Posts tagged IT band syndrome
IT band rolling NOT shown to improve flexibility
foam-rolling-IT-band-exercise

In a previous blog we wrote about why you should not spend your valuable exercise time rolling your iliiotibial (IT) band.  In short, this strong fibrous band will not stretch or move in response to any painful exercise with a foam roller or soft tissue tool of your choice.  This is a classic example of the juice not being worth the squeeze.  Conversely, rolling the surrounding muscles often reduces feeling of tightness and improves mobility across the lateral thigh.  A recent research article examined the impact of foam rolling either a muscle or the IT band on hip mobility.

Hall and colleagues in the International Journal of Sports Physical Therapy randomized 27 participants to perform 3 separate foam rolling sessions: over the gluteal muscles, over the IT band, and a control session (2018).  Authors measured hip flexibility both before and after each  of 3 rolling sessions in each participant.  Consistent with our prior research, no changes in hip mobility were seen after participants rolled their IT bands, but mobility improved after rolling the muscles of the hip.  

Patients are encouraged to roll muscle tissue and not the IT band to optimize their mobility workouts.  

Why Rolling Your IT Band Is A Waste Of Time
Photo Credit: cyclingweekly.com

Photo Credit: cyclingweekly.com

In a prior post we discussed the prevention, treatment, and prognosis for iliotibial band syndrome.  The iliotibial band is commonly injured due to poor running biomechanics (cross over running gait) and muscle imbalances.  Specifically, weakness in the gluteus medius and maximus and an overutilization of the tensor fascia lata muscle which connects into the IT band.  In the presence of this muscle imbalance the IT band is compressed against the knee bone creating friction and pain. 

Often patients in our Boulder Physical Therapy practice ask if they should add foam rolling to their IT band, as in the picture above, to help "release" or "stretch" the IT band.  This extremely painful foam rolling does little for your IT band flexibility due to the strength of this structure.  The IT band is an extremely tough tissue and will not stretch with foam rolling, massage, or any other intervention.  Chaudhry et al found it would take a load of over 9000 newtons (925 kg) to change the IT band by only 1% (2008).  To put the amount of force in perspective, a lion's jaw produces 4,450 N of force.  Thus, the juice is not worth the painful squeeze of the foam roller.  Patients are advised to work with a Physical Therapist to determine the underlying cause of the IT band pain.  To improve flexibility patients should work the soft tissue at the hip vs. the IT band tissue at the thigh.

Risk Factors for Shin Splints and IT Band Pain

As we move towards the middle of summer many runners have experienced an increase in overuse injuries in their legs.  Unfortunately, these running injuries are common among athletes with the vast majority of runners reporting one injury over the last year of training.  Two of the most common injuries include shin splints (medial tibial stress syndrome) and IT band pain.  Both of these injuries can be successfully treated with Physical Therapy, but also may be prevented by modifying known risk factors for the conditions.  

A review article identified the known risk factors for the development of medial tibial stress syndrome in runners (Newman et al. J Sports Med. 2013).  Authors reported prior history of medial tibial stress syndrome, increased body mass index, increased pronation, orthotic use, and fewer years of running experience are all associated with increased risk of these symptoms.

A second review article documented the known risk factors for iliotibial band pain (IT band pain) in runners.  Aderem and colleagues reviewed the available literature on the development of IT band pain from 13 research studies (BMC Musculoskelet Disord. 2015).  They noted increased risk of IT band pain among runners with poor knee control at foot strike.  Increased movement of the knee is due to weakness and coordination in the hip musculature.  Overtime these abnormal movements create friction between the IT band and thigh bone at the knee.  Athletes are encouraged to work with a local Physical Therapist on gait retraining to improve knee control during running.  

Iliotibial (IT) Band Syndrome and Biomechanical Risk Factors in Running

The iliotibial band is a long track of fascia and connective tissue running from the lateral hip muscles including the tensor fascia lata down to the lateral aspect of the knee.  Contrary to popular belief and utilization, foam rolling is ineffective at changing the length or flexibility of this structure secondary to its' density and strength.  The IT band passes behind the bony prominence of the knee as we move our knee from a straight to a bent position.  In the presence of muscle imbalances and poor running technique friction develops between the IT band the bone leading to a painful overuse condition on the outside of the knee called IT band syndrome. 

IT band syndrome is the second most common running injury and is responsible for 1 in 10 running injuries (Taunton et al. 2002).  Runner's most commonly experience a progressively more intense and severe lateral knee pain aggravated by squatting, stair climbing, and running.  Due to its' overuse nature, IT band pain is either precipitated or perpetuated by biomechanical errors in the runner's gait at stance phase.  A recent review article of 13 studies found an inward movement of the thigh under the pelvis and a compensatory movement of the trunk toward the same side at stance phase was associated with future development of IT band syndrome (Aderem et al. BMC Musculoskeletal Disorders. 2015).  Thankfully, these biomechanical changes are successfully treated with Physical Therapy running gait retraining treatments.  

Runners are encouraged to undergo a Physical Therapy screening to identify proximal muscle imbalances and running gait errors associated with the development of future running injuries.