Let’s start with the Iliotibial Band (ITB)
The iliotibial band is an extremely thick, fibrous band of connective tissue that runs the length of the lateral leg from the iliac crest to the tibia. Specifically, the IT band is a thickening of the tensor fascia latae (TFL), a muscle that attaches to the front of the iliac crest. Other than to hold the parts of the leg together, the function of the IT band is to stabilize the knee and assist in locomotion (Cruells Vieira).
Iliotibial Band Syndrome (ITBS) is thought to be an overuse condition caused by the ITB rubbing in an front to back direction across the lateral epicondyle of the femur during movement, such as running and cycling (Fairclough). There are challenges to this school of thought. One being that the pain is caused by inflammation of a bursa between the ITB and the lateral condyle of the femur. Other studies show that there is no such front to back movement of the ITB, as it is firmly attached to the distal femur. One study concludes movement is instead a side to side direction that compresses the iliotibial band against richly innervated fat and the epicondyle during knee flexion (Fairclough). It is also proposed that irritation of a bursa and compression by the iliotibial band are different subtypes of Iliotibial Band Friction Syndrome (Lavine).
But I Have Runner’s Knee!
Where is that pain coming from? If it’s on the front of the knee, then the issue is more likely Patellofemoral Pain Syndrome. Both syndromes are covered under the umbrella of runner’s knee.
Someone with Iliotibial Band Syndrome will complain of pain on the lateral side of the knee, that’s the side that faces out and away from the body. That spot will also be tender if you poke it. The pain will increase with activity, especially when walking or running downhill. While it is typically an issue with runners and cyclists, avid hikers and long-distance walkers are susceptible as well. Think any activity that takes place on a sloped surface.
You’re probably dying to tell me that it’s because of a tight IT band. Au contraire mon frère! Studies counter that and find no proof that the two are linked (Willet, Hamill, Falvey). More likely tension of the gluteus maximus and tensor fascia latae play a role.
Another point of confusion is the hip. If you are having hip pain, then do a little reading about Greater Trochanter Pain Syndrome. Yes, there is a syndrome for that. Hip pain does not present with Iliotibial Band Syndrome.
Step Away from the Foam Roller…
Unless you just like to feel pain. The iliotibial band is a massive piece of connective tissue that is firmly connected to your femur. You can’t just roll it out in the hopes of lengthening it like you would pizza dough and you cannot beat it into submission. When put to the test, any change in ITB length has been found to be negligible (Falvey). There may, however, be a neurological response to foam rolling, which is why it might feel beneficial.
The accepted form of treatment is addressing the acute inflammatory response followed by corrective treatment. A physical therapist can help you with that. Some therapists might suggest stretching the ITB; however, if scientists couldn’t lengthen it, it’s questionable to think that holding a stretch for a few seconds each day is going to make much of a difference. Instead, focus on stretching the tensor fasica latae. Massage steps up by helping to reduce any tension and stiffness in the gluteus maximus and TFL (Lavine).
Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: Implications for understanding iliotibial band syndrome. J Anat. 2006;208(3):309-316.
Falvey EC, Clark RA, Franklyn-Miller A, Bryant AL, Briggs C, McCrory PR. Iliotibial band syndrome: an examination of the evidence behind a number of treatment options. Scand J Med Sci Sports. 2010 Aug;20(4):580–7.
Hamill J, Miller R, Noehren B, Davis I. A prospective study of iliotibial band strain in runners. Clin Biomech (Bristol, Avon) 2008: 23: 1018–1025.
Lavine, R. Iliotibial band friction syndrome. Curr Rev Musculoskelet Med. 2010 Oct; 3(1-4): 18–22.
Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007 Mar;23(3):269-74.
Willett GM, Keim SA, Shostrom VK, Lomneth CS. An Anatomic Investigation of the Ober Test. Am J Sports Med. 2016 Mar;44(3):696–701.