IlioTibial Band Stretch

ITB - what is it?

Keywords; iliotibial band stretch, ITB, iliotibial band syndrome, chiropractic help

Iliotibial Band Stretch is an integral part of the treatment of the so called ITB syndrome , as is the correction of any sacroiliac fixations that frequently accompany this condition.


The Iliotibial band is really a broad tendon that runs down the side of the thigh from the Tensor Fascia Lata muscle, but it is also intimately connected to the gluteus muscles.

The origin of the ilio tibial band, ITB, is on the side of the large iliac bone, the large bone in the pelvis, actually what is called the crest, but no matter, and ends on the side of the knee at what is called the lateral condyle of the tibia, lower leg.

Because it has fibres connecting to the capsule of the hip, it may also cause pain in the groin. Other common causes of groin pain are hip arthritis, the cam and pincer impingement syndromes, hip dysplasia and Maigne's syndrome. And of course a hernia in the groin, and many other medical conditions.


What is the function of the iliotibial band?

These pelvic muscles and the ITB have an important stabilising effect on the pelvis, especially when standing on one leg, as in kicking a soccer ball, but of course also in running, as the ITB is also a very important stabiliser of the knee.

Who gets ITB syndrome?

Anybody can suffer from ITB syndrome, but classically it is athletes who come forward for treatment as the iliotibial band is so important in stabilising the hip and knee whilst running but it occurs in all ages.

Elderly women particularly if they are slightly obese, are prone to bursitis of the Tensor Fascia Lata and gluteus muscles in the area around the lateral femoral trochanter. Iliotibial band stretch for this particular group is difficult as you will see at the end of this page. The condition is often aggravated to a too hard mattress.



A temporary solution is to take four pillows, lay them across the bed, and sleep on the pillows. If this definitely makes a difference, then a softer mattress is in order. Or a thin layer of foam placed over your usual mattress.

Cyclists too are particularly prone, particularly if they persist in riding with the feet toed in. The pain can be on the side of the hip, in the groin, mid thigh and frequently on the side of the knee. Clearly, there is overlap with other syndromes.



Causes

There is no substitute for a thorough history and a careful examination as there are so many potential causes of the ITB. They can be related to training habits, for example poor warmup or cooldown procedures, or always running on a cantered road, particularly if there is an associated short leg on the low side of the road; for example, running on the right shoulder of the road plus a short right leg. Correct function of the foot and ankle, the sacroiliac joints and the hip can either be the main cause or contribute to the misery of this condition. Worn running shoes, the causes are legion.

As stated earlier, weight gain places stress on the pelvis, thus it is not only obese women but also in pregnancy that pain in the ilio tibial band may occur, probably due to increasing instability in the pelvis. Iliotibial band stretch is vital part of the treatment in all groups.



A careful and thorough examination of the pelvis and whole lower limb is mandatory.

Noble's test is used to reproduce the pain in iliotibial band tendonitis. With the patient in a supine position, the physician places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion. Comparing sides is important as it's a tender spot anyway.

The importance of Nobles test is that it enables the clinician to distinguish between a meniscus injury and iliotibial band pain, should Mcmurray's test be dubious. In fact, an itb syndrome causing pain on the side of the knee often accompanies other lower leg and knee conditions. Even for proven osteoarthritis and meniscus pain, the itb should always be first considered, as there remains considerable doubt as to the effectiveness of arthroscopy knee surgery.


The treatment thus is also varied, depending on the findings. 

In the short term, sport should be curtailed or even stopped for a period. Often change to another activity will prevent you from going crazy. For example, take up swimming for a few weeks if you are a runner. Or even cycling, though this could contribute.

Icing over the tender nodules and iliotibial band stretch and the glutes and any other joints that may be involved, the sacroiliac for example, is vital.

Treatment is usually required if the pain doesn't respond to your home remedies with a few weeks. You are unable to correct the fixation in the ankle mortice or sacroiliac joint for example. Guidance on stretches, leg length, whatever your chiropractor finds.

Strengthening of any weak muscles found, often the abductors is important.

Start training on short distances, for runners on level, soft ground rather than on roads, for example. Should runners find that the pain in the leg returns with running, or cycling, then one important simple test is to check the pulses in the lower leg, to rule out leg pain due to intermittent claudication.

Likewise in the older person, iliotibial band stretch will be important, and weight loss should that be necessary. Between a rock and a hard place, the older person in pain cannot exercise, and puts on weight.

In pregnancy, the management of the pelvis is vital. A sacral, or iliac subluxation is usually the underlying problem. There are many gentle treatments now that chiropractors use in the management of pain in the elderly and the pregnant woman with leg pain.



MAIGNES SYNDROME


Because Maignes syndrome, a high lumbar facet syndrome also refers pain to the lateral buttock and thigh, and sometimes the groin, it too should be considered in every case of ITB pain.

Another condition producing lateral thigh pain is Meralgia Paresthetica where the nerve is trapped in the groin.



ITB Stretching

Because it is such a long tendon, stretching the ITB is particularly difficult. The best method of iliotibial band stretch can put undue stress on the pelvic joints, and should be done with care and discretion.

The following pictures will help. What I advise is to really stabilise your whole body with your arms and shoulders over a desk, so that the whole torso is fixed, giving support to the pelvis. It doesn't help to stretch the ITB, should it aggravate the SI joints!

CHIROPRACTIC COALFACE

Mrs S is a 52-year old woman, currently under care. She has typical Tensor Fascia Lata pain, radiating down the iliotibial band. The pain started four years ago for no obvious reason, but was and is associated with a lumbar facet syndrome. Left lateral flexion is painful in the lower back.

A piriformis release two years ago brought no relief at all. In fact, the pain got worse. Astonishingly she is taking 10 analgesics per day, 70 per week! Worse she is taking dual antiinflammatory drugs a lethal Molotov cocktail of medication.

Whilst it's early days, only four Chiropractic Help treatments, she is down to 2-3 pills a day, and despite that she says the pain is at least 30-40% better. Vital are lower back exercises ITB stretches and ice for the pain.



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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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