the IT band

IT'S ALL IN A NAME...

To understand the iliotibial (IT) band you will need to understand its name as well as the names of all the bones and muscles it touches. The fact that this anatomic structure is referred to as a "band" (or the IT tract) tell us something about it in and of itself. This helps differentiate the IT band from other tendons or ligaments in the body. While the band does attach muscle to bone like other tendons, it also attaches bone to bone like a tendon, making it a type of hybrid connective tissue that functions both as a ligament to stabilize the lateral knee as well as a tendon to extend, abduct, and laterally rotate the hip.

IT stands for ilio-tibial referring to its origin on the iliac crest of the pelvic bone, ilium, and the insertion down at the lateral condyle of the tibia (which has it's own cool name Gerdy's tubercle). If you're standing up, you can place your thumb on your pelvic rim (iliac crest) on your side with your finger down at your "hip bone" which is your proximal femur (called the greater trochanter). Draw a line straight down your lateral (outside) thigh to just a few centimeters below your knee and you will have tracked the path of the IT tract from the pelvis to Gerdy's tubercle.

By going beyond the knee on the lateral side, IT helps stabilize the knee along with the more famous LCL (lateral collateral ligament) of the knee. If you cross your left leg by placing your left ankle on your right knee you can feel your pencil-thin LCL on the outside of your left knee (it will literally feel like a pencil because this position stretches the ligament tight). Similarly, your IT tract keeps your knee from moving side-to-side (technically called varus stress). Thusly, the IT band acts like a ligament and is often blamed for lateral knee pain, called IT band syndrome.

Two muscles use this band of connective tissue  to move the hip much like a tendon. These are the mighty gluteus maximus and, the much less known, tensor fasciae latae (pronounced like an order at Starbucks). As you know, the glute max primarily extends the hip pulling the femur in extension from the its origin on the pelvis, but this glute muscle also inserts on the IT band. With this attachment that goes down to the lateral knee the gluteus maximus can also abduct and externally rotate the hip when it contracts.

The tensor fasciae latae or TFL is much smaller but its function can be a bit harder to understand than its mate the glute max. The TFL is a stabilizing muscle rather than a prime mover like the glutes. By tensing up, the tensor fasciae helps stabilize the hip joint when the contralateral leg is off the ground during walking or running. The TFL and IT push the hip deeper into its socket when contracted and prevents the pelvis from dipping down towards the unsupported side. The TFL can also assist the gluteus maximus in extension and abduction. 

As with everything I continue learn about the musculoskeletal system, things like the IT band and its cohort of muscles are more complex and interesting than first glance. If anyone offers you that incredible "quick fix for IT band pain" think twice about the solution when you consider the form and function of this complex piece of connective tissue. Take the now trendy foam rolling...

Now that we know where the IT band lives, shouldn't we foam roll the whole thing, from top to bottom??? In a word, NO!!!! Please don't do this. If you're not afflicted with IT band syndrome, you're likely to be after you smash all the connective tissue between the bones and your roller. 

The most common site for IT band syndrome pain is at the lateral knee. Here the band attaches to the tibia but has to pass over the lateral femoral condyle. Each time a runner goes through a stride the IT has to pass over the distal femur. If inflamed this type of friction will be painful, and stubborn runners often know pain won't improve with continued running. Stretching will help right? And what better way to do this than those cool foam rollers? Yes, but you need to use it correctly. There is little cushion between the distal IT band and the lateral femoral condyle. Placing something hard right on the area of inflammation and pain with your whole body weight is not likely going to decrease the tension and friction. Instead, you can roll the IT band over the thigh musculature but NOT down where it passes directly over the bone. The same can be said about the proximal IT band where it passes directly over your "boney hip" known as your greater trochanter. In the picture above this smiling model is more likely gritting her teeth as she places almost all her weight down on her lateral femur pinching the upper IT band between a bone and a hard roller. Ouch! Don't believe me? Ask Chris Wood in his awesome post...

Why your IT band is not actually the problem!

Don't do this, thinking you're stretching the IT band. You're just leaning.

IF YOU REALLY WANT TO STRETCH THE IT BAND...

Now that you know the anatomy, location, and function of the IT tract you could probably figure out how to stretch it although there are still as many misconceptions about stretching as there is about strengthening. The thing with tendons (and ligaments) is that they don't stretch!!! There is a little give the connective tissue of tendons and ligaments but they are certainly not designed to be stretchy. Otherwise, when your muscles contract the tendon would be stretching before ever pulling on the joint/bone. It would be like trying to lift a weight with a rubber band. 

Therefore, if the IT band is like a big tendon/ligament, it is not meant to stretch!! If you want flexibility in the area of the IT band you need to work the MUSCLES!!

And what are these muscles?? Well, the TFL and the gluteus maximus, of course. To stretch these muscles, not the tract, try some of these below. 

The fix...

Turns out the solution to anything blamed as "IT band syndrome" is likely near its origin at the hip and will have to do with one of its main actions, hip abduction. Everyone trains hip flexion and extension at the gym, and every runner goes through hip flex/extenions a few thousand times each run. Even the most avid gym rats however rarely ever do hip abduction exercises. The only people who get on abduction machines are moms falsely assuming that feeling "the burn" of muscles contracting in the lateral hips mean they are "burning fat" in that area so their hips will magically be "thinner." 

Please, the exercises that make you look silly in at the gym like the clam shell and fire hydrant are actually the ones needed to prevent long term pain. Not the glamour exercises for the mirror muscles most people are doing, but ones you need to know to keep your hips and IT band healthy.