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Joelle Cogliati. Speaker. Teacher. Coach.

The Iliotibial Band

The Iliotibial Band or Tract (ITB) is a long piece of connective tissue on the outside or lateral side, of the thigh. You might only know of this band of fascia if it’s been irritated or causing pain.

It can be indirectly related to Illiotibial Band Friction Syndrome, and in advanced or chronic situations, a primary indicator for a host of many other syndromes or dysfunctions. But, let’s first figure out where it is, what it’s connected to, and why it’s such a stubborn discomfort.

Its name implies its beginning and ending point, or its origin and insertion. Its origin, or fixed point, is on the ilium or the iliac crest; this is the high point of the hip, often referred to as the hipbone. It’s insertion, or more mobile point of attachment, on the tibia, or shin bone; it inserts there on the outside and just under the knee. Interestingly enough, this ITB has attachments to its origin via two muscles a tit superior or top end; it’s attached to both the Tensor Fasciae Latae (TFL) and the Gluteus Maximus. I’m sure everyone is familiar with the Maximus or the largest butt muscle that gives our rump its shape.

The Gluteus Maximus is one of the largest muscles in the body used for power, as in going upstairs, rising from a sitting position, climbing, or running. Technically, it’s used for forceful extension of the hip and lateral rotation of the extended hip. The TFL is a lesser known hip muscle that sits just behind the front spine of the pelvis, or the Anterior Superior Iliac Spine (ASIS). Simply, this muscle braces the knee in walking. Technically, it prevents collapse of the extended knee during walking and assists other muscles in four other knee and hip actions. The muscle fibers of the TFL are firing to their greatest potential when one is walking and carrying weight.

When this band becomes irritated, the discomfort is felt on the outside of the knee. This is due to tension in the ITB which causes friction over a boney prominence of the thigh bone; the lateral epicondyle of the femur sticks out, and when the band is tight, it can friction over the extended piece of bone, and it hurts.

The mystery of this pain felt at the side of the knee, lies in the fact that the actual source of tension is coming from muscles attached to the ITB. If a release of the TFL and Gluteus Maximus are not attended to, this condition can remain or become chronic and very disheartening.

There are other factors that can promote this irritation. For example, when one is running on sloped surfaces… where additional tensile stress can be greater on the “downhill” leg.

Enlarged femoral epicondyles or any type of lateral protrusion from the femoral epicondyle, like a bone spur, is also likely to increase the friction. Women also are more likely to suffer form this affliction due to our naturally wider hips; the angle from the hips to the knee is called the Q angle. When this Q Angle is greater, the stress to the outside of the knee can also be greater. There is also a bursa underneath the ITB which can get irritated as a result of compression. People will usually feel pain with activity that will subside with rest. The pain or discomfort will often be worse when going up or down stairs. Most important, get that TFL and Maximus released. Direct work on the ITB itself can irritate it further.

I can attest personally to having had this syndrome for many years. I saw a Physical Therapist and a Podiatrist extensively, more that a handful of Orthopedist’s (Including those who were treating the 49ers), and a Trigger Point Myotherapist (who helped the most initially). So, it was this acute and chronic pain in my body that directed me to learn as much as I could, and it is the reason why I became fascinated with the Healing Arts. I decided that I would figure this out for myself on every level… physical, emotional, and otherwise.

When I did decide to attend an Institute for Trigger Point Myotherapy, I decided that if I could help just one person with this pain syndrome and save them the many years it took me to figure it out, that I was a success. Pain can be a powerful messenger, if you are willing to listen; it can lead you on a path that you would have not otherwise dreamed could be possible.

In conclusion, 3/4 of the length of the IT Band is not contractile tissue, so it does not shorten or lengthen on it’s own accord! It is truly the muscles attached to it that cause the tension that renders it “short” and painful, or with a high level of random discomfort.

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