Written by: Andrew Millett

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. This blog serves to explain how you can loosen IT bands effectively without foam rolling.

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 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" or “TFL syndrome” are pain in the middle to the distal portion of the IT Band to the outside of the knee. What can happen is that the site of pain or tightness is often not the source. Usually, where there is pain, the source of it is emanating from somewhere else. This relates back to the Joint by Joint Approach. 

Reasons For IT Band Tightness

There are many reasons why someone may feel tightness in their IT band. The reasons your IT band may feel tight can include:

• Lack of soft tissue extensibility (flexibility) from being immobilized.

• Pain Threat Perception

• Poor Core Stability

• Poor Hip Stability

• Exercise/Running Technique

• Poor Hip Mobility

• Poor Ankle Mobility

There can be a combination of reasons listed above, or reasons not mentioned. 

IT Band Release Misconceptions

More often than not, when people complain of pain, discomfort, or tightness in the IT Band is usually not the source of their pain. 

For example, the hip, lumbopelvic complex, the ankle, etc. all impact the biomechanics of the lower extremity. 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 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

Hip and Core Muscles

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.

Without adequate core and hip control, it is a "free for all" with what can happen to the leg. Poor hip and core control can lead to:

• Lateral trunk sway

• Pelvic drop

• Femoral Internal Rotation

• Knee Valgus/Tibial External Rotation

• Foot Pronation

 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.

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. 

 

TFL

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 facing the ground, angle your body to 45 degrees 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 in those 2 areas let's start addressing why your IT bands feel 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 doesn't provide a stable base for the lower extremity to move off, then the leg will follow the path of least resistance and go wherever it wants., usually into the position of femoral internal rotation and knee valgus.

For years, professionals tried strengthening the VMO (Vastus Medialis Oblique) to keep the knee and lower leg from going into a valgus collapse and/or to help track the patella properly superior and inferior directions.

Vastus Medialis Oblique

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 a knee injury.

Assessing the function of the trunk, pelvis, and hip 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.

Exercises for Tight IT Bands

There are better ways to feel a release of the IT Band through exercises instead of exclusively foam rolling.

 Exercise #1 Bridge with March

Key Points:

• Maintain a straight line from your knees, hips and to your shoulders.

• Should be felt in the glutes and hamstrings.  If you feel this in your low back, start over and try "bringing your belt buckle towards your chin"/maintain a neutral spine.

• Keep knees in a line (when looking from the side) when kicking one knee out.

If your form looks good, then try this more advanced variation.

Exercise #2 Bridge with March/Hip Abduction

Key Points:

• Same points as with Bridge with March.

• When bringing the leg out to the side, don't allow the moving leg hip to drop down towards the ground.

If you passed with flying colors, then a more advanced assessment is needed to test for adequate core and hip stability.

 

Exercise #3 Single-Leg Wall Reach

Key Points:

• Maintain good alignment from hip to knee to ankle in the stance leg.  There shouldn't be much knee movement towards or away from mid-line.

• Keep hips square to the wall.  Don't allow the non-stance leg to "fly open."

• Maintain a neutral spine throughout the movement.

• Should be able to maintain a single-leg stance from the start to the end of the movement.

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.

Closing Out: Tight IT Bands

In a future post, I will go into more detail on strengthening and stabilizing the lower extremity once you have established good control and stability of the hip and core.

If you have been dealing with a “tight” IT Band or some other frustrating injury, let’s do something about it. Contact our physical therapy team in Hudson, Massachusetts, and click HERE to take that first step.