Is The ITB Really An Injury Villain?

Why ITB Stretches are not worth your time - Scott Rolph

The Iliotibial Band (ITB) is a structure cursed by athletes and other sufferers alike.  When injury arises a sufferer can be left with a great deal of pain and dysfunction.  Now there are many ways to manage and treat conditions affecting the ITB including stretching however a lot of these methods are out-dated and are not worth your time.  This article is a brief explanation of what the ITB is and its function allowing you to better understand how to effectively treat issues when they arise. The body has layers of fibrous connective tissue surrounding muscles called fascia- think tough “glad wrap.” The ITB is a longitudinal thickening of the fascia along the lateral thigh rather than a stand alone structure.  It runs from the crest of the hip and inserts into the tibia just below the knee, with insertions from gluteal and hip flexor muscles around the hip.  Based on its structure the ITB helps to stabilise the knee in different ranges of movement. Fascia is not a contractile tissue like muscle and therefore cannot become tight but rather it becomes overloaded- a misconception that allows the thought process of stretching being possibly  effective. Problems involving the ITB usually involve overloading and this can be caused by:
  • Abnormal gait mechanics eg. foot pronation, unequal leg length, bowed legs
  • Poor technique
  • Inappropriate footwear
  • Running on slopped surfaces
  • Changes to workload (particulary dramatic increases)
  • Poor core and hip stability (remembering the ITB has insertions from the gluteal muscles and a hip flexor).
Now traditional treatment seems to focus on the ITB itself and stretches.  Obviously though it is important to assess the feet, knees, hips and core strength as well as training, technique and lifestyle to ascertain why the problem has arisen.  A study by Falvey et al. in 2010 found that there is no scientific or anatomical reason to show that a stretch is effective, allowing an increase of less than half a precent or 2mm gained!! Simply put stretches are mechanically ineffective, the ITB is too tough and frankly there are more effective forms of treatment.  In fact it would be a better idea to stop the ITB become tight in the first place. As described above ITB issues require a thorough assessment.  Assessment will look at the total picture of alignment, workload and other predisposing factors. Treatment should focus on loosening hip flexor and gluteal musculature, adjusting workload and addressing biomechanical abnormalities commonly foot pronation with orthotics, weak core and hips with strength exercise and technique work.  Soft tissue work and the use of a foam roller can be used to help return an ITB back to its normal state. So before you rush off and blame your ITB for your troubles remember that the cause of your troubles is most likely something else- your ITB “tightness” is more a symptom of your other problems so see a physiotherapist and get it sorted!!  
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