Are You Foam Rolling Your IT Band? Time to Stop

By Kolten Tea DPT, SCS, CSCS

Oh no another one of these stories? How many of you foam roll your Iliotibial Band (IT Band)? Is this the first line of treatment for lateral knee pain or “Tight IT bands?” Many of you personally may have been out for a run and slowly felt it. The slow increase of the dreaded pain on the outside of the knee. You immediately run to the local Robo Gym and hop onto a foam roller for 3 hours of pain provoking muscle mashing for fear that the IT Band has tightened up. You ask a Physical Therapy colleague, maybe even a doctor,  and what are you likely to hear? “You have a tight IT band, just foam roll to loosen it up.” Well it’s time to stop torturing yourself.

 

Iliotibial Band Syndrome (ITBS) or 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 (1,2). ITBS was originally described as an area of friction occurring between the iliotibial band and the lateral femoral condyle when the knee is flexed around 30 degrees (3). This friction was thought to lead to inflammation, pain, muscle inhibition, and concurrent limitation with activity. Therefore when you run, bike, or produce any repetitive movement that causes pain on the outside of the knee it without a doubt must be the IT band rubbing on the femoral condyle.

However, findings of cadaver studies and biopsies of the lateral knee simply do not support this theory. Fairclough et al (4,5) suggest that there is an appearance of movement of the IT Band on the condyle that are due to changes in tension during varying knee angles. The band does not actually have the capability to slide across the femoral condyle. Instead the IT band applies a compressive force on the joint when the fascia tightens. Therefore, the pain experienced on the lateral knee is most likely due to the IT band not transferring loads properly and compressing the fat pad that lies underneath. This fat pad has demonstrated to have high concentrations of Pacinian Corpuscles and nerve fibers which makes it very good at signalling pain (4). Friction and tightness is not likely the guilty mechanism for pain on the lateral condyle. (5,6)

What is the IT Band and Why Are We Trying To Roll It

The IT band is a thickened part of the fascia on the outside of the leg. It runs from the top of the hip and attaches all the way down on lateral aspect of the knee. It’s the insertional point to the Tensor Fascia Lata and some fibers of the Gluteus Maximus. It provides lateral stability to hip, spine, and knee and has “potential” fascial connections that extend all the way down to the bottom of the foot. Why do you want to roll it? In theory by foam rolling the band, it will break apart adhesions (which are debatable at best) and stretch the fascia (read below) to create less pain and tension.

What is Foam Rolling and How Does it Work?

A foam roller is exactly as it sounds, it’s a cylinder of dense foam that is designed to aid in self myofascial release. When you roll your muscles over the cylinder, the theory is the muscles are lengthened or stretched over the curvature of the roller, resulting in decreasing tightness.

However, foam rollers do not actually stretch the tissue. It compresses the tissue for a very brief period of time (less than one second) as the roller passes over the area. Or you could lie statically one spot in hopes of inducing tissue creep but that sounds even more painful on the lateral leg and unlikely to work as hoped. The time of compression and the amount of tissue distortion are not sufficient enough to make true changes in fiber length.

Now I am not knocking foam rolling completely. It has actually previously been shown to increase blood flow to an area, can decrease pain pressure threshold, improve joint ROM (9), improved arterial flexibility, improves venous function (6) and most importantly to myself,  influences the central nervous system (7). Foam rolling also decreases muscle soreness after intense bouts of exercise (7) without having a decrease in performance (10) . This may make it a better option for a “warm up” as compared to static stretching which may hinder performance. That’s a whole different topic. Nonetheless, changing the actual length of the muscle has not been proven. Vigotsky et al (11) found no change in the length of the Rectus Femoris muscle after bouts of foam rolling to the anterior thigh. There is a time and a place for foam rolling, it’s just not on the outside of the thigh.

Really?

Can We Really Change the Length of the IT Band Anyway?

The short answer is no. In the case of the IT band, a predicted normal load of 9075 N (2,040 lbs) and a force of 4515 N (1,015 lbs) are needed to produce even 1% compression and 1% shear (8). That’s nearly 2,000 lbs of force! I’m sorry but I don’t think rolling repeatedly on a dense piece of foam is going to produce a force of 2,000 lbs. Sorry Foam Roller junkies, the IT band is stuck to the femur, it’s not going anywhere (thankfully).

Not only does it take a superhuman amount of force to lengthen the IT band as noted above but trying to statically stretch it doesn’t seem to work either. When we do try to stretch the IT such as bringing our leg across mid-line with our knee straight, truth be told our hip structures become restricted before tension is ever applied to the IT band. Willet et al (13) discovered that the mid-thigh ITB is not the restricted structure to hip adduction during the Ober’s test. The gluteus medius, gluteus minimus, and the joint capsule constrain adduction before the IT band ever does.

Wait, I Feel Better After Rolling. What Gives?

The IT band is supposed to be tight, provides stability and support to the back, hips, and lower leg. Without it, we would lose considerable stability during upright movement and efficiency during locomotion. Take it out and we’d be stumbling with each step like college students walking home after last call on a Friday night.

The euphoric feeling after foam rolling is likely not tension being released from the IT band. It’s likely cause you just smashed all the receptors in the underlying tissue and everything is numb. That strategy doesn’t offer much of a long term solution as a stand alone treatment.

Our bodies are really good at relaying threats to the brain, which the brain then interprets that threat as “pain”. Diffuse Noxious Inhibitory Control (DNIC) is one of the ways the body modulates pain signals. In DNIC the brain inhibits the signal from traveling up to the spinal cord to the brain. It’s simply a redirection or distraction of pain and the signal is perceived as less severe. DNIC can be seen when you intentionally irritate an area far away from the actual location of injury like pinching your cheek to take away the pain in your foot. In foam rolling, “good pain” or muscle mashing is created to take away the pain in the lateral knee. This seems to be similar to DNIC.

Also, people tend to report that they feel more fluid and able to move better after foam rolling which is likely due to increase neural inhibition of the surrounding area. Meaning, there is less feeling of muscle guarding and sensory aspects in the area. When you can’t feel an area of the body of course if feels more fluid and free.

Finally, if it did actually lengthen the IT band why do we have to keep doing it? Wouldn’t it stretch out after a couple days? Foam rolling often needs repeated to get the same effect, which likely points to modulation of the central nervous system vs actually making changes to the IT band itself.   

My Bubble is Burst, What Should I do Instead?

First, visit a qualified physical therapist or another qualified medical provider for a full assessment. This MAY lead to findings of injuries in other areas and compensations throughout the lower chain. It’s not uncommon for problems in nearby joint causing pain elsewhere in the kinetic chain. The medical professional should be able to develop a good program to move better and strengthen the limiting tissues. If running is what got this all flared up in the first place, they should be able to aid in a running analysis that could show abnormal running mechanics increasing compression of the fat bad for ITBS. However if you are adamant to do this on your own, here is a few ideas

Focus on the muscles that attach to the IT band and near it. This means if you still want to use that 30$ foam roller like it was intended, use on the muscles surrounding the IT band like the Vastus Lateralis, Glute medius, TFL, and Glute Max. You are likely to get the same pain inhibition by rolling the border of the IT band and lateral quad with less pain that rolling directly on the IT band.

Then use this golden window of numbed receptors and strengthen! A good place to start is with the lateral stabilizers in the hip and knee extensor muscles. Orchard et al found that runners with ITBS landed with less knee flexion upon initial contact on the involved limb than uninjured runners (3) . This could indicate unilateral eccentric weakness and poor force transfer at initial contact during running. Even if you think that you are stronger than an ox, try a strengthening program. Sometimes simply the process of strengthening is more protective then objective strength and the nervous system can return to homeostasis.  

Back off your mileage. It’s not uncommon for a sudden either intentional or unintentional increase in mileage to accompany complaints of lateral knee pain. Sometimes just backing off and increasing mileage more gradual may due the trick.

Finally, if you are really desperate and looking for any last thread of hope, check your running shoes. It may be time to get a new pair. Kong et al (12) determined that in as little as 200 miles on a running shoe can lead to altered biomechanics. This doesn’t mean you should get rid of your shoes every 200 miles, that would be 2 weeks for some of you. Just be aware and try a different pair on the next run and see if the symptoms change. If so it might be time for a trip to the shoe store.

Works cited:

  1. McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the master’s runners. Clin J Sports Med. 2006 Mar;16(2):149-54.
  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.
  3. 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.  
  4. 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.
  5. 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.
  6. Okamoto T, Masuhara M, Ikuta K. Acute effects of self-myofascial release using a foam roller on arterial function. J Strength Cond Res. 2014 Jan;28(1):69-73. doi: 10.1519/JSC.0b013e31829480f5. PubMed PMID: 23575360.
  7. Macdonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity.Med Sci Sports Exerc. 2014 Jan;46(1):131-42. doi: 10.1249/MSS.0b013e3182a123db. PubMed PMID: 24343353.
  8. Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 2008 Aug;108(8):379–90. PubMed #18723456.
  9. Behara B, Jacobson BH. 2015. The acute effects of deep tissue foam rolling and dynamic stretching on muscular strength, power, and flexibility in division I linemen. Journal of Orthopaedic Trauma Epub ahead of print Jun 24 2015 DOI 10.1519/JSC.0000000000001051.
  10. Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG. 2014. Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. International Journal of Sports Physical Therapy 9:92–102.
  11. Vigotsky AD, Lehman GJ, Contreras B, Beardsley C, Chung B, Feser EH. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test. Abdala V, ed. PeerJ. 2015;3:e1281. doi:10.7717/peerj.1281.
  12. Kong PW, Candelaria NG, Smith DR. Running in new and worn shoes: a comparison of three types of cushioning footwear. Br J Sports Med. 2009 Oct; 43(10):745-9. doi: 10.1136/bjsm.2008.047761. Epub 2008 Sep 18.
  13. Willett GM, Keim SA, Shostrom VK, Lomneth CS. An Anatomic Investigation of the Ober Test. Am J Sports Med. 2016;44(3):696-701.

Other Great Resources for IT Band

About the Author 

Kolten Tea is a 2013 DPT graduate from Franklin Pierce University in Goodyear AZ. He currently lives in Montrose CO and works for the local Montrose Memorial Hospital in outpatient orthopedics. He is certified as a strength and conditioning specialist and became board certified as a specialist in Sports Physical Therapy in 2016. Kolten is a founder of myptcorner.com, focused on sharing PT passions and knowledge. His interests in physical therapy are PT advocacy, growth, and research.

 

Leave a Reply