I’m sure that you’ve been told or heard of someone foam rolling their IT band to decrease tightness and help with knee pain. This recommendation has been around since foam rollers were invented. However, recent research has shown that foam rolling your IT band may not be needed at all.
In fact, it could be a waste of your time and be deemed an unnecessary self-torture session. You’ll no longer have to torture yourself for torture’s sake to try and get relief from foam rolling. I’ll demonstrate the latest research regarding foam rolling the IT band and who to do instead.
What is IT Band Syndrome?
Iliotibial Band Syndrome (ITBS) is one of the most common overuse injuries in the legs, affecting 7-14% of the running population 1,2. IT band syndrome was originally thought to be caused by friction of the IT band and the outside of the knee joint on what’s called the lateral femoral condyle. This was thought to happen when the knee would bend around thirty degrees and the more repetitions this happened the greater likelihood it would cause issues 3.
Therefore the more that you run, bike, or exercise it should cause friction of the IT band.
Where is the Pain Located with IT Band Syndrome
The pain is located primarily on the lateral thigh and knee a few inches above the joint line. It is usually focal and easy to find with an easily definable location. The pain can also present higher in the lateral thigh as well as having concurrent but related pain in the hip, low back, and lateral knee.
Does Friction Occur at the IT Band?
Studies done on human cadavers have shown that true friction may not occur and other mechanisms are responsible for the pain and discomfort. Due to the changing tension of the IT band during movement, it produces the illusion of friction but no true contact happens.
Instead, the IT band adds a supportive force to the knee during weight-bearing. The muscles of the hip tighten at the top of the IT band and this causes a tensile compression down the entire lateral thigh.
The pain experienced during IT band syndrome is the result of poor load transfer from the hip and thigh muscles through the IT band.
This can result in compression of the fat pad and nerves that lie underneath. Fat pads have a high concentration of nerve endings which makes them sensitive to compression forces. Friction is not the likely culprit.
What is Fascia?
Fascia is the body’s wrapping system that covers the muscles and compartments of the body. The goal of fascia is to aid in infection control of stability, separate compartments inside the body, and acts as a framework for vasculature to travel in.
What is the IT Band
The IT band is thickening in the part of the fascia on the outside of the leg. It runs from the top of the hip and attaches down to the lower leg. It’s an important attachment to hip muscles including the Tensor Fascia Lata and the Gluteus Maximus. Its primary role is to support the leg with lateral stability. This lateral stability does play an important role in support of the spine and pelvis as well as the knee during movement
The important thing to note about fascia, and the IT band, is that fascia is not contractile. Meaning it can’t shorten or change its length like a muscle can. This helps with understanding why foam rolling can’t decrease tightness in the IT band.
What is Foam Rolling and How Does it Work?
A foam roller is a large cylinder of dense foam that helps with self-myofascial release. The theory is that when you roll your muscles over the cylinder the muscles are lengthened and stretched which leads to decreased tightness in the muscles and tendons.
However, as research has progressed, we’ve found foam rollers do not stretch muscles. Instead, they compress the tissue as the roller passes over the treatment area. The time of compression (less than a second most of the time) and the amount of tissue distortion is not sufficient enough to make a lasting change in muscle length.
Foam rolling works by influencing the nervous system more than actually changing muscle structure. The compression forces that the foam roller applies changes the activity at the local nerves and inhibits the communication to pain receptors in the spinal cord. This change in the nervous system is also why it “feels good” to foam roll.
There are still some immediate benefits to foam rolling. Foam rolling has been shown to increase local blood in the immediate area, improves pain threshold, temporarily improves joint range of motion, improves venous function6 and foam rollers cause changes in the nerves7. Foam rolling also decreases muscle soreness after intense bouts of exercise 7.
Does the Length of the IT Band Change with Foam Rolling?
The quick answer is no, the IT band is too thick and strong. To demonstrate this, researchers had to use a force of 2,040 lbs to produce even 1% of length change in the IT band of cadavers.
That’s a huge amount of force and over 2,000 lbs is not a physically possible force to exert during the simple act of foam rolling.
Repeat after me, “You cannot stretch your IT band.”
Stretching the IT Band: Your Hip Muscles Stretch Before Your IT Band Does
Not only is the amount needed to stretch the IT band not humanly possible but it also is limited by the anatomy of the hip.
When you perform the various IT band stretches like the image on the right such as bringing our leg across our body, our hip muscles become tight and limit the movement before a stretch is applied to the IT band.
Even during common Physical Therapy tests for IT band tightness such as the Ober’s Test, the IT band is not under tension during hip adduction range of motion. Instead, the ligaments and muscles of the hip tighten first.
Why Do You Feel Better After Foam Rolling the IT Band?
Foam rolling has that “hurt so good feeling” because you essentially numbed the area by rolling over a sensitive structure. This creates the illusion of feeling looser, but it’s not because the structure has been stretched. That pleasant feeling after foam rolling is what’s occurring with nerves that you just rolled on.
When you roll over the top of a nerve it can temporarily turn it off and reduce the intensity of the signal to the brain. Rolling over the lateral thigh and IT band then is an altered nerve response. If the nerves are no longer signaling pain and are in essence numb, then it will feel light and loose.
Does Foam Rolling Decrease Muscle Tightness
Yes, foam rolling does decrease muscle tightness, at least temporarily! Foam rolling decreases tightness through the same mechanisms as mentioned above and affects muscle length through changes in the nervous system.
The changes in muscle length after foam rolling are short-term changes and do not cause long-term changes in tightness.
This makes foam rolling muscles (not on fascia) a great way to warm up before a competition or running and to aid in post-exercise recovery. It also can help temporarily improve joint range of motion and some muscle flexibility. In a 7 week trial of foam rolling, the joint range of motion improved by 9-18 degrees.
This is not due to the muscle fibers lengthening but be there being less nervous system activity.
Does Foam Rolling Speed Up Recovery
Yes, using a foam roller can aid in improve performance and speed up recovery. This is the area where most of the research as of late has been focused. This is especially true after high-intensity exercise. In a study where one group foam rolled after exercise and the other group did not, while delayed muscle onset improved by greater than 50% after foam rolling.
How Long Does IT Band Syndrome Last?
IT band syndrome can last anywhere from 4-8 weeks depending on the severity of symptoms and treatment provided. In severe, cases it can last greater than 12 months but this is on rare occasions.
Performing exercises such as hip strengthening, stretching, and activity modification can help speed up recovery.
What Should I Do Instead of Foam Rolling for IT Band Syndrome
IT Band Syndrome is a condition of weakness and/or overloading the system, not a condition of tight fascia. While the muscles might feel tight, this is a protective mechanism to stabilize the area because of the lack of strength.
To properly tackle IT Band Syndrome it takes an approach of relieving pain, improving hip and quad strength, and modifying activity levels with a progressive loading program.
Strengthening Exercises
Start by doing hip strengthening exercises either lying on the ground or by using a resistance band around the ankles. Some of our favorite beginner exercises include the Side-Lying Clamshells, Standing 3-way hip, and lateral step-downs. Progress to more difficult exercises as your leg allows.
A lack of thigh and quad strength is also a predictor of having ITBS. In a study done by Orchard et al, they found runners who developed IT band syndrome had less quad strength and less knee flexion when landing.
A great and easy way to strengthen the quads and the rest of the leg is a Bulgarian Split Squat. It focuses on eccentric strengthening and leg stability.
Stretching
In addition, stretching can help with pain control and muscle guarding. Stretching the quad, glutes, and deep hip rotators are the best areas to target.
Pain Modification
Symptom modification such as wearing insoles or even trying taping can help reduce pain levels. We don’t recommend taping long-term but can help with acute symptoms.
Finally, it is important to modify your activity until you are pain-free. You may have to reduce your mileage running, biking, or training for a 4-8 weeks period of time.
Once it begins to feel better, you can increase your activity levels in intensity and time by 10-15% each week thereafter.
FAQ About IT Band Syndrome
Do you Need Surgery for IT Band Syndrome?
Surgery for ITBS is extremely rare and not needed in most cases. Most cases usually respond quite well to conservative care such as stretching, strengthening exercises, and giving it time to heal.
In one study that looked at those who did have surgery, they had ITBS for greater than 18 months and didn’t have any benefit from physical therapy or steroid injections. For those that did have surgery, nearly 100% were able to return to sports and competitions.
How is IT Band Syndrome Diagnosed?
IT Band Syndrome is diagnosed based on signs and symptoms of the presentation. The location of pain, aggravating factors, and history of the symptoms play a large role in determining the correct diagnosis.
X-rays are not typically helpful with diagnosing and are used more to rule out other serious pathologies. MRIs typically won’t show any abnormal findings in ITBS although it can show some edema around the lower leg but isn’t always helpful.
There is a special test called the Ober’s test that is often used to diagnose IT band Syndrome. However, recent studies have shown that Ober’s Test is not a great assessment of the IT band and looks at the length and tightness of the hip abductor muscles.
Should you get an MRI for IT Band Syndrome?
MRIs aren’t normally helpful in treatment or diagnosis for ITBS. The only time we recommend getting an MRI is if the pain continues for longer than 12 months or there is suspicion of other issues such as a possible torn meniscus. You’ll be able to save money without having an MRI.
Does ITBS Cause Numbness
No, numbness in the thigh or feet is not a typical sign of IT band syndrome. Even though the pain map might be similar, numbness in the feet or leg is usually from a nerve compression disorder in the back. If you have numbness or tingling try and focus on the low back with stretches and strengthening.
When Should You Seek Medical Care
Most mold cases of ITBS resolve within 2-4 weeks if you can modify your activities. For cases that linger longer than that we recommend getting some help from a physical therapist or physician. Moderate to severe cases can take quite a bit longer and do benefit from medical advice.
Depending on your insurance, you may be able to go straight you a physical therapist without having to get a prescription from the doctor. Call your local physical therapy clinic and ask if they take direct access.
In Review
Even though foam rolling has been a recommended treatment for IT band syndrome the recent research hasn’t supported it as beneficial. There are specific reasons why the IT band doesn’t respond to foam rolling. There are other ways to treat ITBS at home that are more beneficial and will provide long-term relief and resolution of issues.
Works cited:
- McKean KA, Manson NA, Stanish WD. Musculoskeletal injury in the master’s runners. Clin J Sports Med. 2006 Mar;16(2):149-54.
- Taunton JE, Ryan MB, Clement DB, McKenzie DC, Llyod-Smith DR, Zumbo BD. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med. 2002 Apr;36(2):95-101.
- Orchard JW, Fricker PA, Abud AT Mason BR. Biomechanics of iliotibial band friction syndrome in runners. Am J Sports Med. 1996 May June; 24(3):375-9.
- Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. Mar 2006;208(3):309-16.
- Fairclough J, Hayashi K, Toumi H, Lyons K, Bydder G, Phillips N, Best TM, Benjamin M. Is iliotibial band syndrome really a friction syndrome? J Sci Med Sport. 2007 Apr;10(2):74-6; discussion 77-8. Epub 2006 Sep 22.
- Okamoto T, Masuhara M, Ikuta K. Acute effects of self-myofascial release using a foam roller on arterial function. J Strength Cond Res. 2014 Jan;28(1):69-73. doi: 10.1519/JSC.0b013e31829480f5. PubMed PMID: 23575360.
- Macdonald GZ, Button DC, Drinkwater EJ, Behm DG. Foam rolling as a recovery tool after an intense bout of physical activity.Med Sci Sports Exerc. 2014 Jan;46(1):131-42. doi: 10.1249/MSS.0b013e3182a123db. PubMed PMID: 24343353.
- Chaudhry H, Schleip R, Ji Z, Bukiet B, Maney M, Findley T. Three-dimensional mathematical model for deformation of human fasciae in manual therapy. J Am Osteopath Assoc. 2008 Aug;108(8):379–90. PubMed #18723456.
- Behara B, Jacobson BH. 2015. The acute effects of deep tissue foam rolling and dynamic stretching on muscular strength, power, and flexibility in division I linemen. Journal of Orthopaedic Trauma Epub ahead of print Jun 24 2015 DOI 10.1519/JSC.0000000000001051.
- Halperin I, Aboodarda SJ, Button DC, Andersen LL, Behm DG. 2014. Roller massager improves range of motion of plantar flexor muscles without subsequent decreases in force parameters. International Journal of Sports Physical Therapy 9:92–102.
- Vigotsky AD, Lehman GJ, Contreras B, Beardsley C, Chung B, Feser EH. Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test. Abdala V, ed. PeerJ. 2015;3:e1281. doi:10.7717/peerj.1281.
- Kong PW, Candelaria NG, Smith DR. Running in new and worn shoes: a comparison of three types of cushioning footwear. Br J Sports Med. 2009 Oct; 43(10):745-9. doi: 10.1136/bjsm.2008.047761. Epub 2008 Sep 18.
- Willett GM, Keim SA, Shostrom VK, Lomneth CS. An Anatomic Investigation of the Ober Test. Am J Sports Med. 2016;44(3):696-701.
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Disclaimer: The information provided in this post is for educational purposes only. This is not a substitute for a medical appointment. Please refer to your physician before starting any exercise program.
