STOP foam rolling your IT Band!

This post will challenge what many patients have been instructed to perform in attempts to release the IT Band!

Therefore, I will provide a research review with references and some wordy discussion. By offering as much information as possible, I hope to minimize the attack on my beliefs about foam rolling your IT Band, and articulate why you should STOP doing it immediately!

According to current research, Iliotibial Band Syndrome (ITBS)/Iliotibial Band Friction Syndrome (ITBFS) is considered to be one of the most common overuse injuries in the lower extremity, affecting anywhere from 7‐14% of the running population. It can decrease performance in cyclists, soccer players, field hockey players, basketball players, and rowers. ITBS often leads to an inability to participate in a sport secondary to severe hip, lateral thigh, and knee pain.

The exact etiology is poorly understood. Orchard et al described an area of friction occurring between the iliotibial band and the lateral femoral condyle when the knee is flexed to around thirty degrees. The friction is said to lead to inflammation and pain. However, findings of cadaver studies and biopsies of the area are leading researchers to challenge this theoretical model. In addition to fascial restrictions, Ferber et al studied three hundred recreational athletes and identified decreased iliotibial band and iliopsoas extensibility in recreational athletes.

itb-diagram-01Physical therapy is often recommended. Interventions such static stretching, strengthening, manual therapy and neuromuscular re‐education have been researched. Pinshaw et al stressed the importance of addressing shoe wear and training schedules.

Deep friction massage is often used to treat ITBS (think foam rolling on your IT band), but current research does not support it.

So now I want to discuss my opinion about other treatment options besides foam rolling.

The IT Band is not a muscle, tendon or ligament. It is unique structure and can not be treated as a typical tight muscle. In 18 years of treating patients, no one has ever came in saying their IT Band is getting better from foam rolling, not once! And trust me, I taught many folks to foam roll the IT Band, but stopped several years back with excellent results since.

Now just above to the IT Band is the TFL (Tensor Fasciae Latae) muscle, which runs from the anterior pelvis to the outer hip bone. It is the muscular portion of the IT Band, but it is in front of the hip and is ideal for foam rolling. So instead of laying on your side on top of the roller, you have to reposition and stay above the hip and in front. (See the black arrow pointing at the TFL)

itb-diagram-02While you have the foam roller out, get to know the gluteals, quads and inner thighs after releasing the TFL on each side. You can also use a tennis ball or Lacrosse ball as tolerated on all of these structures listed and pictured. Some core strengthening and leg exercises would then be performed for postural re-education.

So its really a simple shift in where to treat, but most importantly, STOP FOAM ROLLING YOUR IT BANDS NOW!!!!!

References:

  1. McKean KA Manson NA Stanish WD. Musculoskeletal injury in the master’s runners. Clin J Sports Med. 2006 Mar;16(2):149‐54. [PubMed]
  2. Taunton JE Ryan MB Clement DB McKenzie DC Llyod‐Smith DR Zumbo BD. A retrospective case‐control analysis of 2002 running injuries. Br J Sports Med. 2002 Apr;36(2):95‐101. [PMC free article] [PubMed]
  3. Lavine R. Iliotibial band friction syndrome. Curr Rev Musculoskeletal Med. 2010 Jul 20;3(1‐4):18‐22. doi: 10.1007/s12178‐010‐9061‐8. [PMC free article] [PubMed]
  4. Orchard JW Fricker PA Abud AT Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May‐June;24(3):375‐9. [PubMed]
  5. Fairclough J Hayashi K Toumi H Lyons K Bydder G Phillips N Best TM Benjamin M. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. Mar 2006;208(3):309‐16. [PMC free article] [PubMed]
  6. Fairclough J Hayashi K Toumi H Lyons K Bydder G Phillips N Best TM Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74‐6; discussion 77‐8. Epub 2006 Sep 22. [PubMed]
  7. Ferber R Kendall KD McElroy L. Normative and critical criteria for iliotibial band and iliopsoas muscle flexibility. J Athl Train. 2010 Jul‐Aug;45(4):344‐8. doi:10.4085/1062‐6050‐45.4.344. [PMC free article] [PubMed]
  8. Pinshaw R Atlas V Noakes TD. The nature and response to therapy of 196 consecutive injuries seen at a runners’ clinic. S Afr Med J. 1984 Feb 25;65(8):291‐8. [PubMed]
  9. Schwellnus MP Mackintosh L Mee J. Deep transverse frictions in the treatment of iliotibial band friction syndrome in athletes: a clinical trial. Physiotherapy. 1992 Aug 10;78(8):564‐8. doi: 10.1016/s0031‐9406(10)61197‐2.
Stephen Dunn