Iliotibial band stretches don’t work? Really?! So why does it seem like they prescribed for iliotibial band syndrome by practically every physical therapist in the world?
IT band stretching is just another obsolete bit of simplistic conventional wisdom, like a million other bad ideas that have been repeated infinitely on the Internet. Stretching your iliotibial band is probably only a slightly helpful treatment, at best. At worst, IT band stretching is a complete waste of your time, and reinforces an incorrect understanding of how IT band pain works.
And that’s assuming you are actually even stretching your IT band in the first place.
Most people never succeed in applying a good, strong stretch to their IT band. All the commonly prescribed IT band stretches are mechanically ineffective.1 There is research available that shows how to apply tension to the IT band, but it appears to be unknown to most doctors, therapists, and trainers.
Prefer video? I have a good video tour of basic IT band myths, including the stretching myth:
Stretching is probably the most common advice given to people with lateral knee pain. Almost every ITBS patient is told to stretch by a doctor or therapist, and it is repeated literally tens of thousands of times on the internet.
But there is no evidence that stretching will prevent2 or fix3 IT band pain. No researchers have studied the problem properly, and preliminary data are underwhelming. Not only is the IT band a difficult structure to stretch, but it is doubtful that IT band tightness is even a problem that needs solving.All preliminary scientific tests of stretching for ITB syndrome are underwhelming at best.
It is not safe to assume that stretching works just on the say-so of your physiotherapist, or running mates who swear by it, or because it’s recommended by every article on the internet about IT band syndrome. Stretching is generally over-rated, and especially in this case.4
The most common kind of stretches recommended for the iliotibial band are also the least likely to be effective, simply because they are focussed on stretching the iliotibial band and the tensor fasciae latae muscle, and there is no good way of applying any significant amount of stretch to these structures. Not everything in the body can be stretched.5 There are biomechanical difficulties:
The usual IT band stretches are missing a particularly crucial component: knee flexion. For any hope of stretching this structure, you simply have to include knee flexion. And yet almost no one does.
As discussed above, the iliotibial band does not have a well-defined attachment point on the knee, the way most tendons do. Instead, it spreads out and blends into the capsule of connective tissue that surrounds the knee. Thus, knee position clearly affects tension on the iliotibial band — and it has long been recognized that the iliotibial band is tightest around 30˚ of flexion.7 An iliotibial band stretch without knee flexion is just not much of an iliotibial band stretch.An iliotibial band stretch without knee flexion is just not much of an iliotibial band stretch.
And there’s more.
Another other vital thing that is rarely included is “anchoring” the pelvis. The tensor fasciae latae muscle and the iliotibial band “hang” from a “hook” on the front of the pelvis, the anterior superior iliac spine, or ASIS for short. If you want to stretch anything attached to the ASIS, you need to hold it in place.
Elementary, right? The easiest way to do this is simply to lean your torso away from that corner of the pelvis. This takes up the slack in the lateral and anterior abdominal muscles, and pulls up on the pelvis. The anchoring is also greatly facilitated by raising the arms as well, because that takes up a lot of slack in the very long latissimus dorsi muscle, which tightens the broad thoracolumbar fascia and, again, significantly helps to anchor the pelvis.8
But this is all mucho ado about almost literally nothing, and it’s time for the shocking punchline. Suppose you did everything right: how much would you actually change the length of your IT band? How far would it move?
About 2 millimeters — an overall change in length of less than half a percent.
In 2010, Irish researcher Dr. Eanna Falvey and her colleagues measured the mechanical effect of a basic IT band stretch (like the standard one illustrated at right) plus a more sophisticated stretch, and found virtually no difference: the IT band was effectively unaffected, making it one of the unstretchables. And that was including knee flexion, in a stretch carefully applied to corpses by anatomists!9 If that doesn’t move the IT band, certainly runners don’t stand a chance.
And so, unfortunately, conventional iliotibial band stretches, prescribed and described practically everywhere — even the better ones — are simply not able to do the job. Assuming it’s even a job worth doing.
So there are better stretches. But, more importantly, there are also better options for IT band syndrome than any stretch!
In my experience, practically everyone who is looking for IT band stretching information would be better off learning much more about IT band syndrome first, because the subejct is a minefield of myths and misconceptions (not just about stretching):
Some health professionals have taken the time to study ITB syndrome properly, of course. But it’s usually impossible to luck out and find one before your training schedule is blown to smithereens.
This is an excerpt from a much larger tutorial for both patients and professionals. It will teach you basically everything there is to know about ITB syndrome. There is no foolproof system for beating iliotibial band syndrome (and please do not believe anyone who offers one). But if you read the full tutorial, I can guarantee that you will know the condition better than most doctors, and you will know your options inside and out.
Full access to the ITBS tutorial is available immediately for USD$1995, or you can start by reading several free introductory sections.
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