Whether you are a runner, sit at a desk throughout the day, or prefer to lift weights, anyone can suffer from tightness or pain in their Iliotibial Band (IT) Band. There are many reasons why someone may feel tightness in their IT band.
photo credit: http://www.beginnertriathlete.com/cms/article-detail.asp?articleid=1214
Those reasons can include:
-Lack of soft tissue extensibility (flexibility) from being immobilized.
-Pain Threat Perception
-Poor Core Stability
-Poor Hip Stability
-Poor Hip Mobility
-Poor Ankle Mobility
Some of those reasons can have a combination of more than one reason or for reasons not even mentioned.
First off, what is the IT Band?
Well, the IT Band is a piece of fascia that attaches on the lateral portion of the pelvis, Tensor Fascia Latae (TFL), and Gluteus Maximus, and progresses down the outside of the thigh and eventually inserts on the Tibia. The Tensor Fascia Latae and the IT Band, assist in preventing the knee from moving laterally. Fascia is like saran wrap that goes from the top of your head and is present throughout your entire body all the way down to your feet. It works with muscles to help transmit force to various areas throughout the body.
The IT band is a common source of blame for reasons why someone may have pain on the outside of their thigh and/or knee. Common complaints of "IT Band Syndrome" are pain in the middle to distal portion of the IT Band to the outside of the knee. What can happen is that the site of pain is often not the source. Usually where their is pain, the source of it is emanating from somewhere else. This relates back to the Joint by Joint Approach.
Another way to think of this is like when a pebble is thrown into a pond. When the pebble hits the water, there is a "ripple effect" from the site where the pebble hits and the ripples continue farther out.
photo credit: eddierivero.org
How does this relate to the IT Band? Well, more often than not, where people complain of pain/discomfort in the IT Band is usually not the source of their pain. Back to the ripple effect example:
If the center of the ripples in the picture above where the pebble hits is where the person is experiencing pain, the IT Band, with each ripple, this represents another area in the kinetic chain that could potentially impact the bio-mechanics of the lower extremity and in turn the pain felt in the IT Band.
For example, the hip, lumbo-pelvic complex, the ankle, etc. Each of these areas, as well as others, could potentially contribute to the problem.
So, now that we have established that the source of the problem could be coming from somewhere else, why does your IT Band continue to feel tight?
You could try some self-myofascial release (SMR) with a foam roller or lacrosse ball to the IT Band and it may feel good for the short-term, but it isn't addressing why it's "tight."
It could potentially feel "tight" because the IT Band and/or TFL are trying to compensate and control the internal rotation of the femur and lower leg instead of other muscles properly controlling and stabilizing the lower leg.
For the brevity of this post, we will focus on the hip and the muscles surrounding the hip and core
The muscles of the hip and core control many of the forces that go through the entire lower extremity. They control the position of the hip all the way down to the foot and ankle. If someone lacks appropriate hip control, this can lead to bio-mechanical faults throughout the entire lower extremity and trunk.
photo credit: flexibilityrx.com
Without adequate core and hip control, it is a "free for all" with what can happen to the leg. With poor hip and core control this can lead to:
-Lateral trunk sway
-Femoral Internal Rotation
-Knee Valgus/Tibial External Rotation
Now, if someone demonstrates one of these abnormalities, it DOES NOT mean they are going to have issues. It usually becomes an issue when it is either micro-traumatic in nature and the repetitiveness of going into this type of position eventually irritates certain structures, for example the IT Band.
If someone presents with this type of positioning in a macro-traumatic event, then there is typically some type of ligament or soft tissue compromise, usually, ACL/MCL tears, or meniscal tears, to name a few.
With these micro-traumatic events over time, this constant motion of femoral internal rotation/knee valgus can cause an irritation of the distal IT Band.
photo credit: pittsburghpaincenter.com
Instead of trying to foam roll your IT Band, try performing some type of Self-Myofascial Release (SMR) to your Tensor Fascia Latae and Vastus Lateralis.
The TFL is the muscle that attaches to the IT Band. By doing some type of manual therapy to this area, it can decrease the amount of tension that is placed upon the IT Band. Also, perform some type of SMR to the Vastus Lateralis.
photo credit: studyblue.com
photo credit: http://medical-dictionary.thefreedictionary.com/vastus+lateralis
Here is a video demonstrating how to perform SMR on the Vastus Lateralis and TFL:
When performing SMR on the Vastus Lateralis, instead of being face down to the ground, angle your body to 45 degrees in relation to the ground and roll where the outside of your Quadriceps meets your IT Band.
When performing SMR on the TFL, find your Anterior Superior Iliac Spine (ASIS) or the "hip bone" on the front of your hip. Then go approximately 4 inches down and 2 inches laterally to work on the TFL.
Now that you have performed SMR to those 2 areas, let's start to address the reason why it feels tight in the first place.
Back to what we were talking about before about hip and core control. If the core and hip musculature of the body don't provide a stable base for the lower extremity to move off of, then the leg will follow the path of least resistance and basically go wherever it wants., usually into the position of femoral internal rotation and knee valgus.
For years, professionals were trying to strengthen the VMO (Vastus Medialis Oblique) in attempt to keep the knee and lower leg from going into a valgus collapse and/or to help track the patella in the proper superior and inferior directions.
photo credit: sportskneetherapy.com
According to Dr. Christopher Powers in the Journal of Orthopedic and Sports Physical Therapy, his study, "The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective," found that impaired trunk, pelvis, and hip control played a role in respect to knee injury.
By assessing the function of the trunk, pelvis, and hip, this may give us insight into how the rest of the lower extremity functions.
Here is a simple test to perform to see if you have adequate hip and pelvic stability:
Also check out my previous post regarding the Bridge with March at Matt Ibrahim's website, Movement Resilience.
Bridge with March
If your form looks good, then try this more advanced variation.
Bridge with March/Hip Abduction
If you passed with flying colors, then here is a more advanced assessment to test for adequate core and hip stability.
Single Leg Wall Reach
If you found difficulty with any of the aforementioned tests, then you are a candidate for improving your core and hip stability.
Ways to regress the Single Leg Wall Reach is by bending the back knee, placing your hands on your hips, or holding onto a TRX for assistance.
In a future post, I will go into more detail on how to strengthen and stabilize the lower extremity once you have established good control and stability of the hip and core.
Let me know if you have any questions!
Here I will be writing and posting about topics ranging from physical therapy, injury prevention/reduction, and strength and conditioning.