The great mystery of the Illiotibial Band
Understanding IT Band Pain: From Diagnosis to Healing Through Personal Experience and Professional Expertise
The IT Band: When Pain Becomes a Powerful Messenger
Hello! I have both personal and professional experience that I would love to share with you in the form of technical and heartfelt illuminations.
At 19 years old, I couldn't walk around the corner without experiencing high levels of pain on the outside of my left knee. I started in seasonal athletics when I was 4 years old, and by the time I was 19, I had been a competitive swimmer for 15 years, a competitive softball player for 13 years, and had waited tables for four years—a very stressful unilateral sport!
This excruciating pain was depressing, and for 10+ years, the professionals had no answers at all. It just kept getting worse.
At some point, I was given the name of the orthopedic group for the San Francisco 49ers football team, and I decided to give them a chance. They didn't give me the orthopedist I had requested, but they did send me to the geriatric doctor in the group! I am grateful because that doctor said, "I think it may be your iliotibial band!"
Hallelujah! At least I had a name for something tangible that finally gave me my first real lead!
And make no mistake: pain can be a terrific messenger. It can lead us onto a new path we may not have otherwise discovered. I left my fine dining career and began my journey into treating soft tissue. Your head saved my athletic sanity, and I wanted to help others do the same.
And I DID heal it! WE healed it.
The tenacity, curiosity, and proactive position I seized a hold of, like the tail of a tiger, led me to my career in medical and orthopedic massage therapy.
I vowed then that if I could help just ONE person save time, money, and sadness, then I would be a true success! That was 33 years ago and tons of thousands of people later.
Wahoozie and Hallelujah!
Understanding the Iliotibial Band
The iliotibial band, or ITB, is named for its attachment points. The more fixed upper portion is on the iliac crest, or hip bone, and its lower, more mobile portion is on the lateral tibia, or shin bone.
The thickest and largest portion runs down the side of our thigh, lying over the largest quad muscle, called the vastus lateralis. Pain and discomfort are almost exclusively felt at the lower end, outside the knee. The tension of the ITB rubs across a bony piece of the thigh bone, the lateral epicondyle of the femur, twice for every step and every pedal stroke that we take.
Ouch.
Let's find out exactly why this potentially obscure discomfort and/or pain is not treated properly, why it cannot truly be released or lengthened by "foam rolling" on the IT band itself—and how that can actually make it worse.
Here's the kicker: The ITB has 0% contractile tissue!
It does have longitudinal collagen fibers, but they, too, have no laxity. This means that it definitely does not shorten and lengthen on its own accord. This also means that the source of tension causing it to shorten is not coming from the ITB itself.
However, the contractile tissue, aka muscle fibers that do shorten and lengthen, comes from far above in the hip. More specifically, the TFL/tensor fasciae latae and gluteus maximus, the largest muscle in the human body.
When these two fated muscles get tight, short, torn, scarred, or bound in any way, they pull the ITB into even greater tensile stress. This band is already likened to the strength and tension of a soft copper wire! It's already a badass of stability and immense tensile strength.
Why Do These Muscles Get Tight?
Why do these two muscles get tight? Loaded with trigger points? Overworked and underpaid? And why does this affect women more than men?
Well, these are some of the primary causative factors. I have identified four of them for you here:
- The Q angle
- Uneven pavement surfaces
- Leg-length discrepancies
- Walking while carrying weight, especially on one side
The Q Angle
The Q angle is the angle from the hips to the knees. Women have a greater Q angle for a divine reason: We carry babies and give birth.
Walking and Running on Uneven Surfaces
Walking and running on uneven surfaces stresses the hip stabilizers more—the glutes, hip flexors, abductors of the gluteus medius and minimus, and the ITB. This can add to pelvic asymmetry and create an imbalanced effect on muscles attaching to the ITB.
Leg-Length Discrepancies
When we fine-tune an epic bicycle, we have a professional bike fitter make adjustments to the millimeter! The human musculoskeletal system is NO different! One millimeter makes a tremendous difference!
Walking While Carrying Weight
Walking while carrying weight puts a tremendous and technical load on the TFL. Any moms out there? Any of you women carrying babies on one hip?
Your superficial fascia will literally take on the shape you are asking it to. It does this to support you in what you are attempting on a repetitive basis.
However, that shape generally stays until you unwind it with myofascial techniques like Rolfing, Structural Integration, and skilled myofascial release from an experienced licensed massage therapist or soft-tissue expert.
Myofascial Release and Self-Care
I highly recommend finding a 3'-8" inflatable ball for self-care success, myofascial release, self-massage, and self-trigger-point release. Balls are more dynamic, more versatile, and much more user-friendly on a daily basis. They can also go places that a roller cannot, like the feet, hip flexors, pecs, and especially specific trigger points.
The balls increase core work and proprioception, just like doing your squat on a BOSU rather than the floor.
Any increase in proprioception is an increase in effectiveness.
My Favorite ITB Stretch
My favorite all-time stretch for the ITB is in the form of a descending side plank.
- Find a chair, table, bench, or secure piece of furniture.
- Find a comfortable position for your elbow/forearm to lean onto, with your shoulder securely and directly over your elbow.
- Put your side body in the best straight alignment you can find.
- Begin to release your hip down toward the floor.
- Go only as far as you can while continuing to breathe deeply.
- Allow for the opening.
- Rotate the side hip, rolling it slightly forward and slightly back—this helps to isolate both anterior and posterior fibers from TFL and maximus to more specifically lengthen.
- The windshield-wiper posture from yoga, if you know it, is an excellent form of internal and external rotation at the hip.
Strength Isn't Always the Answer
Strength training is not exactly your desired "go-to" when muscle-tendon units are inflamed, strained, and/or short and tight.
Concentric muscle loading is a shortening contraction. If the tissue is too short, shortening it further through the compensation, recruitment, and dysfunction that it already possesses will not help.
Look into eccentric loading to keep muscles strong and long. Concentric loading is against gravity with resistance, like a bicep curl. Eccentric loading is a deceleration, slowly working with gravity and a lengthening resistance.
Don't get misguided by the psychology of having someone tell you, "You're weak," and that you need strengthening to heal exhausted tissue. Of course, there are exceptions, like people who train specifically to break down tissue, build calcium, and persevere through what the average human couldn't even fathom. Martial artists and special operations military would be two potential examples of exceptions.
Otherwise, for the average human, this misperceived "weakness" can simply be tissue that is overworked, strained, and in need of recovery and specific fine-tuning for reeducation.
Keep Asking Questions
Keep putting those questions out there. Keep searching, because the answers will come. Never give up on your dreams, no matter what body shape, size, or challenges you face.
Get tenacious.
I refused to give up, and I refused to have such a high level of pain at such a young age. Nearly 30 years later, at 57, my opportunity to self-reflect on alignment in a mirror allowed that perfect moment of insight. Right away, I had two associates confirm a 7 mm leg-length discrepancy in my right tibia.
I was tickled that my solution is a C2 Cork Lift for $4! I have been dreaming of being a trail runner my entire life, so I tried it the first season of the lift in my shoe, and now I can trail run…hey, not fast yet! But what a joy!
