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The Truth About the ITB



The Truth about the ITB (Ilio Tibial Band)

Dispelling a few myths.

Fact: The IT Band is a tendon.

The IT Band, is a large, broad, flat tendon located on the outer thigh, with attachments originating from the iliac crest, Tensor Fascia Latae, and Gluteus Maximus muscles and inserting at the knee. The IT Band overlies the outer quadriceps (Vastus Lateralis muscle).

A tendon is a soft-tissue structure that connects muscle to bone.

Tendons are viscoelastic tissues. Tendons are not contractile, meaning they cannot contract to shorten like a muscle.

The function of tendon structures is to transfer force produced by the contractile component (muscle) to the connecting bone. They act as biological springs that can stretch elastically, storing and releasing energy during movement and regulating the muscle's mechanical performance.

Fact: The IT Band stabilises the knee.

The IT Band functions to stabilise the knee by action of the hip and pelvis muscles to control excessive knee movement and maintain alignment of the leg.

False: The IT Band can be tight.

Tightness implies that the soft tissue can contract and loosen. As the IT Band is a tendon, it cannot contract, or shorten, and, therefore, cannot be tight. This would be equivalent to saying that the Achilles tendon or the patellar tendon is tight, which, again, isn't possible.

The appropriate term to use when discussing a restrictive tendon is stiffness. This is based on the physiological properties and composition of the tendon.

Further, tension on the IT Band from the Gluteus Maximus, Tensor Fascia Latae (TFL), or Vastus Lateralis (VL) muscles can be interpreted as tightness.

Truth: As a tendon, the IT Band will not increase its resting length when stretched and elongated.

Maybe: The IT Band should be stretched.

Stretching is most commonly used to improve flexibility by increasing the resting length of a muscle. The attached muscles are the Gluteus Maximus and the Tensor Fascia Latae (TFL); stretch these muscles instead of the ITB.

False: The IT Band is the primary source of outer thigh tightness or discomfort.

The confusion arises because of the anatomy and layering of soft-tissue structures of the thigh. The IT Band overlies the VL muscle (one of four quads, or quadriceps, muscles). The VL originates in the front outer quadrant of the thigh and extends back to the hamstrings, travelling under the IT Band. The VL is the most common source of tightness or discomfort in the outer thigh. IT Band stiffness needs to be differentiated from the VL to address the symptom properly and effectively.

Maybe: The IT Band is the primary source of knee pain.

The pain must be differentiated from numerous other soft-tissue structures around the knee, especially the lowermost VL muscle and tendon. The IT Band may be a significant source of pain, but it must be diagnosed correctly.

IT Band Syndrome may be the source of knee pain when:

1) Pain in the knee occurs during activity and subsides with rest,

2) Pain is located approximately two centimetres above the lateral knee joint line,

3) Pain occurs when the knee is flexed at thirty degrees,

4) Pain is aggravated by stairs and running downhill.

True: Injured tendons heal more slowly than muscles.

The lower blood supply and metabolic rate of tendons result in slower healing of tendon injuries.

Maybe: The IT Band should be rolled on the foam roller.

Rolling is typically used for releasing muscles (i.e., contractile tissue). The IT Band is a broad tendon and, as previously discussed, tendons are non-contractile tissue and thus cannot be tight or loosened.

False: The IT Band is the source of pain when you roll on the foam roller.

The VL is the most likely source of discomfort when rolling. The IT Band and VL are compressed between two hard surfaces: the roller and the femur. The VL, being softer muscle tissue, will most likely be painful when compressed between two hard surfaces.

However, it is recommended that when stretching for tightness, discomfort, or inflexibility, the tight muscle be determined and stretched or rolled accordingly.

True: Resistance training can alter the stitiffness of a tendon.

In 2002, a study by Kubo et al. demonstrated that resistance training can increase the stiffness of tendon structures. This can be used strategically to manage tendon injury or prevent injury from occurring.

About the Authors

Ryan Emmons and Angela Pucci are chiropractors and ART, Graston, kinesiotape, and medical acupuncture providers, focusing on biomechanics and sports performance therapy. They are the co-owners of Cadence Chiropractic and Sports Therapy in Calgary. See www.cadencesportstherapy.com.

"The Truth about the IT Band" was first published in the November/December Winter Running & Fitness Issue of IMPACT Magazine.


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