Iliotibial Band Stretch is an integral part of the treatment of the so-called ITB syndrome , as is the correction of any sacro-iliac fixations that frequently accompany this condition.
The Ilio-tibial band is really a broad tendon that runs down the side of the thigh from the Tensor Fascia Lata muscle, but it is also intimately connected to the Gluteus muscles.
The origin of the Ilio-Tibial band ( ITB ) is on the side of the large Iliac bone (actually what is called the crest) and ends on the side of the knee at what is called the lateral condyle of the tibia (lower leg).
Because it has fibres connecting to the capsule of the hip, it may also cause pain in the groin.
These pelvic muscles and the ITB have an important stabilising effect on the pelvis, especially when standing on one leg (as in kicking a soccer ball), but of course also in running, as the ITB is also a very important stabiliser of the knee.
Who gets ITB syndrome?
Anybody can suffer from ITB syndrome, but classically it is athletes who come forward for treatment as the Ilio-tibial band is so important in stabilising the hip and knee whilst running but it occurs in all ages.
Elderly women , particularly if they are slightly obese, are prone to bursitis of the Tensor Fascia Lata and Gluteus muscles in the area around the Lateral Femoral Trochanter. Iliotibial band stretch for this particular group is difficult as you will see at the end of this page. The condition is often aggravated to a too-hard mattress. A temporary solution is to take four pillows, lay them across the bed, and sleep on the pillows. If this definitely makes a difference, then a softer mattress is in order. Or a thin layer of foam placed over your usual mattress.
Cyclists too are particularly prone, particularly if they persist in riding with the feet toed in. The pain can be on the side of the hip, in the groin, mid thigh and frequently on the side of the knee. Clearly, there is overlap with other syndromes.
There is no substitute for a thorough history and a careful examination as there are so many potential causes of the ITB. They can be related to training habits, for example poor warm-up or cool-down procedures, or always running on a cantered road, particularly if there is an associated short leg on the low side of the road – running on the right shoulder of the road plus a short right leg. Correct function of the foot and ankle, the sacro-iliac joints and the hip can either be the main cause or contribute to the misery of this condition. Worn running shoes …
As stated earlier, weight gain places stress on the pelvis, thus it is not only obese women but also in pregnancy that pain in the ITB may occur, probably due to increasing instability in the pelvis. Iliotibial band stretch is vital part of the treatment in all groups.
Noble’s test is used to reproduce the pain in iliotibial band tendonitis. With the patient in a supine position, the physician places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion.
In the short term, sport should be curtailed or even stopped for a period. Often change to another activity will prevent you from going crazy. For example, take up swimming for a few weeks if you are a runner. Or even cycling, though this could contribute.
Icing over the tender nodules and iliotibial band stretch and the glutes and any other joints that may be involved – the sacro-iliac for example – is vital.
Treatment is usually required if the pain doesn’t respond to your home remedies with a few weeks. You are unable to correct the fixation in the ankle mortice or sacro-iliac joint for example. Guidance on stretches, leg length … whatever your chiropractor finds.
Strengthening of any weak muscles found, often the abductors is important.
Start training on short distances, for runners on level, soft ground rather than on roads, for example. Should runners find that the pain in the leg returns with running (or cycling), then one important simple test is to check the pulses in the lower leg, to rule out LEG PAIN due to intermittent claudication.
Likewise in the older person, iliotibial band stretch will be important, and weight loss should that be necessary. Between a rock and a hard place, the older person in pain cannot exercise, and puts on weight.
In pregnancy, the management of the pelvis is vital. A sacral, or iliac subluxation is usually the underlying problem. There are many gentle treatments now that chiropractors use in the management of pain in the elderly and the pregnant with leg pain.
Maignes syndrome, a high lumbar facet syndrome also refers pain to the lateral buttock and thigh, and sometimes the groin, it too should be considered in every case of ITB pain.
Because it is such a long tendon, stretching the ITB is particularly difficult. The best method of iliotibial band stretch can put undue stress on the pelvic joints, and should be done with care and discretion.
The following pictures will help. What I advise is to really stabilise your whole body with your arms and shoulders over a desk, so that the whole torso is fixed, giving support to the pelvis. It doesn’t help to stretch the ITB, should it aggravate the SI joints!