The Illusive Iliotibial Band
Exactly What is the IT Band and What is Its Function?
Occasionally, a client will tell me that they’ve been told that they have a tight IT band. They then ask me what they can do at home to help alleviate it. This often leads to a conversation about exactly what is the IT band and how does it function.
To understand the iliotibial band (or IT band, for short), we need to understand fascia because the IT band is not a muscle - it is actually a superficial sheet of fascia.
What is fascia? We know that fascia is a type of tissue that wraps and weaves throughout our bodies beneath our skin. It connects and separates everything in our body and its everywhere. It is fluid filled and highly innervated with about 250 million nerves. It contracts separately from our muscles. It is an extension of our brain, telling our brain things like where our body is in space and how far we can stretch.
Types of fascia We know that there are two types of fascia. Superficial or subcutaneous fascia sits just below the skin and covers the entire body. Depending on its location, superficial fascia varies in density from thin (such as on the back of the hand) to quite thick (as on the bottom of the feet). It is filled with adipose tissue, nerves, blood vessels, lymph vessels and connective tissue.
Th other type, deep fascia, surrounds and penetrates muscle bellies and encases each little muscle fiber to hold them together and create functional groups, it wraps and supports the organs, and it fills the spaces between. Similar to superficial fascia, it also contains blood vessels and nerves.
Fascia gives our bodies their shape. Dr. Andry Vleeming, an expert on fascia, calls it “your soft skeleton”.
The orange comparison To help describe fascia, it is often compared to an orange. You can think of the orange peel as your skin. Removing the peel reveals a soft white covering that encompasses and holds together the fruit. Separating the individual segments of the orange reveals more of the soft white covering that encompasses each individual segment, with more white penetrating each segment. You can think of the soft white coverings as our fascia and the orange fruit as our muscles, tissues, and organs.
So, back to the IT band… and its anatomy. The IT band is not a discreet free-floating band all by itself as often depicted in textbooks, but one part of a cylinder of fascia which wraps and covers the entire upper leg sort of like a stocking, called the fascia lata. The IT band arises so gradually within the fascia lata that it is impossible to make a clear line of separation between the two. It has vertical fibers that are made of silvery-white collagen and is very tough (think Tyvek envelope tough). It is located along the lateral thigh. It emerges from the gluteal fascia, becomes wide and dense over the vastus lateralis (the largest and strongest of our quadriceps muscles) and then narrows in width into a strong cable alongside the lateral knee before inserting at the tibial tubercle. It also penetrates deep through the tissues below to attach along the length of the femur, creating a “T” shaped structure.
There are two muscles that attach to the IT band. Both the tensor fasciae lata (TFL), a small muscle at the outside of the hip, and the gluteus maximus attach to the IT band. The TFL assists with internal rotation of the hip and extension of the knee. The gluteus maximus extends and externally rotates the hip, assists with abduction of the thigh, as well as stabilization of the extended knee. These two muscles create the main pulling force on the IT band.
Only humans have IT bands. Interestingly, while all mammals have fascia lata, only humans have an IT band. As upright humans who stand, walk and run, this regular and repetitive strain on the fascia lata creates a remodeling response in the body, slowly causing thicker, denser collagen fibers to be laid down, eventually leading to the development of our IT bands. As babies, we are not born with IT bands! Other mammals, as quadrupeds, have no need for an IT band.
The IT band’s main purpose is to maintain stability of the knee and hip so they don’t pop out laterally.
The second most common running overuse injury is IT band friction, also known as IT band syndrome. It occurs mainly in long distance runners especially during deceleration phases (think going downhill) and is felt as lateral knee pain while exercising. Recent research now thinks it might be caused by the highly innervated fat pad that sits beneath the distal IT band that gets compressed by the IT band during flexion and extension of the knee. A 2004 research study of young female athletes at the University of Connecticut found that of the athletes that developed IT band syndrome, none of them had tight IT bands.
Approaches to IT band pain. So, what can be done to alleviate pain and/or friction along the IT band and/or lateral knee? Since the IT band’s main purpose is to create stability for the knee and hip, we don’t want to soften it as it needs that tension in order to create stability.
Some recommend rolling out and stretching the IT band, but is that possible? Research shows that stretching the IT band creates a lengthening of roughly 2 millimeters, which is an overall change in length of less than half a percent.
Current thinking recommends:
Instead of rolling out and compressing down on the ITB, try skin rolling or lifting or myofascial release to open the layers of tissue to allow fluid in to increase hydration hereby increasing tissue glide and reducing friction. Think slow movements. Fascia is slow to change and releases only when your body feels safe.
Foam roll or massage the TFL muscle which attaches to the IT band. Again, think slow movements.
Stretch the TFL muscle. Yoga poses to stretch the TFL can help bring relief. Because of their extended, held poses, yin yoga and restorative yoga are good choices for stretching and releasing the TFL. Yoga poses to stretch the TFL include: bananasana (banana pose), parighasana (gate pose), virabhadrasana II (warrior II pose), utthita trikonasana (extended triangle pose), and anjaneyasana (low lunge)
Strengthen the gluteus maximus. Since the TFL and glute max work together to create the needed tension on the IT band to create stability, its important that both muscles are pulling their weight. It is thought that perhaps a weak gluteus maximus will yield its pull on the IT band to the TFL, creating tension and pain. Yoga poses to strengthen the glute max include: Utkatasana (chair pose), virabhdrasana II (warrior II pose), virabhdrasana III (warrior II pose), setu bandha sarvangasana (bridge pose), and salabhasana (locust pose),
Stretch, massage or foam roll the muscle running beneath the IT band, the vastus lateralis. It is thought that perhaps an overactive vastus lateralis will press into the IT band from the inside creating tension and pain.
