Everybody on the internet needs to stop rolling their IT bands and telling everyone to do it as well. Here’s why:
To be honest I NEVER advise anyone to roll their IT band because there is no evidence it’s doing anything. And not only is it not doing anything, it bloody hurts like a mother tucker.
So why is everyone on the internet obsessed with rolling it? Why does every “fitness influencer” advise that you get on the floor and roll your IT band? Perhaps they have been advised by their physio, chiro or massage therapist? Maybe they’ve just been so used to doing it they can’t see beyond the reasons as to why you should stop. Or maybe some girl did it at the gym and posted it on her Instagram feed and all of a sudden she’s an expert.
Whatever the reasons are, I have always hated the concept of rolling the IT band or any tendon for that matter. Especially a tendon as large, thick and complex as the IT band. But what is the IT band? First an anatomy lesson the fitness influencer on Instagram may not know.
What is the IT band?
The IT band, also known as the Iliotibial Band is a very thick and dense piece of connective tissue. It runs the length of the femur on the lateral aspect of the thigh. From it’s attachment on the hip (at the iliac crest) it joins the TFL (tensor fascia latae) with your gluteus maximus and the gluteal aponeurosis along with the gluteus medius. Anatomically speaking the IT band is easy to find but extremely difficult to separate from its surrounding attachments with other muscles. Unless you’ve had experience with palpating this tendon it’s not as easy as just laying on a roller.
Without a doubt the IT band is large and spans a great deal of distance on the outside of your thigh. And even though the IT band is NOT a muscle, does it have a function? Or does it simply act as a “stabilizer” and “anchor” for other more dominant muscles? Since the IT band acts as a tendon (due to its attachment of muscles) why would you want to elongate it or release it? As that is the reason behind rolling any tissue of the body. To elongate and to release “tension”. Not to mention that the IT band also has many connective tissue properties. That is, it lacks the ability to stretch due to its adaptive shortening properties.
All this adds up to a very special role which in fact has many therapists still scratching their heads. Although the anatomy does not sway based on opinion the treatment and assessment vary from therapist to therapist. Ask any clinician and a majority of them love to get their clients to roll the IT band out. Others, such as myself will tell you different. So why is there such a diverse approach to treatment?
IT band syndrome and pain patterns
When a client comes to me with any pain, there are procedure protocols to determine root cause of the pain. Taking a history, assessing the tone, texture and function along with passive and active tests will help determine where said pain is stemming from. Furthermore not everyone has a “tight” IT band. We need to stop this perpetual cycle of assuming everyone has a “tight” IT band because they lack mobility and can’t stretch. In addition, stretching is a poor indicator of function. We can’t all be flexible and do the splits.
Everyone loves to label their conditions or symptoms. All my clients want to know what they have, how to fix it and how to avoid it. Unfortunately the world of soft tissue therapy is still in its infancy when compared to other fields of health and medicine. That being said, there are some key factors that help clinicians and therapists determine and assess pain patterns in the body.
IT Band Syndrome
The most common problem of the IT band is the Iliotibial Band Syndrome (ITBS). By definition this is a repetitive strain injury that presents as pain on the outside of the knee and feels worse when walking down a hill or a set of stairs. Although many runners suffer from it, anyone can get it. Someone who decided to finally get off the couch and hike a 10 km trail will most likely aggravate their knees which will show up as an IT band issue.
Since ITBS is so common, you’d be amazed at how often it can be misdiagnosed. The other culprit to knee pain or “runner’s knee” may be patellofemoral pain syndrome (PFPS). This type of pain will show up on the front of the knee and the two can become one. More often than not the two can become confused. Since pain can sometimes become obscured due to the proximity of the muscles and tendons involved.
Even so, sometimes a diagnosis of true ITBS is out to left field if pain persists around the knee as well as the lateral side of the knee. Some even suggest it’s a hip issue. One of the frustrations with ITBS is how sudden the onset of symptoms can appear. In chronic cases ITBS seems to linger for months, if not years, and can cause severe flare ups. But again the question is, does rolling the IT band help?
IT band myths
Rolling of the IT band
One of the most perpetuated myths about the IT band is that it can be solved with rolling. Many on the internet love to advise rolling of the IT band and will continue to advise this routine with an uneducated guess at best. So why does it keep gaining popularity despite the lack of evidence that it works?
Even though many trained therapists (and zero trained influencers) still recommend rolling of the IT band there is no basis for this recommendation. The idea of myofascial release can help in some instances to relieve tension built up in tissues especially muscles. Considering muscles allow for contractility, extensibility, elasticity and excitability. In patients, myofascial trigger points can show up as dense, stiff, hypercontracted and painful spots upon palpation. These trigger points are congested areas of muscle fibers that can’t seem to “relax” due to either internal (cellular level) or external (outside the body) factors.
At the cellular level it is believed that the stiffness may arise from the hypercontracture of the sarcomere (the unit that makes up skeletal muscle tissue). This constant stress on the tissues themselves can increase the release of myokines, inflammatory cytokines and neurotransmitters that contribute to myofascial pain syndrome.
The figure below shows the hypothesized mechanism of initiation and continual loop of myofascial pain syndrome. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285362/#B41
Massage for the IT band
Another popular myth is massage therapy. Even massage therapists across the board are taught that aggressive massage techniques can aid in “relaxing” and elongating the IT band. That this will somehow help pain on the lateral aspect of your knee. But again, I ask why the need to relax it and elongate it? Why are we stretching it? There is no proof that this will actually help to relieve the pain with ITBS.
Massage therapy is believed to increase blood flow to tissues. It has many circulatory benefits on the body. However massage seems to activate the mechanotransduction signaling pathways more, decreasing inflammatory cytokines and increasing mitochondrial biogenesis. All this adds up to a reduction in focal adhesions which may decrease muscle stiffness. To emphasize that these changes occur in muscles, not tendons. Don’t forget that the IT band is not a muscle!
From my clinical experience, I have never met someone who felt better after a massage session of their IT band or seen anyone enjoy rolling their IT band. Like I’ve mentioned before, it hurts like a mother tucker and the result is minimal at best. Let’s not forget that the IT band sits directly over the femur. Anatomically positioned directly over bone with no cushioning under the IT band. It’s no wonder it hurts!
Stretching for the IT band
Again this is just a bogus theory that stretching can aid in relieving pain at the lateral aspect of the knee. You’ve probably seen everyone and their grandma try and stretch out their IT band. Unfortunately for these people it is almost impossible to stretch out the IT band due to it’s complex biomechanics.
First off, the IT band is just too tough to stretch. No amount of movement will move that guy despite the look of nausea on your face. It is designed to withstand an insurmountable amount of load so trying to stretch is it futile.
Secondly, although it may appear like an easy target to move, you do have to take into account your body design. This being your hips and all the surrounding muscles of your hip. These short and small muscles limit the motion of your hip joint which in turn make it impossible to stretch the IT band. Your hips don’t lie when it comes to biomechanics. Not to mention, your knee plays a critical role at the attachment of the IT band.
Stop rolling the IT band
In my personal and professional opinion rolling the IT band does nothing but create a cycle of inflammation and pain onto an area that might already be inflamed and irritated. Why add fuel to the fire?
Like i’ve mentioned before, the IT band is unique in its orientation and functionality. It does not behave like most tissues of the body and does not need to be stretched or elongated. The IT band also serves as a knee stabilizer due to its strength and attachment points at the knee. Having said that it needs to be “tight” in order to do its job. Why else would we need to have it? Can you imagine a weightlifter with a relaxed IT band trying to squat 550 lbs?
So if there’s no need to roll the IT band, what should you do for ITBS?
There are many hypothesis and many forms of therapy that try to address and correct iliotibial band syndrome. There is not one therapy that will cure ITBS, but for obvious reasons, my background favours active release techniques over massage any day – due to the active component of an active release treatment. Despite my own background in massage and ART®, it’s not a one size fits all approach. Unless a trained therapist can get their hands on you, it’s impossible to know if you have true ITBS.
To summarize, just stop rolling your IT band. It pains me to see everyone on the internet go bat shit crazy over an ideology that has no basis of support. It hurts, it’s uncomfortable to perform, and results are minimal at best. Unless you’re a glutton for abuse and you consider it a form of S&M. I’m not here to judge your choices but consider why you are doing yourself harm.
Are you trying to roll your IT band? Have you had any benefits from it?
You are allowed to be both a masterpiece
and a work in progress simultaneouslySophia Bush