurs
While it is serving its role as a helper, the ITB can sometimes generate pain. The old theory was that the ITB runs over a bony prominence near the knee joint, and because of its position, it could sometimes go back and forth over that bony prominence which can create friction and cause irritation.
Now research suggests that ITB syndrome is caused by compression of the ITB against a fat pad that sits between the ITB and the muscle underneath. This can be caused by abnormal amounts of load on the ITB through muscle imbalance, running gait mechanics, or in some cases your knee posture.
How To Treat ITBS
You’ll find some conflicting opinions about treatment techniques, mainly about foam rolling. But before we get into that, let’s focus on the root of the problem.
ITBS is commonly associated with an imbalance between weak posterior chain (glutes and hamstrings especially) and stronger anterior chain (quads and hip flexors) muscle groups, with especially increased tightness at the TFL. My first step with people who have ITBS is to start to address this imbalance through posterior chain strengthening, and anterior chain stretching, with some trigger point release at the TFL.
Here are some examples of exercises that I might give someone who is struggling with ITBS:
If you are a runner dealing with ITBS, your running gait mechanics may be contributing to the problem. Often increasing your cadence (steps per minute) to at least 165 spm can help prevent over striding, which recruits more anterior muscles like the quads and TFL.
Foam Rolling
If foam rolling has changed your life and helped you return to running, congratulations! I’m happy for you. But when my patients ask me if they should foam roll to help with their ITB pain, I tell them that I would rather they spend time on posterior chain strengthening and anterior chain stretching. But if you do foam roll, spend more time on the TFL and glute max! The ITB is made of connective tissue that DOES NOT STRETCH like muscles do. You can think of the glute max and TFL as bungee cords connected to a rope (the ITB). Stretch the bungee cords, not the rope. Additionally, if ITB pain is from the fat pad underneath, compression may not make it feel better. Cupping or decompression may be better at managing symptoms!
Have you been struggling with ITBS? Come talk to us about it!
Disclaimer: The information provided in this blog post is for general informational purposes only and is not intended as medical advice.
Sources
Hyland S, Graefe SB, Varacallo M. Anatomy, Bony Pelvis and Lower Limb, Iliotibial Band (Tract) [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537097/
Hutchinson, L.A., Lichtwark, G.A., Willy, R.W. et al. The Iliotibial Band: A Complex Structure with Versatile Functions. Sports Med 52, 995–1008 (2022). https://doi.org/10.1007/s40279-021-01634-3
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