This blog looks at whether foam rolling the IT Band is your best option, and just what that pain on the outside of your knee may be
Some of you may already be questioning the title as you know rolling your Iliotibial – IT band works for you.
From the start let me say, this isn’t a strict instruction, if you feel it works for you keep doing it, any beneficial treatment that you undertake in an effort to keep you running should be continued.
The Iliotibial Band is a connective tissue that runs down the side of the upper leg. It originates from the Ilium (hip bone) and connects to the Gluteus Maximus and Tensor Fascia Latae (see pic to left), travels all the way down the upper leg laying on top of the vastus lateralis muscle (part of the quads) to an insertion point over, on and below the knee on the tibia.
One of the IT Band’s main jobs in running is to stabilise the knee while it is load-bearing, helping to prevent it from collapsing inwards or outwards (sideways). Every now and again the IT Band can flare up at the point where it moves across the lateral femoral epicondyle (the classic rounded bone shape at the bottom of the thigh bone on the outer side) causing a burning sensation on the outside of the knee, a condition known as Iliotibial Band Syndrome. There’s still a bit of disagreement as to what causes the pain, whether it is the friction that aggravates the tendon tissue or whether it is simply pressure on the nerve endings where the IT band is pressed against the bone. Either way it stems from tension.
Many runners are told (often by other runners not medical specialists or therapists) that the IT Band should be stretched to alleviate the symptoms. The reality though is that clinical testing has shown that the IT band can’t be stretched but instead treatment should focus on lengthening and relaxing the Tensor Fascia Latae and Gluteus Maximus. They are the muscles that generate tension in the IT band. The TFL helps to pull the knee upwards while running but because it is involved in multiple contractions throughout a run it can get tight, the same is true of the Gluteus Maximus when the hip is extending the leg behind the body each step (muscles can create tension in themselves when they are repeatedly contracted).
To alleviate tension in the IT Band you can take a two-pronged approach consisting of foam rolling and stretching the Glute Max and TFL.
Although it is difficult to see in the picture, Matt is sitting on top of a foam roller. He started by sitting flat on top of his sit bones and then transferred weight onto his right side. The leg on the same side as the muscle being rolled is placed on top of the supporting leg. You then simply roll off the front of the roller feeling for points of tension, when you find one, hold still on top of it for at least thirty seconds. The intensity and precision of the roll can be increased by using a ball instead of a roller. The ball can range from a firm tennis ball all the way up to a hockey ball in hardness, the harder it is the more intense the response from the muscle.
The glute stretch is nice and simple. Lay on your back, pick a leg and using your arms simply hug your knee in towards your chest on the opposite side. Try not to rotate your back, keep your hips close to the ground. Hold the stretch for at least thirty seconds. You can repeat the stretch up to three times on each side if you wish.
The above exercises will help to alleviate tension in the IT band but they won’t necessarily solve the problem long-term. Time and time again leg problems stem from hip muscles that either aren’t firing or are weak. Specifically the Gluteus Medius and Gluteus Maximus muscles aren’t providing the stability and strength to the hip and legs that they should be. If you’d like some exercises that can get these muscles switched on and stronger click here and here.
Rolling the IT Band itself is still a matter of conjecture, there is still lots of research going on to try to find whether it is beneficial, The case for rolling the IT Band argues that the IT Band can get ‘tangled’ up with the myofascia that lays on top of the vastus lateralis (large muscle on the outside of the upper leg). Some rehab professionals believe that foam rolling the IT Band can separate the two surfaces allowing them to work more independently (but most rehab professionals agree that a sports and remedial massage therapist will be able to do this much more effectively).
The TFL Foam roll takes a bit of setting up, you have to lay on top of a foam roller with the roller pushing into the gap between your hip bone and the bone that sticks out of the top of the side of your leg (Greater Trochanter). Your whole body should be at a forty five degree angle (the roller on the floor being zero degrees) as the TFL doesn’t run down the front of the body. Use small movements to locate any tension points and maintain pressure for at least thirty seconds before changing side.
The TFL can be stretched by taking a one legged kneeling position, you then open up the side (that has it’s knee on the ground) to about forty five degrees, raise the same side’s arm above your head and gently lean sideways and back. You should feel the stretch down the side into your hip. Hold the stretch for a minimum of thirty seconds on the point where you feel tension (it may change as you stretch).
As with any injury, your first port of call should always be your GP, who should refer you onto a chartered physiotherapist. If you choose not to visit your GP then you can try the above exercises, if you’ve self diagnosed correctly they should have the desired results but be patient, it can take up to twelve weeks (or more) of complete rest of the injured and therapy to get pain free. If you would like someone to assess your knee so you know for sure, and you are local to us then pop in to see our Sports Therapist in either Cambridge or Peterborough and they can provide some treatment and point you in the right direction.
Enjoy your running