Activity, Pain Relief, physical therapy

Can your IT Band actually be tight?

I’m guessing if you found yourself here, you are having some sort of IT Band problems. You might be having pain on the side of your thigh up towards the hip, down towards the knee, or just along the whole dang side. You’ve come to the conclusion it’s your IT Band, but are not sure how to fix it. Let’s chat about it!

I like pictures, so let’s use this one to help figure out exactly what the IT Band is and what it does. The iliotibial band, IT Band for short, is not a muscle. Can you see it’s white on the picture? It’s actually connective tissue. Now, not to get too grotesque, or compare you to a chicken, but we are animals after all! When you eat a drumstick, there’s always that white gristly stuff on the ends that chewy and you can’t eat very well. That’s connective tissue. It is completely different from a muscle. So we can’t treat it like one.

Can you stretch it? Short answer, no. A new article published last year confirmed that the IT Band is firmly attached to the femur. Because it’s connective tissue, it doesn’t have much extensibility like a muscle. Another cadaver study proved that the IT Band doesn’t even cause hip tightness, but it’s likely caused by the surrounding muscles. Sounds like all the foam rolling in the world isn’t your answer for improving your IT Band pain.

Now onto the correction part. There are many surrounding muscles to the IT Band and around the hip in general. When the muscles on the frontside of the IT Band become too dominant (hip flexors, outside quad muscles), the muscles on the backside of the ITBand (hamstrings, and glutes) will become too inactive. Now you have a hip that is rotating forward too much due to the pull of the muscles. Your pelvis has difficulty rotating backwards (hip extension) because the posterior muscles are not active enough to overcome the dominant front muscles, so your femur has to take up the slack and create that extension you need to walk, run, bend, twist, etc. Your IT Band is stuck on the femur, so now it’s getting too much torque from the end attachment points (pelvis and tibia) due to over-movement of the femur.

In order to relieve IT Band pain, you have to correct the underlying imbalance. The IT Band isn’t the problem in this situation, it’s just trapped in the middle of a muscle battle. Using the diaphragm (it’s attached to the hip flexors, learn more here), hamstrings and glutes, effective correction of the pelvis can occur. When pelvis mobility is restored, tension on the IT Band will be released and you will have permanent correction.

That may sound easy, and in some cases it is. However, re-patterning can be tricky. Your body has established this pattern and position over the course of a very long time, and there are other factors that can be influencing this position. Poor abdominal activation, especially with the obliques, poor ribcage positioning, and poor imbalance between the right and left side of the hip can also impact the tension on the IT Band. This is the reason I perform a full body assessment and look at a multitude of joints in your body.

Recap: The IT Band is attached the femur, doesn’t stretch, and can become trapped in a muscle battle between one dominant side and one inactive side. Stretching and foam rolling have been proven ineffective. Re-establishment of proper pelvis mobility (hip extension) through the activation of the diaphragm, hamstrings, and glutes will reduce the tension on the ITBand. This is true even if your IT Band hurts more at your knee. Finally, there can be other factors that influence the position of your IT Band, so a postural assessment is key in making sure your issue isn’t being created by other factors.

Having some IT Band issues that need working out? If you are interested in having a postural assessment done and start getting your pain under control, give me a shout!

References: Scand J Med Sci Sports. 2010 Aug;20(4):580-7. doi: 10.1111/j.1600-0838.2009.00968.x. Epub 2009 Aug 23. Willett, G. M., Keim, S. A., Shostrom, V. K., & Lomneth, C. S. (2016). An Anatomic Investigation of the Ober Test. The American Journal of Sports Medicine44(3), 696–701.

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