Iliotibial Band Mechanics

Type in “iliotibial band” or “IT band” on Google. No, seriously, go ahead and Google it. What did you find? I can tell you. The vast majority of websites state that treatment for IT band issues is stretching. Why is that an issue? It seems logical. If it’s tight, then stretch it. The problem lies in that fact that the IT band becomes tight because of faulty mechanics in the lower extremity, not by simply being tight. A quick review of anatomy shows that two key muscles are responsible for moving the leg out to the side into what is termed abduction.

Abduction is vitally important not only for moving your leg to the side, but for stabilizing your leg when you’re standing on one leg with activities such as running or walking. The two main muscles that abduct the hip are called the gluteus medius (GMe), the second one is called the tensor fascia latta (TFL). The TFL is the muscle that inserts into the IT band. This muscle originates on the front outside portion of the pelvis and tapers to the band. The band then continues down the side of the leg and inserts just past the knee. There are two sites that are common for IT band issues. One is at the hip on a bony prominence called the trochanter. The other site is at the side of the knee. When a person does not have good strength in the gluteus medius (GMe) the TFL takes over and acts to stabilize the hip. When this situation occurs the IT band is tensioned. With this tension we see pressure on the trochanter and the lateral knee. This is also the feeling the leads people to believe that the IT band is tight. It is not tight, it is just reacting to the load applied to it by the TFL.

Treatment of this condition includes specific exercises to restore strength of the gluteus medius. The result is significant and dramatic improvements in all IT band issues. The initial exercises for the (GMe) are performed in a position that optimizes the contraction of the gluteus medius. They are performed lightly in an effort to eliminate old patterns of movement and substitution of the TFL. Once this muscle has restored some strength and the ability to contract normally, the exercise load is increased. The final step is to return to dynamic activities such as running or landing from jumping.