The other day I was working with a patient who had knee pain. After examining the patient, I determined that they would benefit from using a foam roller. I brought the patient to the gym, pulled out a foam roller and placed it on the floor. The patient then proceeded to tell me that they felt that their knee pain could be because their IT band is tight.
To this I replied, “YOUR IT BAND IS SUPPOSED TO BE TIGHT!”
I understand that physical therapists are probably partially to blame for people thinking that their problems are due to tight IT bands. At one point in my career, I probably was telling patients that their IT bands were tight. As a runner, I was led to believe that my knee problems were due to my tight IT bands. So, this comment that brought on my frustration is partially my fault. Now, I am here to help dispel some of the myths that both myself and others liked me had helped to create. Yes, your IT band is tight. It is supposed to be that way.
The job of your IT band is to help provide stability to your knees. The IT band also works in conjunction with the muscles in your hip to help you to extend, laterally rotate and abduct your hip. If your IT band were loose, you would be at a greater risk of tearing the ligaments in your knee. Or your hips might sag and wobble as you walk and run. In other words, you would constantly look like a model sashaying down the runway. Prolonged walking and running with this type of deviation would probably lead to things such as damage to your hip and knee joints (I am imagining the horrible things that would happen if we did not have IT bands as I write this).
So, what is an IT band?
IT band is short for iliotibial band. It is a band of connective tissue that arises from the fibers of the tensor fasciae latae, or TFL. Connective tissue is not a muscle, but a type of tissue that helps to hold the body together and provides support. The TFL is a muscle that attaches at the side if the hip. The job of the TFL is to help stabilize the hip during activities such as running and walking.
If the TFL along with other stabilizing muscles in the hip were weak, and not doing their job, every time you would put weight through your leg while running and walking, your opposite hip (the side that is not on the ground would drop down (again think of the poor model sashaying down the runway). The fibers of the TFL run down the side of your hip to the greater trochanter. The greater trochanter is a bony area that sticks out near the top of the femur (thigh bone). It is an attachment site for some of the muscles in the leg (such as your gluteus medius, gluteus minimus and piriformis to name a few). At the greater trochanter, the fibers of the tensor fasciae latae give rise to the fibers of the IT band. The IT band then connects on the outer side of the tibia (shin bone) just after it passes over the knee joint. With this connection, the IT band crosses over the knee joint. Sometimes the TFL and IT band together are referred to as the iliotibial tract.
The IT band does not directly connect to your patella or kneecap. However, there are connective tissue fibers that connect the IT band to the kneecap. This is called the lateral patellar retinaculum.
Is the IT band a muscle?
No. As I said before, it is a band of connective tissue. You cannot stretch your IT band. You can stretch your tensor fasciae latae which has connections to your IT band. You can also stretch muscle groups such as your hamstrings and quadriceps (some of the muscles in the thigh) which sit alongside your IT band. Yes, I understand that this statement may lead to an argument amongst other nerdy physical therapists.
Why am I rolling my IT band?
Friction between the IT band and the outermost muscle at the front of the thigh (one of the quadriceps muscles called the vastus lateralis) can cause adhesions to form. These adhesions can pull at the fibers surrounding your kneecap and cause pain at your knee. Think of a snag on a sweater. When you pull t the snag, you might see other parts of the sweater start to pucker and move. These adhesions may be partly to blame for issues regarding how the patella moves when your bend and straighten your knee.
Rolling the outside of your leg using a foam roller can help to improve bloodflow to this area. The improved bloodflow can help to improve the health of these tissues and can help to improve tissue recovery. Rolling in this area can also help to decrease tension at your vastus lateralis. Tension in your vastus lateralis may also be to blame for your patella not moving properly when your bend and straighten your knee.
Rolling the IT band has been suggested to provide an analgesic effect (painkilling effect) at your knee.
Why do I get pain at either my hip, or knee? Isn’t this the IT band?
We often times run into problems with our IT band when there is an increased amount of friction between the IT band and some of the other structures around it. These structures include muscles, boney prominences (parts of your bone that stick out as part of the normal structure of the bone), and bursa (fluid filled sacks that sit in between muscles and other soft tissues and help to decrease friction between those things). Making large increases in the mileage that you run, or poor running mechanics, or both can increase the amount of friction between your IT band and the surrounding structures.
So, say that you went out at ran 20 miles without having really run before. The increased friction between your IT band and the muscles surrounding it would create adhesions between the IT band and the muscles surrounding the IT band. These adhesions can bother either your hip or your knee, or both.
Or if you were to run with really weak hip and ankle muscles you would get a lot of extra movement at your hips. This extra movement would increase friction, and lead to adhesions at your IT band and the muscles that surround your IT band. As stated before these adhesions can lead to pain at either your hip or knee.
The takeaway
Stop bashing your IT band for being tight. It is only doing its job. Stretching, rolling and strengthening the muscles around your IT band can help to decrease issues that were once attributed to problems with the IT band. Exercises to help improve your balance and the strength of the muscles around your hips can also help to keep the pain from returning.