Can we please stop telling people to roll their iliotibial band/tract (ITB’s)? Can we please stop telling people that the ITB needs to be “lengthened” and the way to do this is by rubbing the shit out of vastus lateralis? If your “fix” for ITB pain has been limited to attempting to release tension from the ITB, please read on.
A patient came to see me recently for some soft tissue work on her forearm and elbow after a hand injury. When asking about her previous experience with Health Care Professionals she told me she saw one for her unresolved “ITB Syndrome”. After being treated for 2 months at 3 days per week she discontinued care without improvement. The treatments consisted of cross friction to the ITB and vastus lateralis ONLY and were “too painful” to continue.
In addition to her chronic ITB, she also had “very tight hips”. She decided there was nothing that could be done for her ITB as it just would not release. Little did she know that if we removed her ITB and tied it between 2 trucks driving in opposite directions, there would still be little change in the length of her ITB.
I decided to take a peek at the hips after treating her initial complaint. My NKT® assessment found bilateral iliacus muscles compensating for ALL 3 glutes (max, med, min)! The body is very wise as it likes to use the path of least resistance to conserve energy. A basic survival strategy if you will. Sometimes this human body brilliance comes at a cost though. For this patient it was like her nervous system had forgotten about the her glutes! As you can see below the ITB has a very intimate connection with the gluteal muscles. If the body is not accessing the gluteal muscles it makes perfect sense that iliacus and ITB would compress the hip joint leading to repetitive strain and pain.
After a bit of release to the iliacus and activation of her gluteal muscles she was able to attain hip range of motion that she had not experienced in years (esp combined flexion and abduction). For those who like orthopedic tests, we went from a positive FABER to a negative. There was no need to treat to ITB in this scenario.
In my experience, the ITB neurologically tightens to protect a hip that does not feel stable. The ITB does not just “tighten” and need to be “lengthened”. This assumption is based on a very poor and outdated understanding of the human body. If the ITB is the hardest working structure in the hip, why are we penalizing it? This would be analogous to punishing the employee who works overtime while other employees slack off. Doesn’t make sense, does it? Speaking of not making sense…
LESSON for PRACTITIONERS – Find the weak link in ITB pain. NKT® is excellent for this.
LESSON for PATIENTS – If your therapist is only addressing the ITB and not correcting the underlying movement dysfunction, consider seeking a second opinion. I would be happy to refer you to a practitioner in your area who will aim to address this.