Iliotibial band syndrome (ITBS) is the most common injury of the outside of the knee in runners and it is also the major cause of lateral knee pain in bike riders. In the good old days, the way we treated it was to jump on a foam roller and inflict as much pain as possible to ourselves as we tried to “stretch” the ITB and roll out the ‘adhesions’ in the tissue. The thing is that as you self-inflicted some major pain with the roller; your knee pain often didn’t get any better.
Here are some common questions about the ITB
Can you stretch your ITB?
The simple answer is no! The ITB is an incredibly dense fibrous band of tissue and has a firm attachment to the entire length of the femur which means any potential lengthening is physiologically impossible. Research has shown that in fact it can only change length by about 2mm or less than 0.2% of it's overall length. No amount of stretching will change it's length.
Should I roll my ITB?
Probably not. The last thing we want to do to a tissue that is painful because of a compression issue is to compress it further by rolling on it with our body weight.
Early research into ITBS suggested that it was a frictional condition that caused inflammation where the ITB attaches to the lateral femoral condyle (think outside bone of the knee) but recently this theory has been challenged with suggestion that ITBS is more likely caused by excessive compression of the layer of fat between the ITB and the bone.
So if the ITB can't stretch and hates compression, best to avoid the foam roller
What about taking anti-inflammatories?
As we said - new research challenges whether inflammation of the ITB is actually occurring when it's sore. So anti-inflammatories are probably not going to be the answer.
What about using a foam roller on other muscles?
There is good evidence that foam rolling
1. Helps mobility by improving the range of motion of the joints
2. Makes us feel good by reducing fatigue after exercise
3. But it probably doesn't increase power or strength of muscles.
What should I do then if my ITB is sore?
Best bet is to focus your attention on the muscles at your hip - Gluteus Maximus and the Tensor Fascia Lata (TFL) which may be the cause of your pain. The TFL inserts directly into the ITB with the ITB behaving as an elongated tendon of the TFL. Also, a substantial portion of the Gluteus Maximus inserts onto the ITB too. Addressing any tightness or weakness in these muscles could have more of an effect on your knee pain than anything else. Soft tissue therapy, massage or dry needling the myofascial trigger points of these two muscles are good options. Seek out your allied health professional to expertly diagnose and treat the issue and save yourself the pain of the roll.