Saturday, December 10, 2011

Myths of the ITB

Someone asked me via Twitter yesterday if I could help to find anything on the ITB and in particular anything that would indicate against stretching it.  Not sure when I became the internet guru, but I was intrigued and did a quick search.  I should really have referred her to Colin

Anyway, what I found was this article:

Iliotibial Band Syndrome (ITBS) Myths

One of the myths it points to is this:

It’s the result of a tight ITB, so stretching to elongate the ITB is called for. WRONG: the ITB is a very thickened band of fascial tissues that is impliable. Unlike tendon and muscle tissue, the ITB cannot be permanently lengthened by stretching. Stretching can temporarily increase the length of the ITB by 5%, but this apparent change is probably due to a stretching of the two muscles that actually control tension on the ITB, the tensor fasicia latae and the gluteus medius. Tension on the ITB during running results partly from the contraction of these muscles, but when they are weak it appears to result from the downward collapse of the opposite hip when one leg is planted (which stretches the ITB over the hip, increasing tension.

Makes sense really.

So, if you suffer from ITBS that you cannot shake or which keeps coming back… Strengthening and stabilizing your core during running and modifying your gait to improve tracking of your knees and feet is probably your best bet in the long run. Everything else is a band-aid.

Any comments?


Anonymous said...

I battled a horrible case of ITB Syndrome for over a year and I finally cured it. I scoured the internet, saw a Physical Therapist, tried Pilates, tried yoga. I was just about to try Pilates when I finally discovered the two causes: sitting too much and crossing my legs when I sit.
I have a standing desk, but I'd started using a stool with it too much. I ditched the stool and became conscious of how often I cross my legs. Now I'm sans-ITBS.

Anonymous said...

*about to try accupuncture

Bill said...

Good stuff here:

Fordaldo said...

I've always understood that the ITB tends to get "stuck down" to the other tissues and structures and that's where some of the problems lie. I like manual therapy or K-Star's "crosswise" foam roller technique to unglue. Ouch!

JeffHansen said...

Heres a "worked for me". My knees would always hurt after running especially after hills, my runner friends suggested it could have to do with the ITB (Thats as far as any diagnosis went).
I started running with Vibram 'barefoot' style shoes and now, no knee problems.
Not even at work, and I am an electrician who is always either crouched at a plug or climbing ladders. As long as I run regularly, knee problems gone.
Very pleased, now I wish I could find something that would work similarly for my self diagnosed "tennis elbow"!

Mike Reinold said...

Good stuff as always, couldn't agree more. Sometime I feel like we focus too much on "mobility" all the time, which in turn leads to further "instability."

I'm going to link to this in next week's "Stuff you Should Read" article, thanks

Izaak said...

For several years I've used foam rolling for the IT bands with clients (and myself) and have always had good results. I never found a stretch that seemed to be effective so I essentially dropped it from most programs even when I believed IT bands to cause some other dysfunction. I think an important distinction to make is the difference between stretching and something like foam rolling or other soft tissue work in terms of mobility. Improving mobility does not necessarily mean improving flexibility. Stretching primarily improves flexibility (and in the case of the IT bands, is ineffective anyway, as seen in this post), but is neither sufficient nor necessary to improve mobility.

Anonymous said...

I totally agree with that, Chris. Good stuff. The ITB can be massaged and rollered to help with any adhesions, offering some relief. But ultimately, I find ITB issues being a function of muscle balance and biomechanics... weak glutes, dominant TFL, poor running mechanics, poor bike set up. Addressing these issues will offer more respite from ITBS than any stretching routine performed on this relatively inelastic band.

Aaron said...

I had ITBS from when I started running in my late teens. I tried a bunch of stuff with stretching, bands, shoes, you name it. It wasn't until I changed from being a heel striker that I saw results. For me it was biomechanics. Landing on my heel and 'rolling thru' my stride caused my ITB to rub across my knee just enough to get inflamed over long runs. Now that I land midfoot, I no longer have this problem.

Jen Brown (SpartaPT) said...

Thanks again for your time in hunting this out for me.

As to when you became an internet guru, I had thought that I read about it on your site hence the tweet. Guess that's what you get for being the 'go to' guy for research ;)

Thanks again & warm regards

Chris said...

Thanks for all the comments - interesting to see that people's experience is of the importance of proper biomechanics.

@Mike - thanks for the comment, I really enjoy your bog and learn a lot from it.

@ Jen - thanks


Shawn said...

Seems most here agree regarding the influence of Glut Med. I have found often the Glut to be inhibited as much if not more than simply weak... IASTM techniques work wonders here along with (pick your favorite) Kinesiology Tape.

djpope said...

Hey Chris awesome post,

I wanted to also say that besides stabilizing the core you mentioned weak hip musculature that allows the knee to travel medially during gait / running and stretches the ITBand.

Chris Powers is one of the leading researchers behind knee pain. He's showing that making improvements in hip musculature strength(Hip external rotation and abductions)is doing wonders for relieving knee pain.

Also, the IT band can get bound down and stuck to its surrounding tissues. Sometimes some soft tissue work is what the doctor called for!

Anonymous said...

I believe the "mobility" were searching for is the ITB mobility on the surrounding fascia, rather than elongation. by the way, ITB attaches to tfl and glute max, not medius. i have heard this before though, maybe some anatomical variations out there

vijay said...

The best I've found for these types of issues is structural integration (rolfing/hellerwork etc). Self myofascial release techniques just don't cut it in many cases. AS much as I use a whole host of body workers these guys are the only ones I've found to be able to address underlying fascial issues in the body.

Anonymous said...

gluteus maximus not gluteus medius

BeFit said...

Thanks for the post Chris and thanks for the link to it Mike.

My way to treat it is as follows:
1. Train Transversus abdominis
2. Make glut medius dominant obove TFL again
3. Train glut max
4. Kinesiotape above lateral condyl femur and put ice for anti-inflammation
5. Foam roll ITB for adhesions (you are probably foamrolling VLO more than ITB but that's ok)
6. Stretch TFL and glut MAX, beacause these are the 2 muscles that come together in the ITB
7. One I haven't heard and only rarely see other therapist doing: train TFL at end-ROM, this is in sidelying position on the table dropping (eccentric aspect is important for more sarcomeres in serie)and pulling the leg out of maximal adduction and extension.

Sorry for the grammar mistakes and thanks for the post.


Eric Shane said...

I have heard the same thing about the IT band not being capable of truly "stretching" but I cannot find the article. Any source for this information. Much appreciated.