Is it possible to stretch the ITB? This is question that I frequently have to address with patients that have a hip or knee problem. The patient will often have been told that their ITB is ‘tight’ and that they need to stretch it. There is plenty of anecdotal information on the internet fuelling the urge to stretch it as well as the current trend to foam roller everything.
Let’s address whether this wide, long, thick piece of fascial tissue can truly be stretched.
Initially it is a difficult structure to stretch due to its proximity and even when you have the back, hip and knee in an optimal position for an ITB stretch the evidence suggests that the change in length in negligible. Studies conducted on cadavers and applying weights to the ITB demonstrated only a few millimetres of change.
The ITB friction syndrome is another diagnosis that has been questioned with the theory being that the distal (outside of knee) part of the ITB has rubbed over certain structures to create an irritation. This theory has no evidence supporting it and certain studies have identified that the highly innervated fat tissue underneath the distal part of the ITB is more likely to be the structure that has been irritated and the causes are multifactorial.
Ultimately if you foam roller the ITB its probably not detrimental although it is highly uncomfortable and doesn’t offer any benefit. Patients do comment on that the foam rolling or stretching helps and perhaps as with a lot of therapies are we changing things more centrally (the brain) with the sensation of rolling merely a distraction from the actual knee pain and more important than any supposed tissue changes.
In conclusion, as therapists we should be questioning why has the patient got knee pain? How are they loading their leg? What is the alignment from the hip and foot? And fundamentally, how frequently and intense are the training sessions?