Jan 2017 28

The Iliotibial Band

By: Dave Wheeler

Last week I blogged about ITB syndrome and how frequent it actually is.

Before turning to how to treat ITB syndrome (in the unlikely event that you have it), we need to know just what the ITB is and how it's made up.


The job of ITB

The role of the ITB is to stabilise the knee.

This is actually most important when we're standing & slouching a bit (i.e. putting most our weight on one leg). The ITB locks the knee turning the whole leg rigid to support the weight of the body.

It also helps keep your knee in a relatively straight position when you walk, run or squat.

Because it's an "Intentionally Tight Band" it stops your leg wandering in front of you when you take a step (which would cause you to trip over yourself).


The anatomy of the ITB

The Iliotibial Band is NOT a distinct anatomical structure in it's own right - it's an extension of the fascia that originates under the hip flexor muscle Tensor Fascia Latae  (TFL) and which runs down the lateral (outside) of the leg to the bony knobble  right on the side of the knee.

The ITB isn't a muscle. It doesn't contract. It doesn't have the same composition of muscle - specifically it's pretty short on elastin (the stretchy stuff); it does have lots and lots of collagen fibres, which gram for gram are stronger than steel (and about as stretchy).

If the TFL at the top of the hip gets too tight from over-exercise, then the muscle pulls too much on the "steel cable" which is the ITB. Since the ITB attaches to bone at the lower end, that muscle tightness at the very top of the leg is actually felt way down at the side of the knee.


Treating a "tight" ITB

OK, so that's a bit of mickey-take... since the ITB is essentially a steel cable it can't, in and of itself, get any tighter than it is. The only sense that it can get tighter is if the TFL muscle pulls on it excessively (so tight in the sense of "pulled tight", like a tight rope).

So all that talk you get from some people about a tight ITB that needs foam rollering is just an Old Wives Tale.

Massage on ITB has a minimal effect. In fact, research has shown that it has no benefit at all (Ellis, Hing & Reid, 2006). What has been shown to work is the stretching technique called Muscle Energy Technque (Pedowitz, 2006). Let's be clear though, that what this does is  to use the ITB as a lever to stretch the problem muscle - the TFL - vigorously.

Remember, though, from last week's blog, that  the only time you need this kind of work is if you're feeling pain on the outside of your knee (at the knobbly bit on the outside of your knee).

As ever, if you think I can help, give me a call.