IT Band Stretches – Learn The Secret

Of all the acronyms used within the world of running related injury, ‘ITB’ must surely sit near (if not at) the top. Anyone who has suffered from ITB Syndrome will tell you that it can be extremely tricky to recover from.  With its characteristic pain on the outside of the knee preventing many a runner from exceeding a certain mileage. Or sometimes from even running at all.

In case you are not aware, ITB stands for Iliotibial Band. A long band of immensely strong connective tissue that travels from the upper hip (ileum) all the way down to the top of the outer shin bone (tibia), just below the knee. Some of you may know it as one of the most excruciating parts of the leg to foam roll. Something we will address later on.

One of the most frustrating things for runners about ITB Syndrome is advice on how to deal with it. Which can vary incredibly depending on whom you talk to or what you read. This is probably down to the fact that no one is quite sure yet about what actually causes ITB syndrome (more on that later).

Of the ‘solutions’ handed out one of the most common is IT Band stretches. Standing with one leg crossed over the other and then leaning to the side. Or a version of the popular pigeon pose from yoga. Although some runners proclaim that these stretches help them recover. It may be surprising to hear that there is absolutely no evidence that IT band stretches do anything to help recovery from ITB Syndrome.

In fact, as we will see shortly, study of the structure of the IT band suggests that it is highly unlikely it can be ‘stretched.’ At all no more than a couple of millimetres. This may explain why although IT band stretches seem to work for some runners, others find no benefit whatsoever. And some even see symptoms get worse. Let’s take a look why.

• Bonus Content – Check the bottom of this post to watch an interview with sports therapist and author of this article Matt Phillips as he shares even more on this important subject.

Anatomy of the Iliotibial Band

When you see the word ‘syndrome’ in describing a running related injury, it generally indicates that science is not quite sure what the cause actually is. Theories as to the mechanism behind ITB Syndrome have appeared and disappeared over the years. Which is why treatment can vary so much depending whom you talk to.

To understand why this is, let’s take a look at the anatomy of the Iliotibial Band.

As can be seen in the diagram, the Iliotibial Band is a long piece of connective tissue running down the outside of the thigh. From the upper hip (ileum) to just below the outer knee (tibia). Note that it is connective tissue Represented in white on the diagram. In contrast to the red muscle and made of fascia. The same fibrous tissue that makes up tendons and ligaments.

The IT band is the longest piece of fascia in the human body. And like all fascia it is immensely strong. With an ability to handle huge amounts of load. Yes, it’s stronger than steel. And the ITB is thought to play a major role in transmitting the forces involved with locomotion. Which includes running.

Cause of ITB Syndrome

The traditional proposed mechanism behind ITB Syndrome is that the IT Band becomes ‘too tight’ and starts rubbing against the lateral femoral epicondyle, a bony prominence on the end of the thigh bone (femur). This is where the idea of IT Band stretches comes from. Loosen the ITB and the rubbing will stop. Unfortunately, there are a couple of issues with such reasoning:

• It is highly unlikely that the IT Band can be stretched

• It is unlikely that a ‘looser’ IT Band would help prevent ITB Syndrome.

ITB: Can It Be Stretched?

As we mentioned previously, the ITB is immensely strong. It needs to be in order to handle the loads put through it. Research has shown that the traditional IT Band stretches really don’t make much difference to the length of the ITB. Even one study that used heavy duty machinery only managed to increase the length of the ITB by 2mm. It really is tough stuff.

Despite what the studies say, many physical therapists still perform the ‘Ober Test’ as part of their assessment in order to measure ‘tightness’ in the IT Band. Some of you may already be familiar with it. You lie on a couch on your side whilst the therapist lifts your top leg behind you (into hip extension) to see how much it is able to fall over the side of the couch.

If it doesn’t fall much, you are said to have a tight IT Band. And are thus given IT Band stretches. The 2016 study ‘An Anatomic Investigation of the Ober Test’ (Willet et al) concluded that ‘the Ober test assesses tightness of structures proximal to the hip joint, such as the gluteus medius and minimus muscles and the hip joint capsule, rather than the ITB.’

In effect, neither the Ober Test nor the IT Band stretches typically handed out afterwards actually stretch the IT Band. Which brings us to another couple of popular ‘treatments’ for ITB Syndrome, foam rolling and deep tissue massage.

ITB: Foam Rolling & Deep Tissue Massage

Along with IT Band stretches, foam rolling and deep tissue massage are definitely up there amongst the most popular ‘solutions’ for ITB Syndrome. Unfortunately, like stretching, neither are supported by any evidence and in fact they could potentially make symptoms worse.

Remember how tough the IT Band is? Stronger than steel we said. So, do we really believe our body weight on a foam roller or the elbow of a physical therapist is actually going to make any difference to ITB structure?

The idea that we can (or need to) ‘break down knots’ or ‘scar tissue’ are archaic and unfounded. Surgeons need knives to cut through scar tissue. And remember, the ITB is not a muscle Applying pressure to muscles can make differences to their tone and length (e.g. the tensor fasciae latae and glutes). But the ITB which is essentially more similar to a tendon will not respond in the same way to foam rolling or massage.

Our body tells us this is the best way it knows how, pain.  Too many runners are led to believe that pain (for more, please read Good Hurt versus Pain) is a necessary component of ‘breaking down knots’. It’s not. In fact, enduring ‘over the top pain’ may make symptoms worse. By firing up your nervous system unnecessarily and causing it to become more sensitized.

ITB: Attached To The Thigh Bone

Research throws another curveball into the idea that the ITB can be ‘stretched’ or ‘freed up’ from the structures below. Dissection and MRI scans show that the IT Band is not just attached to the hip and the shinbone. It is also attached at various points along the whole length of the thigh bone (femur). Meaning that moving the hips away from the shinbone will not cause any significant lengthening of the band.

The discovery of these attachment points along the femur casts doubts over the whole proposed cause of ITB Syndrome. With many of these attachment points just above the knee, it is unlikely that the IT Band as once suggested rubs against the lateral epicondyle when the knee is bent and straightened. Meaning that irritation of the ITB itself is probably not the issue.

The 2006 study ‘Is iliotibial band syndrome really a friction syndrome?’ (Fairclough J. et al.) concluded that symptoms may be caused by a slight sideways movement of the ITB compressing an innervated layer of fat between the ITB and epicondyle. And in doing so stressed the potential importance of hip muscle function (please read Cross Over Gait for more) in dealing with ITB Syndrome.

What Does Work For ITB Syndrome?

=If we accept that IT band stretches are unlikely to help runners recover from ITB Syndrome, we must now ask ourselves what will help? Well, remember what we said it’s called a ‘syndrome.’ Because we’re really not sure what causes it. And not knowing the cause makes it a little tricky to find a solution. That said, of the research that has been done (more is needed) there have been promising outcomes for two interventions:

• Strengthening The Hip Abductors

• Increasing Step Width

Strengthening The Hip Abductors

Despite the fact that hip weakness has sadly become a bit of a ‘fix all’ in the world of running related injury. As far as ITB Syndrome goes there is some promising evidence. The 2000 study ‘Hip abductor weakness in distance runners with iliotibial band syndrome’. (Fredericson et al.) concluded that distance runners with ITB Syndrome have weaker hip abduction strength in the affected leg compared to the unaffected leg.

Though the study does not necessarily mean that weak hip abductors are the direct cause of ITB Syndrome, it presents an interesting relationship that we can work with and include within a bigger rehabilitation program for ITB Syndrome. For information on how to strengthen the hip abductors please read Hip Strengthening For Runners.

The main role of the hip abductors in running (particularly the gluteus maximus and gluteus medius) is thought to be reducing hip adduction (drifting inwards of the leg). Though research shows that strengthening these muscles does not always cause an automatic change to running form.

Combining this approach with some gait retraining may be an effective intervention for ITB Syndrome. Particularly if the runner in question happens to run with a narrow step width. Which brings us nicely onto the next section.

Increasing Step Width

In 2012, a study entitled ‘Step Width Alters Iliotibial Band Strain During Running’ (Meardon et al.) assessed the effect of step width during running on factors related to ITB syndrome. Fifteen recreational runners ran at various step widths. Including at their preferred width, at +5% of their leg length, at -5% of their leg length.

The study revealed that greater ITB strain and strain rate were found in the narrower step width condition. It also showed that running with the feet just 3cm wider reduced ITB tension by up to 20%.

This presents us with a useful intervention for runners suffering from ITB Syndrome who also have a narrow step width. In case you are not aware, by narrow step width we are referring to a ‘cross over gait.’ Crossing the body’s midline (with either one foot or both feet).

Though once again, narrow step width may not be the direct cause of ITB Syndrome (there are plenty of runners out there with a narrow step width who are not sufferers). If widening the gait slightly allows the nervous system to experience pain free running, it could play a valuable part in aiding recovery.

Whether the runner (once recovered) returns to their normal narrow width running form or stays with the new form is not necessarily important. What is important is that the time spent running pain free thanks to the modified width has permitted recovery. For more information please read Cross Over Gait.

In Summary

Many runners delay their recovery from ITB Syndrome because they are devoting too much time to non-evidence based interventions. Until the research says otherwise, IT band stretches (along with foam rolling) fall into this category. So my advice would be to look elsewhere for solutions.

Although we are still not sure what the direct cause of ITB Syndrome is, research suggests that hip abductor strength training coupled with step width increase may for some runners be a good direction to take. As always, it is important to remember that 80% of running related injuries are caused by inappropriate training, be it running too often, too intensely or for too long.

Pain is your body’s way of telling you that you have asked too much of it.  That you have crossed thresholds set to protect you from serious injury. Make sure your recovery program from ITB Syndrome takes this into account. Or you will probably find yourself in the same position once again in a few months time.