We've all seen a picture like the one to the right, of some man (or woman) foam rolling the entire length of the outside of their leg and unlike this picture here, some people are even smiling about it.
Actually, this picture is pretty accurate. This guy looks very unhappy at the pain he is inflicting on himself.
All you are really doing is compressing your muscles/fascia against your femur.
Not to mention that you can't actually stretch your IT Band. It's just not physically possible. So why is it that people, especially those with knee pain, are still being told to stretch and foam roll their IT Band?
My first thought is that whoever is telling you this is not up on the latest fascial research, or they simply heard it from a source they trust (other healthcare provider, teacher or well meaning friend) and therefore have no reason to doubt it's validity.
The Illiotibial or IT Band, is a thick layer of fascia on the outside of the upper thigh. It's a-vascular, meaning that it has very little, if any blood flow and therefore, rolling to increase circulation and blood flow is pretty pointless.
And unlike some other smaller tendons in the body, does not slide or stretch.
IT Band syndrome is often diagnosed as pain in the lateral side of the leg closest to the knee. It is most often caused by an inflammation of the tendon or in some cases, the fat pad that protects the IT Band from rubbing against the patella. Trying to relieve the pain by compressing it with foam rolling doesn't work.
You're only causing more irritation.
A study in 2010 concluded that it would take approximately 2000 pounds of pressure to elongate the IT Band less than 1%.
Now that we know you cannot stretch your IT Band, here are some muscles you should pay attention to.
Tensor Fascia Latta (TFL): This small but mighty muscle, found between the gluteus medius and Rectus femorus (quadricep) controls your IT Band. The tendons of both the gluteus medius and TFL make up the IT band. It assists in flexing the leg at the hip, medially rotatates (turns leg inward) as well as moves your hip into ABduction (moves away from mid-line).
People often have weak or under active TFL due to sitting for prolonged periods of time with little movement in between. The muscle becomes chronically shortened and tightens up, giving the appearance or sensation that your IT Band is tight.
My favorite tool for targeting TFL is the MB5 massage ball. I find that a ball gets into the smaller space better than your traditional foam roller. It is the size of a small cantaloupe and the density of the material is harder than a tennis ball, but not quite as hard and painful as a lacross ball.
Quadricep Group: The quadriceps are made up of 4 muscles - rectus femorus, vastus lateralis, vastus medialis and vastus intermedius.
Vastus Lateralis (VL): Is the quadricep muscle on the outside of the leg. The VL is often mistaken for the IT Band since it crosses over the middle of the muscle. Because this muscle attaches to the lateral side of the knee it is often a key culprit in lateral knee pain.
Rectus Femorus: This is your main quad muscle and a key component in knee stabilization.
Vastus Medialis: This quad muscle runs on the medial (inside) of the leg between the Rectus Femoris and Adductor Longus and is largely responsible for knee stability.
Vastus Intermedius: The vastus intermedius has a short muscle belly and a long tendon that attaches to the inside of the knee, close to the vastus medialis. It lies under the rectus femorus and therefore is in accessible to massage therapists.
Tibialis Anterior and Peroneus: The Tibialis Anterior, often called the shin, is the larger of the anterior muscles of the lower leg and is largely responsible for flexion and eversion of the ankle. Poor ankle mobility and/or foot biomechanics, especially in those with "flat feet" will cause the tibialis anterior to over stabilize the ankle.
When the tib. anterior gets too tight, the head of the fibula sometimes gets "stuck" since it can no longer articulate or glide properly (think of pistons in an engine block) back and forth during movement. This causes knee pain because the patella is forced to bare the brunt of the movement.
The Peroneals are responsible for stabilizing the ankle at the medial maleolous (inside ankle bone.) and run the length of the anterior leg, opposite the tibilais anterior.
Since the knee is basically at the mercy of ankle mobility and hip stability, anyone who has ever sprained and ankle often finds accompanying knee pain.
To improve ankle mobility and decrease knee pain you must target both the peroneals and the tibialis anterior. The video below works for both msucles
Targeting these specific muscles between massage appointments can significantly decrease your knee pain, increase mobility and help increase athletic performance.
Foam rollers and massage balls can be purchased at the office by calling (603) 370-9193.