Iliotibial Band Syndrome (ITBS) is a commonly occurring overuse injury that creates pain on the outside of your knee. ITBS occurs after repetitive motion of the knee. Runners, cyclists, and military recruits most commonly suffer from this condition but it can be experienced by any athlete.
Foam rolling has been a technique used by manual therapists in an attempt to treat ITBS. The purpose being to break up small myofascial adhesions in an attempt to lengthen the IT Band and take pressure off the outside of the knee. Diving deeper into the relevant anatomy and the research performed on ITBS shows we can show that their is no possible way to lengthen IT Band.
- IT Band Attachment: The IT Band is firmly attached to your femur (long leg bone) by an intermuscular septum (see picture). Some have suggested that the ITB’s sturdy attachment to the linea aspera of the femur essentially creates an I-beam which leaves very little room for the connective tissues to lengthen.
- IT Band Make Up: The IT Band itself is made up of dense fibro-cartilage. This isn't the elastic tissues that make up our muscles and tendons. Stretching the IT Band ( a dense, fibrous, cartilage) is like trying to stretch a steel cable. It's not possible.
- Research: A recent study by Falvey demonstrated that the IT band itself does not lengthen in common stretches such as Ober and Straight Leg Raise. They concluded that a treatment plan focused on stretching the IT band is based on an incorrect understanding of the relevant anatomy and pathology of the ITB/TFL complex.
This calls into questions whether foam rolling is a necessary treatment for ITBS. It usually hurts like hell, is it worth it? If we aren't actually lengthening the IT Band might we look elsewhere for more effective treatments? While foam rolling may temporarily decrease pain through a 'pain gate' model, to create sustainable, long term results for the treatment of ITBS we must look elsewhere.