In this post we look at what causes ITB syndrome in runners and why foam rolling probably won’t work.
The medical definition of a syndrome is a set of signs and symptoms that are correlated with each other. These are often related to a disease or a disorder.
Defining IT band issues as a syndrome not only makes it sound more serious than it is, what disease or disorder could it possibly be related to?
The confusion doesn’t end there.
In the top two Google hits on the issue I have read the IT band being described as both a ligament and a muscle. It’s neither.
In fact it’s not even a discrete structure, but an integral part of the fascia of the leg as you can see in the image below.
A recent cadaveric study showed in all cases it was attached to the femur at the linea aspera. From the greater trochanter to and including the lateral femoral condyle. In other words the whole of the thigh bone.
Common rehab approaches to ITB syndrome
The main focus of your rehab thus far will have included strategies that attempt to lengthen the IT band including stretching and foam rolling.
It’s thought that tightness in the IT band leads to friction at it’s attachment on the lower leg, as the band irritates a bursa that sits between it and the lateral femoral condyle.
If something is attached to the length of a bone the size of your femur do you think you can stretch it? Unlikely.
No doubt you’ve also been told to foam roll your IT band in an attempt to lengthen it. This is a largely fruitless activity and akin to foam rolling your car door to make it shut better.
Studies have shown the ITB to have similar tensile properties to soft steel. It won’t get longer and if it did you’d have more to worry about than a sore knee. It’s strong for a reason.
Interestingly in the previous cadaveric study the authors failed to find a bursa between the lateral femoral condyle and the ITB on a single cadaver.
So you can’t lengthen it and the thing that it’s supposed to be rubbing on may not even exist.
What causes ITB syndrome then?
I recently read the issue described as either an overtraining problem or a biomechanical one. It’s both. The former causes the later.
When you exceed a muscle’s tolerance of force, your nervous system will respond by preventing that muscle from contracting. This leads to compensation as other muscles must now work harder to take up the slack.
When you have a number of muscles inhibited in this way, you will move differently as your CNS attempts to work around these weaknesses. Thus an overtraining issue becomes a biomechanical one.
The pain you feel at your ITB attachment is a direct result of this effect. At some point you will have increased your training load beyond the capacity of certain muscles. You are now running slightly differently as a result, placing stress on your IT band.
Your pain is merely a symptom of a larger issue. Focusing your attention on the symptom and not the cause is rather like taking paracetamol for a headache and continuing to drink beer. In the long term it won’t work.
The long term solution to ITB syndrome
There is some research to suggest that working on weakness in your hip abductors, (the muscles that reside on the side of your pelvis) will help.
Anecdotally I usually find these muscles to be weak in the clients I see for IT band issues. These and others.
In the last 3 months I’ve helped people suffering from pain at the ITB attachment by working on weakness in their feet and ankles, abductors, adductors and trunk. It’s never a one muscle solution for a long term fix.
If you’ve foam rolled your IT band to destruction and been doing glute exercises for what seems like an eternity, but still can’t run without pain, don’t worry you’re not alone.
Book a call to find out what else might be going on.