The iliotibial band is uniformly, firmly attached to the femur
PainSci summary of 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 at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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:
These three articles on PainScience.com cite Falvey 2010 as a source:
- PS Save Yourself from IT Band Syndrome! — All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
- PS The Unstretchables — Eleven muscles you can’t actually stretch hard (but wish you could)
- PS IT Band Stretching Does Not Work — Stretching the iliotibial band is a popular idea, but it’s very hard to do it right, and it’s probably not worth it
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:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.