One current craze in the health and fitness world is the use of a foam roller. Foam rollers are proven to hydrate tissue and improve flexibility without any detriment to power or skill. Most fitness enthusiasts know what a foam roller is and often use it during movement prep and muscle activation exercises. Some know the benefits of using one, however not many know that smashing your lio-tibial band (ITB) until your grimacing is actually a pointless task.
Over the past couple of years, many clients and friends have asked about foam rolling the ITB. My response usually involves asking them what they want to achieve by foam rolling which usually sounds something like “Pete at the office said it will loosen my ITB and stop my knee hurting”. Now, I have no problem with Pete and his suggestion, in fact it’s a great idea to help hydrate your myofascial tissue; but it won’t fix your knee and it won’t ‘loosen’ your ITB.
In the game of chinese-whispers, foam rolling your ITB is probably the one which has gained most momentum over recent times. A gentle application of slow pressure onto quads, hamstrings and the ITB is recommended prior to and after exercises. For me and my clients, this gentle application is enough – there is no need to buy ‘The Beast’ foam roller (infact anything which claims to ‘deactivate trigger points’ should be questioned) I wouldn’t want to jab that into my quad to be honest. It’s going to be painful! From a sellers perspective, foam rollers are great. Cheap to make and easy to sell; hence the evolution of foam rolling becoming a do or die activity. It’s not long before hardware tools become marketed as ITB fixers!
Lets take three common pathologies that diagnose the ITB as the perpetrator:
Runners knee, ITB friction syndrome and lateral clicking hip syndrome
For these injuries, there’s a common treatment protocol in place from physical therapists – most will prescribe some soft tissue release work through the ITB, some heat and stretches and a little bit of a reduction in activity to allow for recovery. Then we see how we feel in 7-14 days. Most people will then have some great symptomatic relief and will be able to head out for a run again. However it is merely a band-aid solution treating only one part of the chain. The cause of your pain will be either above or below your ITB, lets discuss why:
The ITB is a fascial bridge connecting the hip and the knee, distributing stresses and movements. Establishing the anatomical connections that the ITB has is encouraged to assist in diagnosis, but often overlooked. The ITB is part of the tractus ilius tibias (TIT) which is a fascial band running from the top of the hip, laterally around the knee, and into the plantar fascia of the foot.
Deltoid of Farabeuf
A generic textbook definition of the ITB will describe the proximal attachment to the TFL and it’s distal insertion below the knee into fibula head. A functional description, allowing us to understand movement of the lower limb will mention the deltoid of farabeuf. If we look fascially at the ITB, the structure completely changes. DoF expands the current anatomical definition with more insertions and a greater influence upon gluteal muscles. The DoF suggests superficial fibres of the gluteus maximus and medius attach into the TFL and consequently into the proximal portion of the ITB. Now we can see that the function of the two gluteal muscles have a large influence on our ITB’s position and mechanical stress. This direct effect on ITB function is vital in rehabilitation and conditioning.
Below the ITB
Movement of the foot can affect the insertion of the ITB into the fibular head. Why? Well any movement from the distal end of the fibula creates movement at the proximal head (where the ITB inserts). Plantar and dorsi flexion of the ankle joint creates movement at the distal end of the fibula. Imagine we have limited dorsi flexion of the ankle joint (a very common problem) resulting in the distal head of the fibula ‘stuck’ posteriorly. Up the chain, our proximal distal head is pulled posteriorly placing the ITB in traction. All of our hard work foam rolling the painful ITB is not increasing the range of movement at our ‘stuck’ ankle joint.
Start your assessment and movement patterns above and below the ITB. Analysing your TIT (from your plantar fascia and tracking this up to the iliac crest of the glute medius) is essential. The ITB is only a symptomatic problem in the TIT. Look above and below the ITB, it’s a mechanical transfer device producing symptomatic pain.
“Brain of the upper lower limb”
A quick point to make is the structural difference of the ITB doesn’t make it a black sheep! It’s fascial, collagenous make-up helps position the rest of the quadriceps and hamstrings ensuring muscular balances are maintained. We also have 6 ‘quad’riceps but we’ll discuss that later on.
Remember, like many other muscles in the body it has a lot more attachments than we give it credit for!
1) Look above and below the ITB when presenting with pain on the lateral leg
2) Ensure a good range of dorsi-flexion at the ankle
3) Poor gluteal function can lead to symptomatic ITB pain.