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,” John Fairclough, Koji Hayashi, Hechmi Toumi, Kathleen Lyons, Graeme Bydder, Nicola Phillips, Thomas M Best, and Mike Benjamin, Journal of Anatomy, 2006.
- “An anatomic study of the iliotibial tract,” Eduardo Luis Cruells Vieira, Eduardo Alvaro Vieira, Rogerio Teixeira da Silva, Paulo Augusto dos Santos Berlfein, Rene Jorge Abdalla, and Moises Cohen, Arthroscopy, 2007.
- “Effects of simulated vastus medialis strength variation on patellofemoral joint biomechanics in human cadaver knees,” TQ Lee, MD Sundusky, A Adeli, and PJ McMahon, Journal of Rehabilitation Research & Development Vol, 2002.
- “Sonographic evaluation of the iliotibial band at the lateral femoral epicondyle: does the iliotibial band move?,” Elena J Jelsing, Jonathan T Finnoff, Andrea L Cheville, Bruce A Levy, and Jay Smith, J Ultrasound Med, 2013.
- “Deformation Response of the Iliotibial Band-Tensor Fascia Lata Complex to Clinical-Grade Longitudinal Tension Loading in-Vitro,” Mark Wilhelm, Omer Matthijs, Kevin Browne, Gesine Seeber, Anja Matthijs, Phillip S Sizer, Jean-Michel Brismée, C Roger James, and Kerry K Gilbert, 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:
- Photobiomodulation therapy is not better than placebo in patients with chronic nonspecific low back pain: a randomised placebo-controlled trial. Guimarães 2021 Pain.
- No effect of creatine monohydrate supplementation on inflammatory and cartilage degradation biomarkers in individuals with knee osteoarthritis. Cornish 2018 Nutr Res.
- The CANBACK trial: a randomised, controlled clinical trial of oral cannabidiol for people presenting to the emergency department with acute low back pain. Bebee 2021 Med J Aust.
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.