Prior to a training session, every once in a while a corporate clients will say “man my IT bands are so tight, what’s wrong with it.” Nothing is wrong with the IT band–it is not short, it is not tight, and it is not the bane of your existence. In fact, based on your movement patterns, your IT band is doing what you have taught it to do.
What is the IT band?
The iliotibial (IT) band is a thickening of the lateral aspect of fascia on the thigh known as the fascia lata (aka latae). We are not born with a thick lateral fascia; it thickens over time based on our movement. Anatomically, the fascia lata encapsulate the entire upper leg and extends down to the lower leg. The fascia attaches to the hip and traces down and wraps around the femur over all the musculature (quadriceps, hamstrings, and adductors) eventually blending into the lower leg and attaching to the tibia and fibula. At the proximal end and anteriorly, the tensor fascia lata (TFL) attaches to the iliac crest and blends into the fascia lata near the greater trochanter. Similarly, on the proximal end but posteriorly,
gluteus maximus attaches to the iliac crest, sacrum, and other areas before it travels down at an angle with some fibers attaching to the femur and others continuing around to also blend into the fascia lata.
During normal human development, the TFL and the gluteus maximus contract to help stabilize the pelvis over the femur during crawling, walking, and eventually. As these muscles contract, they generate force through the fascia lata, especially when walking and running. As the body weight comes slamming down on one foot, the muscles of the hips must contract forcefully to stabilize the pelvis. Early in the 19th century, orthopedic surgeon, Henry Davis, proposed that when soft tissue was placed under even a moderate load, it would begin to remodel. Fitness professionals are taught how Davis’s Law applies to the healing of tissue as it will heal along the lines of mechanical stress (Clark, Lucett, & Sutton, 2018; DeCarlo, DeRosa, & Ellenbecker, 2009). However, one of the most published and cited authors on the subject of skeletal biology, Harold Frost, MD, expanded on Davis’s Law to note not only does soft tissue remold after injury, but it also displays a thickening effect when sufficiently stressed, much like bone remodels after being deformed by loading (Frost, 1972). Therefore, over the course of many months and years, humans emerge with this thickened lateral fascia lata, which extends from the ilium to the tibia that we call the IT band. It is important to recognize that the IT band lies directly over the vastus lateralis, and in most cases, the IT band can identify the center of the lateral quadriceps muscle.
Your movement patterns are the problem!
IT tissue only develops into a noticeable thickness because we are a bipedal species. An injury requiring surgery, a sustained trauma, and our daily movement patterns over time determine IT band health. In the case of my corporate clients, if they moves more, sits rarely and uses their body by working, lifting, and doing other things comparable to light to moderate manual labor; then they would probably not be subjected to IT band syndrome. However, most of us are not able to do this enough to keep certain muscles (such as the glutes) strong and powerful enough to maintain neutral posture and proper joint alignment.
How does it become dysfunctional?
As a Titleist strength and conditioning coach and personal trainer my experience has shown me that one of the main causes of IT band problems is posture that leads to imbalances in the hip. The first sign at the hips may be an anteriorly rotated pelvis (i.e., anterior pelvic tilt or APT). APT is common in those that sit for many hours per day. When seated, the TFL will become stuck short. The TFL creates tension in the fascia lata, thus, if it is mechanically short (what many would call tight), when someone stands from that seated position it will tug at both the pelvis and the lateral aspect of the fascia lata (aka the IT band). Often just standing is not enough to cause pain, however, as soon as the person begins to walk, run, lunge, jump, or many other things common in a workout, the short TFL applies more and more tension to the IT band.
During APT, not only is the TFL short, but the glutes are lengthened. Lengthened muscles are often not able to produce the force necessary to hold up their end of the bargain regarding stabilization and posture compared to their short counterparts. The glutes are positioned to resist the TFL, thus balancing the pelvis and reduce the anterior tug on the IT band. In a perfect relationship, the TFL and glutes would work together to maintain a healthy position of the IT band. But when the TFL takes over, it increases tension in the IT band, which is often felt as tightness leading to friction between the IT band and some bony part of the femur. Ouch is the outcome.
A second, yet related dysfunction that may cause IT band discomfort is an overactive vastus lateralis. The IT band lies directly over the vastus lateralis. Since the vastus lateralis is the largest and most powerful of the quadriceps, it can become dominant over the glutes in many individuals. Given the fiber type and position of the muscle, it does not take long for it to begin to hypertrophy, pressing into the IT band from the inside. As the hypertrophy continues, the IT band will begin being pushed into a stretch. The result is, yet again, feelings of tightness and eventual friction between the IT band and some bony part of the femur. If this is how your client feels assume the vastus lateralis could also be an overactive muscle because something is helping the glutes move the body up and down and propel itself forward.
So how do you feel?
Feelings are not facts. Just because something feels tight does not mean that it is short and tight. In fact, it is more common for muscles that are long to feel this way (e.g., hamstrings, upper back, and neck). We must use movement as our guide to what is tight or not. Begin by performing the overhead squat assessment.
From the lateral view, if the TFL is short and overactive and the glutes are underactive, the pelvis will tilt forward as they squat. It is common for a client with IT band trouble to demonstrate foot flattening and knee valgus during the overhead squat as the TFL can produce internal femoral rotation while the vastus lateralis can contribute to knee valgus. Corrective exercises to consider:
BRIDGE
DEADLIFT
TFL ROLLING
TFL STATIC STRETCH
BIRD DOG INTEGRATED MOVEMENT
QUAD STRETCH
Parting Words
IT band syndrome/discomfort is a common condition that leaves a lot of clients in pain. In many cases, these are individuals are just becoming active and are looking to change their lives with the help of a fitness program. There is nothing more disheartening as suffering from any syndrome soon after beginning. The purpose of the IT band is to transmit force from the glutes and TFL down the lateral thigh to the lower leg, thus providing support. IT band syndrome is an overuse injury that is derived from poor movement patterns and excessive tension on a supportive structure. A corrective exercise program cannot be implemented until the IT band is assessed by a qualified physical therapist (PT), Orthopedist, or certified personal trainer (CPT) has performed an assessment.
References
Clark, M. A., Lucett, S. C., & Sutton, B. G. (Eds.). (2018). NASM essentials of personal fitness training (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Clark, M. A., Lucett, S. C., & Sutton, B. G. (Eds.). (2014). NASM’s essentials of corrective exercise training. Burlington, MA: Jones & Barlett Learning.
DeCarlo, M., DeRosa, C., & Ellenbecker, T. (2009). Effective functional progressions in sport rehabilitation. Champaign, IL: Human Kinetics Publishing.
Fairclough, J., Hayashi, K., Toumi, H., Lyons, K., Bydder, G., Phillips, N., … Benjamin, M. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: Implications for understanding iliotibial band syndrome. Journal of Anatomy, 208(3), 309-316. http://dx.doi.org/10.1111/j.1469-7580.2006.00531.x
Frost, H. M. (1972). The physiology of cartilaginous, fibrous, and bony tissue. Springfield, IL: C.C. Thomas.
Lavine, R. (2010). Iliotibial band friction syndrome. Current Review in Musculoskeletal Medicine, 3(1-4), 18-22. http://dx.doi.org/10.1007/s12178-010-9061-8