The iliotibial band is uniformly, firmly attached to the femur
Three articles on PainSci cite Falvey 2010: 1. The Complete Guide to IT Band Syndrome 2. The Unstretchables 3. IT Band Stretching Does Not Work
PainSci commentary on Falvey 2010: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
Researchers studied the anatomy of the IT band on 20 cadavers and tested different IT band stretching methods. They confirmed that the IT band really is “uniformly” and “firmly” attached to the thigh bone, “from greater trochanter up to and including the lateral femoral condyle” — in other words, the full length of the femur. (They also didn’t find a bursa under the IT band in a single cadaver.)
They also carefully measured the mechanical effect of a basic IT band stretch, plus a fancier stretch, and found that even ideal IT band stretching resulted in almost no elongation of the IT band: only about 2 millimeters — an overall change in length of less than half a percent. The IT band is definitely one of the unstretchables.
They concluded with this understatement: “Our results challenge the reasoning behind a number of accepted means of treating ITBS.” One of the authors described their findings thoroughly in a (recent, 2016) blog post.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Iliotibial band (ITB) syndrome (ITBS) is a common cause of distal lateral thigh pain in athletes. Treatment often focuses on stretching the ITB and treating local inflammation at the lateral femoral condyle (LFC). We examine the area's anatomical and biomechanical properties. Anatomical studies of the ITB of 20 embalmed cadavers. The strain generated in the ITB by three typical stretching maneuvers (Ober test; Hip flexion, adduction and external rotation, with added knee flexion and straight leg raise to 30 degrees) was measured in five unembalmed cadavers using strain gauges. Displacement of the Tensae Fasciae Latae (TFL)/ITB junction was measured on 20 subjects during isometric hip abduction. The ITB was uniformly a lateral thickening of the circumferential fascia lata, firmly attached along the linea aspera (femur) from greater trochanter up to and including the LFC. The microstrain values [median (IQR)] for the OBER [15.4(5.1-23.3)me], HIP [21.1(15.6-44.6)me] and SLR [9.4(5.1-10.7)me] showed marked disparity in the optimal inter-limb stretching protocol. HIP stretch invoked significantly (Z=2.10, P=0.036) greater strain than the SLR. *TFL/ITB junction displacement was 2.0+/-1.6 mm and mean ITB lengthening was <0.5%* (effect size=0.04). Our results challenge the reasoning behind a number of accepted means of treating ITBS. Future research must focus on stretching and lengthening the muscular component of the ITB/TFL complex.
related content
- “The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome,” Fairclough et al, Journal of Anatomy, 2006.
- “An anatomic study of the iliotibial tract,” Vieira et al, Arthroscopy, 2007.
- “Effects of simulated vastus medialis strength variation on patellofemoral joint biomechanics in human cadaver knees,” Lee et al, Journal of Rehabilitation Research & Development Vol, 2002.
- “Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?,” Jelsing et al, J Ultrasound Med, 2013.
- “Deformation Response of the Iliotibial Band-Tensor Fascia Lata Complex to Clinical-Grade Longitudinal Tension Loading in-Vitro,” Wilhelm et al, International Journal of Sports Physical Therapy, 2017.
Specifically regarding Falvey 2010:
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.