New Trends in IT Band Pain Relief

It has been assumed that the primary purpose of the Ilio Tibial Band (ITB) was to provide lateral stabilization. However, recent research, including studies from Catherine Eng, summarized in the Harvard Gazette tells a different story.

What Is The IT Band?

The ITB connects the Gluteus Maximus (GMax), the Tensor Fascia Latae (TFL) to the lower leg (tibialis anterior and tibia). This large piece of fascia originates from the outside of the buttock, crest of the hip (ileum) the and outside of the upper thigh and runs down the outside of the leg, attaching below the knee. The ITB is basically a long, flat tendon. It may well have a role in stability – tests with cadavers have shown that tremendous machine generated forces only lengthen the ITB by just 1-2mm!

How the ITB Works for Energy Return

Eng explains that the front part of the ITB stretches as the leg swings backward, storing elastic energy. That stored energy is released as the leg swings forward during a stride, returning energy. The back portion of the ITB stretches as the leg swings forward and returns energy as the leg extends backward. These dynamic stretches are driven by movement and make substantial changes to the tissue over time.

Rethinking Classic ITB Syndrome

In athletes, the shortened ITB is said to rub over the femoral condyle on the outside of the knee (or sometimes near the hip) and becomes inflamed. Typically, this can be triggered by anatomical differences, over-training and other training errors. Some pain may come from tension on the upper and lower attachments of the ITB itself.

ITB Syndrome in the General Population

Different considerations apply for the general, less athletic population. Imagine a 58 year old woman who has not exercised much over the years and has become less flexible. She walks regularly and has developed signs of ITB. Chances are that her gait has shortened; her leg just doesn’t go into significant extension or flexion at the hip anymore.

This means that the rear part of the ITB is not stretching dynamically as her leg swings forward and the front part isn’t stretching as the leg swings backward. In our subject, a shortened gait translates into a shortened ITB that can rub across the femoral epicondyle and become irritated – just as for the over-training athlete.

Increasing the stride will dynamically stretch and gradually lengthen the ITB and reduce inflammation. Given the strength of the ITB, you simply cannot lengthen the ITB with any type of static stretches.

Self Care Treatment

Prior to each of these gentle, passive stretches trigger points in the muscles should be cleared with self-compression using a tennis ball or other tool. This is not an exhaustive list of muscles that might contribute to ITB pain or to a shortened stride but may be useful as a starting point:

  • Psoas stretch – The primary hip flexor limits extension of the leg. The primary trigger point is located deep in the abdomen:

  • Rectus Femoris stretch – This is the only quad that crosses the hip and can restrict hip extension.

  • TFL stretch – As an assistive hip flexor we want movement here.

  • Hamstring stretch – This is the primary limitation of the leg swinging forward.

  • Spinal erector stretch – Often recruited by weak glutes to assist with extension of the thigh at the hip.

  • Rectus abdominis stretch – The superficial abs become tight, hindering full leg extension.

 

Strengthening other key muscles can support a longer stride. As with stretching, trigger points in these muscles can be released before strength training:

  • Gluteus maximus – Provides dynamic stretch on the front ITB as the leg extends.

  • Gluteus medius – Stabilizes the hip and assures proper operation of the TFL.

  • Transversus Abdominis –Reduces static load on the spinal erectors and glutes.

For reducing ITB pain in the general population, success in any specific maneuver is less important than lengthening the stride. Some may find that pain or other limitations in their knees, hips and low back limit their ability to comfortable perform this entire routine. If so, modify as needed.

We want to stretch the front and back aspects of the IT band AND strengthen the muscles that will help maintain that stretch as you walk with a longer and stronger stride.

If you think you are having IT band pain, you may find that a session or two to identify and treat root causes of your individual case is helpful. Call us at 630-858-0000 today to make an appointment!

 

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2019-07-12T08:41:01-06:00
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