Your friend, the iliotibial band
Oct. 18th, 2004 11:33 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ninevirtuesIf you like bodies and want to know how the heck they do what they do, read on. If not, feel free to skip.
The IT band is a tough, fibrous band that runs down the outside of your thigh. It attaches to muscles at your hip (gluteus maximus and a special little tiny one called the tensor fascia lata) and runs so far down that it also attaches to the head of your fibula (the second bone in your lower leg).
It tends to be especially tight in runners and cyclists (and hmm, triathletes are notorious for ITB tightness), so for years, we thought that the best thing to do if it was tight was to stretch it. Logical, right?
Except... the IT band is made of tough, fibrous connective tissue. If you removed one from a cadaver and tried to stretch it, you would probably find that it has extremely high tensile strength, and was never meant to stretch. (More than likely, it's there to provide structural support for the femur, which carries loads of 7x your body weight during running, and 2.5 to 3x your bodyweight when walking.) Hmm, do you really want to stretch out your structural support? (Maybe not.)
The best practice for knee injuries related to ITB tightness used to be "stretch and massage the ITB". Now, it's more likely to be "stretch the gluteus maximus, gluteus medius, and TFL, which make up the origins of the ITB". If the other end of the ITB (the one attached to the fibular head) is causing the trouble, though, I'm not so sure how much that would help. Perhaps we should add "stretch, ice, and massage the distal attachment point of the ITB, and make sure the ITB is not adhered to the quadricep muscle underneath it," to that list.
Comments from the bodyworker and gym rat crowd? ("Huh?" is a perfectly acceptable comment. So are references to any crack I may have smoked, or be planning to smoke, today. ;-)
The IT band is a tough, fibrous band that runs down the outside of your thigh. It attaches to muscles at your hip (gluteus maximus and a special little tiny one called the tensor fascia lata) and runs so far down that it also attaches to the head of your fibula (the second bone in your lower leg).
It tends to be especially tight in runners and cyclists (and hmm, triathletes are notorious for ITB tightness), so for years, we thought that the best thing to do if it was tight was to stretch it. Logical, right?
Except... the IT band is made of tough, fibrous connective tissue. If you removed one from a cadaver and tried to stretch it, you would probably find that it has extremely high tensile strength, and was never meant to stretch. (More than likely, it's there to provide structural support for the femur, which carries loads of 7x your body weight during running, and 2.5 to 3x your bodyweight when walking.) Hmm, do you really want to stretch out your structural support? (Maybe not.)
The best practice for knee injuries related to ITB tightness used to be "stretch and massage the ITB". Now, it's more likely to be "stretch the gluteus maximus, gluteus medius, and TFL, which make up the origins of the ITB". If the other end of the ITB (the one attached to the fibular head) is causing the trouble, though, I'm not so sure how much that would help. Perhaps we should add "stretch, ice, and massage the distal attachment point of the ITB, and make sure the ITB is not adhered to the quadricep muscle underneath it," to that list.
Comments from the bodyworker and gym rat crowd? ("Huh?" is a perfectly acceptable comment. So are references to any crack I may have smoked, or be planning to smoke, today. ;-)
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no subject
Date: 2004-10-18 09:58 am (UTC)Same sort of logic I use for someone who has rhomboid pain due to rounded shoulders and short pec minor. I know working on the rhomboids won't fix the problem, but for the client, it feels good! So, I start with some of that, and then move them supine and start educating the client about how something in the front can be causing the pain in the back.
One last note: when I saw my first ITB in a cadaver lab, my immediate thought was "Damn, that's practically a bone!" So thick and so fiberous... yeah, you're not stretching that thing one bit.
well hmm...
Date: 2004-10-20 04:19 am (UTC)Yeah, my instructors didn't say this, but you can definitely get some traction, with massage and stretching, on the TFL, glutes, and the ITB attachment point by the fibular head.
Hmm. Now about massaging that ITB. Do you ever find that it's rolled forward and adhered to the quad underneath it?
Re: well hmm...
Date: 2004-10-20 07:26 pm (UTC)What sort of thing would cause that? And what symptoms would it present?
Re: well hmm...
Date: 2004-10-21 03:11 pm (UTC)I heard about that from one of my sports massage instructors at McKinnon (a guy who has a sports massage practice in Berkeley). I've never seen it, but I bet you'd see it with cyclists, runners, or XC skiers who use their quads a lot, and what you'd see is one of those middle aged fibrous people, (one of the ones who think 'yoga' is a four letter word, maybe? ;-) and the IT band would be forward of where you'd think it would be, the TFL would be rock hard, the person would be complaining about anterior knee pain, and it would be very hard to move the ITB-- it would seem adhered to the quad. (Reach down and grab your own ITB; you can probably separate it, to an extent, from the quad underneath it. If it was adhered, you couldn't do that.)
Mind you, I've never seen this, and a brief cruise through PubMed and the APTA website looking for articles that mention this phenomenon turns up _nothing_. So it may be a figment of my (or the instructor's) imagination. Give me a couple years in practice and I'll know for sure. (grin)
More on that ITB
Date: 2004-10-31 06:01 pm (UTC)Cryptic note under the hip bursitis section of my course notes-- written by the prof, a clinician at Duke:
ITB can move ant. and post. to greater troch w/running esp if LLD
Translation: If you have a leg length discrepancy, and you are a regular runner, your IT band may migrate anterior to or posterior to the greater trochanter of your femur.
There ya go.