Prehab Volume 1: Iliotibial Band; Stop Rolling your ITB’s
By: Jordan Shallow
It seems that every weekend warrior with any twitch or twinge in their low back, knees or hips has been getting a shotgun diagnoses of “ Oh you have tight ITB’s”, followed by a brief demonstration of foam rolling, which would involve nothing more than a few haphazard see-sawing oscillations on a roller.
The patient will nod their head in affirmation and set off back into the world – foam roller in hand, hell bent on curing every possible lower extremity pathology that they could ever have. Then there they are, crowding those matted corners in the gyms just rolling their troubles away.
Let me interject; if your calves were the roots of a knee or ankle problem would you sit in the corner of the gym, hammering away on your Achilles? Or if your biceps were causing you pain at the elbow or shoulder, would you assault your antecubital fossa? No?
Then why is ITB rolling the accepted paradigm?
The iliotibial band is an inert band of connective tissue that spans the lateral aspect of the leg, from the hip to the tibia, with fibrous connections to the glute max and tensor fascia late (TFL). It has no stretch receptors, muscle spindles, golgi tenon organs or anything that would respond to a stretch stimulus such as foam rolling.
Peeling back the onion…
The ITB is merely a messenger, an avascular, non- innervated, non-contractile tendinous/ligamentous structure that merely relays a message from the glute max and TFL while stabilizing the lateral knee. But the standard course of treatment unwaveringly starts with battering the messenger, bludgeoning it to no end, and to no resolve. So the first layer of the onion should start with doing the noble thing and freeing the messenger by addressing TFL hyper tonicity and properly balancing the muscles that act on the hip and ITB.
We’re not done there
The real problem with the Iliotibial band doesn’t come from its inherit “tightness” as its acted upon from the muscles of the hip, but rather comes from its proximity to the vastus lateralis. Over time chronic, tight TFL’s and unbalanced hip musculature can cause the ITB to approximate and form adhesions with the vastus lateralis (most lateral of your four quadriceps muscles). These adhesions can causes the ITB to follow the lateralis as it moves actively into knee extension and as it eccentrically loads in knee flexion. These adhesions in more severe cases can manifest as a “clicking “ or “snapping” of the ITB, as it gets dragged over the lateral femoral condyle at approximately 30 degrees of flexion.
I don’t want to come off snide, or rude in my explanation of conventional foam rolling. Anyone who has taken it upon him or her self to track down the root of their pain or proactively get ahead of potential problems has my upmost respect. Hell, even I have found myself adopting the conventional paradigm, and just rolling back and forth on a foam roller thinking I was addressing my biomechanical issues. To clarify conventional foam rolling isn’t wrong. It’s just not optimal.
The progression of ITB foam rolling involves no rolling at all. It requires you to do the work around the foam roller. Assume the position of normal ITB foam rolling, involved side down on the roller, keeping the lateral thigh perpendicular to the roller. With your top leg, anchor your involved leg by placing the heel of your top leg superior to the patella of your downside leg. Supporting your body weight with your arms slowly lower your body towards the floor until your torso, and involved leg are parallel with the floor. Once you’re in position make sure the roller starts 2 inches below the hip (greater tuberosity of the femur). This will be your first of four spots along the ITB that we are going to target. The subsequent three points will be evenly spaced between position one (two inches below the hip) and our final position 2 inches above the lateral knee.
At each point we will rest the foam roller in place, then slowly move our knee into full flexion, to ensure a full range of motion try to slowly kick yourself in the butt. When full flexion is achieved hold that contraction for 2 seconds before initiating the extension phase. Slowly bring the knee from a fully flexed position, to a fully extended position, making sure to activate the vastis medialis (VMO) as the knee comes to terminal extension. This terminal knee extension of the VMO is imperative, as both the ITB and VMO act on the patella- the ITB draws the patella laterally and the VMO tracks the patella medially. So any discrepancy between VMO strength and ITB tightness can manifest itself in a lateral tracking of the patella in the intercondylar fossa of the femur. One full pass of knee flexion and knee extension while resting on a single point of the ITB is considered one rep. You will perform three reps at each point. And then repeat the protocol on the opposite side.