Facts on IT Band (iliotibial) & Massage for the IT Band in Santa Barbara, Ca.

Have you been noticing pain on the outside of your knee, hip, or thigh without a known injury? If your answer is Yes, then you may be experiencing symptoms of Iliotibial Band Syndrome. Iliotibial Band Syndrome (IT Band Syndrome) presents as pain along the outside of the thigh from the hip to the knee.

Beyond the pain and discomfort, you may also hear audible snaps as the tissue frictions over the outer edge of the thigh bone. Your IT Band is a strong, thick, fibrous band of tissue that runs down the outside of your thigh. As you can see in the illustration below it extends all the way from your hip bone to the top of your shinbone as it melds with the musculature of your hip and thigh to assist with stabilizing both areas during movement.

With repeated bending and straightening movements of the knee, the IT Band may friction and irritate surrounding tissues, causing pain. It is most common for people who often perform the repetitive motion, especially distance runners, cyclists, or new recreational athletes.

Your physical therapist will be able to identify whether your pain is a result of IT Band Syndrome or another problem based on your symptoms as well as a physical examination assessing your strength, flexibility, gait pattern, and quality of movement.

Once your concerns are identified as IT Band Syndrome, you and your physical therapist will design a customized plan of care to address your imbalances and movement dysfunction.

The IT Band runs down outside of the thigh from the hip to just below the side of the knee. The iliotibial band (ITB, IT Band) or iliotibial tract is a reinforced band of dense fibrous connective tissue/ fascia in the thigh  connecting proximally to the Tensor Fascia Lata and Gluteus Maximus muscles, and distally to the lateral condyle of the tibia ( Gerdy’s Tubercle).

Iliotibial band syndrome (ITBS or ITBFS, for iliotibial band friction syndrome) is a common injury to the knee, generally associated with running, cycling, hiking or weight-lifting (especially squats).

IT Band Massage: ITBS SIGNS & SYMPTOMS

• Pain is gradual at onset and worse with activity
• Pain felt at lateral thigh and lateral knee
• Thickening, adhesions and fibrotic nodules ( like adhesions along the fascia) of the affected IT Band ( especially in the knee area where theres a lot of movement)
• Hypertonicity and Trigger points in the Tensor Fascia Lata, gluteus maximus, hip flexors, rectus femoris leading to decrease circulation and shortening of these muscles
• Inflammation at the lateral femoral condyle due to tight IT Band. There could be rubbing and inflammation at the hip due to trochanteric bursitis
• With anterior pelvic tilt, lumbar pain, and SI joint hypermobility
• Valgus or hyperextension at the affected knee
• Pes planus

Iliotibial Band Contracture & IT Band Friction Syndrome

•  ITB Friction Syndrome is inflammation and pain where the IT band crosses the lateral femoral condyle
• ITB contracture is the shortening or thickening of the IT band
• ITB Contracture and Friction Syndrome may occur unilaterally or bilaterally
• The fascia surrounding Glute Max and Tensor Fascia Lata (TFL) join to form the IT band
• IT band provides lateral support to the knee
• When fascia is contractured, biomechanics of the knee and hip are restricted. Ankle and SI joint may compensate
• Bursa between the greater trochanter and IT band may become inflamed ( trochanteric bursitis)
• Trigger points in glute max and TFL may also contribute to ITB tightness

 IT Band Massage: CAUSES of IT Band Syndrome / IT Band Contracture

IT Band Friction Syndrome

• Prolonged, repetitive activities where knee and hip are flexed – like running, cycling
• Contributing factor – poor TFL stretching procedures, anterior pelvic tilt, tight TFL, glutes

ITB Contracture

• Activities or occupations that place the knee and hip in flexion (cycling, horseback riding, prolonged sitting, running with pronated feet) and allows ITB and TFL to tightened
• Postural Imbalance – anterior pelvic tilt/hyperlordosis
• Prolonged wheelchair use, bed rest

IT Band Massage: OBSERVATION

• Hypertonic IT Band creates an indentation in the lateral thigh
• Unilateral IT Band contracture, lateral pelvic tilt can be seen on the affected side
• The affected knee is valgus
• Pes planus on the affected side
• With bilateral IT Band contracture, anterior pelvic tilt due to short ITB and TFL
• Hyperlordosis from anterior pelvic tilt, short hip flexors, rectus femoris
• IT Band friction syndrome may show redness, edema at affected lateral femoral condyle
• Lateral quads and hamstrings may be tight

IT Band Massage: PALPATION

• Tenderness along with IT Band, especially distal 1/3, also at the greater trochanter
• Affected IT Band thickened, adhesion present
• On the affected side – hypertonicity and trigger points in the TFL and glute max.
• On non – affected side – hypertonicity and trigger points in the hip flexors
• If bilateral, hypertonicity and trigger points in TFL, glute max, rectus femoris, iliopsoas, adductors, and Quadratus Lumborum
• With friction syndrome, inflammation, heat, swelling, point tenderness local to the lateral femoral condyle area

IT Band Massage:  ROM TESTING

• Active Free ROM of the affected knee, hip, SI joint, and Lumbar Spine
  •  Reduced extension and adduction of the hip
  •  Painful knee extension with friction syndrome ( esp. in the act of extending the knee – tight band snaps to the lateral femoral condyle)
•  Passive Relaxed ROM of the affected knee, hip, SI joint
  • Painful at the lateral knee with extension
  • Active Resisted testing of TFL, rectus femoris, glute max, glute medius, iliopsoas, Quadratus Lumborum

IT Band Massage:  SPECIAL Orthopedic TESTING

• Thomas Test – tight ITB, TFL, rectus femoris
•  Ely’s Test – right rectus femoris
•  Ober’s and Modified Obers – tight ITB, TFL
•  Noble’s Test

IT Band Massage Therapy Treatment

• Fascial Techniques to ITB, in various directions and interspersed with effleurage ( to drain and because fascial work there is painful)
  • Skin rolling, Cross-hand spreading, C and S bowing techniques, J stroke
• Cross fiber friction to adhesions, followed by ice and stretch
• If friction syndrome is present, inflammation at lateral femoral condyle makes onsite fascial technique impossible. Use ice locally. Working on the proximal IT Band can reduce tightness in the distal IT Band until the inflammation is gone and on-site work is possible.
• TFL muscle massage: treat hypertonicity, adhesion, trigger points by ( skin rolling, petrissage, stripping to the attachment at the iliac crest and around trochanter, GTO at trochanter where TFL distal musculotendinous junction located)
• Glute max: massage for hypertonicity and trigger points
• Repetitive effleurage to lateral leg and glutes to increase circulation
• Contrast hydro can improve circulation
• Rest of affected leg: treat iliopsoas, quads, hamstrings, adductors, muscles of the lower leg
• Passive Relaxed ROM of hip and knee. Ankle, knee, hip, SI joint treatment with joint play itb massage, massage for its band, it band massage therapy, massage therapy for its band, massage treatment itb, massage treatment band

IT Band Massage: SELF CARE

• Deep moist heat to loosen IT Band ( if there is no inflammation)
• Contrast hydrotherapy to increase circulation
• Ice to lateral femoral condyle with acute friction syndrome
• Self-massage to IT Band and TFL (foam roller)
• Stretch TFL, especially if seated for long periods. ( with arms raised, affected leg behind, front leg lunged down, bend sideways)

Common treatments include:

• Flexibility and mobility work: dynamic stretching, static stretching, and foam rolling.

  • Key Points: Your dynamic, static, foam roll stretches should address the muscles that connect into the IT band: tensor fasciae latae, vastus lateralis, and glutes vs rolling directly on the fibrous tissue (see anatomy photo above).

• Progressive strength training addressing the muscle groups of the core, hips, thigh, and lower leg.

  • Key Point: You should not reproduce your pain and/or snapping with any of your exercises addressing the quadriceps, hamstrings, glutes, and hip rotators.

• Biomechanics training to address movement pattern dysfunction and gait abnormalities.

  • Key Point: Often movement patterns such as your gait, squats, and step-ups can be retrained in a mirror with the guidance of your physical therapist.

• Activity modification like relative rest, reducing mileage and repetitive stress movements will help reduce friction and inflammation in the tissues as you heal.

  • Key Point: Rest is relative. If your body is used to running 40 miles per week, rest may be reducing your mileage to 20 miles per week.

IT Band Kinesio Taping

IT Band Exercises

Massage for IT Band

more info at::

https://www.runnersworld.com/advanced/a20797159/beating-the-band/

https://themusclemedics.com/it-band-pain-papillion-massage/

Do We Need To Massage The ITB?

*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
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