At the beginning, everything goes smooth and well in running, but as soon as you increase the mileage, problems begin to emerge. The Iliotibial band syndrome, also known as “windscreen wiper effect”, the famous pain on the outside of the knee well known by running enthusiasts.
There are certain things that as a community of runners, we all often do, despite recent research providing a growing body of evidence that in fact we might be better to have a slight re-think. Static stretching before exercise is the classic example quoted when talking about modern research going against long standing practices.
In this post though, I’d like to focus on another common practice – Foam Rolling the Iliotibial Band (ITB).
For some time, a popular method of treating and managing the pain of ITB Syndrome has been to engage in the often painful practice of foam rolling. The supposed rationale being that this will “stretch the ITB” and break down “adhesions” within the implicated soft tissues. The belief being that this will release, lengthen, and reduce tension in the ITB.
Firstly, let’s talk about the anatomy of the ITB and structures involved in the pain associated with ITB Syndrome.
Iliotibial Band Anatomy
The iliotibial tract is a condensation of muscle and tendon into a structure called the ITB. It extends from the outside of the pelvis (“Ilio”) above the hip bone and runs along the outside of the thigh, over the prominence of the hip and knee and ends just below the knee joint (“Tibial”).
The ITB is a long, thick band of non-contractile tissue, and is essentially a thickening in the lateral line fascial system. Tests have shown that the ITB has an incredibly high tensile strength (not dissimilar to that of steel cable), so stretching it is pretty much out of the question! However, one of the upper attachments of the ITB is a muscle called Tensor Fascia Latae (TFL).This relatively small muscle of the lateral Hip plays a huge role in determining the tension of the ITB – if it gets tight, the ITB gets tight as a direct result.
Just above the points where the ITB attaches close to the outside of the knee, it passes over the Lateral Femoral Condyle, the bony prominence on the outside of the knee. Previously, it was thought to be the repeated friction of an overly taught ITB crossing this bony prominence that caused the inflammatory pathology and localized pain of ITB Syndrome.
Recent research however suggests that this pathology and pain may actually be due to repeated compression of either the small bursa or fat pad, that sits protectively between the ITB and Lateral Femoral Condyle. This compression coming directly from increased tension of the ITB itself.
Foam Rolling Your ITB
So, with the above facts in mind, given that the pathology and pain may well be more linked to compression rather than friction, what good could come from the compressive action of foam rolling the ITB local to the painful or tight area?
Instead, a more appropriate use of the foam roller, or self-massage device would be to focus on trigger pointing TFL and muscles around the hip, to help remove tension from these muscles which create tension in the ITB directly.
For advocates of foam rolling the ITB directly: Yes, it is possible that short-term relief from ITB related knee could theoretically be experienced in some individuals, as a neurological response to the “different kind of pain” inflicted by the roller. However, is it not better to address the causes of the problem in the first place?
Read also: Best Foam Rollers in UK
Of course, in a long term treatment plan, further investigation is required to identify the reasons for increased tone in TFL and other muscles affecting the ITB.