The most commonly cited reason for stretching the iliotibial (IT) Band is to alleviate knee pain. Before we can state the best way to stretch it, we need to talk about what the IT band is, and then how it influences knee pain. What is the IT band? It’s imperative to note the IT band is not a muscle. I’m not sure if people realize this or not, but based on the way people talk about it, and talk about stretching it, I’m pretty sure people often think of the IT band as if it were like any other muscle. It’s not. Multiple muscles insert into the IT band. So rather than the IT band being a muscle itself, it is a band made of other muscles. The two big muscles comprising the IT band are the gluteus maximus (GM) and tensor fascia latae (TFL). It is crucial to understand the TFL and GM comprise different portions of the IT band. The TFL comprises the anterior portion and the GM the posterior portion. Using the Anatomy Trains philosophy from Tom Myers, we can see while the GM and TFL insert into the IT band proximally (starting at the hip), other muscles insert into the IT band distally too (at the knee). The anterior portion of the IT band connects into the tibialis anterior (TA) while the posterior portion connects into the peroneus longus (PL). Therefore, there is a connection between the TFL and the tibialis anterior, and another connection between the GM and peroneus longus. And all of these insert into one band. How does it influence knee pain? This is where things get a little messier. The most common cause of knee pain is an imbalance between all these muscles acting on the IT band. Specifically: the TFL is overactive and tight, but the tibialis anterior is underactive and long (remember these two muscles are connected on the anterior portion of the IT band). And then the peroneus longus is overactive and tight, but the GM is underactive and long (these two are connected on the posterior side of the IT band). By looking at the specific actions of these muscles we can begin to figure out how pain arises. At the hip, the TFL abducts, flexes, and internally rotates the femur. It also laterally rotates the tibia. Meanwhile, the GM has almost the complete the opposite effect: Hip extension, lateral rotation of the femur and some possible internal rotation of the tibia. That is, the TFL and GM have almost completely opposing actions at the hip and knee. This is why most often when one is strong/tight, the other is weak/long. At the knee: Peroneus longus pronates and plantarflexes the foot and has some effect on lateral rotation of the tibia. The tibialis anterior helps to supinate and dorisflex the foot and internally rotate the tibia. That is, the PL and TA have opposing actions at the knee and ankle. In fact, these muscles not only insert at the IT band, they actually form a band together at the bottom of the foot! Again, indicating when one is strong/tight, the other is weak/long. Remember, the TFL is dominant over the GM, and the PL is dominant over the TA. Therefore, in terms of movement, we have a dominance of internal rotation of the femur, a dominance of lateral rotation of the tibia, and a dominance of pronation and plantarflexion of the foot. This is overwhelmingly the predominant cause of knee pain for people. And this is why so many people are trying to stretch their IT band. However, now we can tell just “stretch the IT band” is a poor remedy. We need to stretch the band in a very specific manner in order to get rid of our knee pain. The most effective stretch is going to calm down the overactive muscles and wake up the underactive ones. We need to loosen the tensor fascia latae and peroneus longs, but tighten up the gluteus maximus and tibialis anterior. An ideal stretch will combine: -Hip adduction (loosen TFL) -Lateral rotation of the femur (loosens TFL and tightens GM) -Hip extension (loosen TFL and tighten GM) -Internal rotation of the tibia (loosen TFL and PL, tighten GM and TA) -As well as ankle dorisflexion and supination of the foot (loosen PL and tighten TA) Why most IT band stretches suck ass Now that we know what makes an ideal IT band stretch to help get rid of knee pain, we can talk about why some stretches aren’t as good. Let’s look at some of the most commonly used IT band stretches: Breaking this down: -We have lateral rotation of the femur (good) -Possibly some internal rotation of the tibia (possibly good) -Hip Abduction (Uh oh –This tightens the TFL) -A great deal of hip flexion (Shit –also tightens the TFL and actually stretches the GM. Opposite of what we want.) -Ankle plantarflexion and no pronation or supination (This isn’t good, but, you could modify this to make it better) This is actually a fairly good stretch for the posterior aspect of the IT band. But as we’ve dissected at this point, we rarely want this. I’d say at least 95% of people with knee pain / people who need to loosen their IT band don’t want to stretch the posterior part. Don’t forget about the abdominals Before criticizing another stretch, this is a good place to talk about the abdominals, specifically the external obliques. If we agree that a tight TFL is a common issue in those with knee pain (if you don’t, you’re wrong), we need to also look at how a tight TFL affects the abdominals. I don’t want to go into another diatribe on movement at the hip, but suffice to say much like the TFL and GM have opposing effects on the hip, so do the TFL and external obliques. That is, the TFL pulls the front of the hip down and the EO pulls the front of the hip up (so do the glutes). In someone with a tight TFL, not only will they potentially have weak glutes, but they will have weak EO too. The result is a lordotic posture: Therefore, a common effect of trying to stretch the TFL is an associated lordosis. This is because the TFL is tight and doesn’t like being stretched, it’s “stiffer” than the abdominals, so it pulls the hip downward to try and lessen the stretch. Not something we want when we’re trying to loosen that sucker up. This is my long way of saying when attempting to stretch the TFL -and IT band subsequently- we need to pay careful attention to how the hips and lower back are moving. Ideally, they aren’t. Realistically, they do. This is often a pain in the ass to get people to do properly. We’ll come back to this. Keep it in mind for now. The next stretch: Breaking it down: -We do have hip extension this time (Much better than the other stretch) -We have ankle plantarflexion (Not good. But this could be modified in the stretch. Although it still wouldn’t be ideal) -We have hip adduction (Good) -We have either a neutral tibia or lateral rotation of the tibia (not good) -Femur is either in neutral or medial rotation (Not good) At least this stretch is targeting the TFL portion of the IT band and not the GM portion. However, there are other issues. Referencing the importance of the external obliques, remember how we want the EO to be stiff when we stretch the TFL / IT band to make sure we’re generating as good of a stretch as we can and we’re not achieving movement from the lumbar spine. You can’t see it in the video, but I guarantee the girl has a lower back arch during that stretch. Look around the internet of people doing this stretch and you find this rather quickly: Notice the arched lower back? While the TFL / IT band is still being stretched some, we’re not doing anything to concurrently stiffen up the abdominals. Next, due to the lordosis, we’re generating a bit of stretch on the glutes. Finally, we’re also promoting mobility at the lumbar spine. Mobility at the lumbar spine is a precursor to lower back pain. While you could cue the person to squeeze the abs to prevent the lower back arch, I find people have a really, really hard time with this. They just don’t know when they’re doing it properly, the right way it should feel, etc. It’s like coaching a 40 year old virgin. Sorry, doctor, but you sir do not have the “world’s best IT band stretch.“ The better way Breaking this down: -By making sure the knee does not fall out to the side we have hip adduction (Good) -A tiny bit of lateral rotation at the femur (Good). More can be accomplished but I find this doesn’t influence the stretch much. -By letting the leg fall to the ground we let gravity give us hip extension (Good) -Internal rotation of the tibia from turning the foot in (Good) -Ankle dorisflexion and supination by pulling the big toe up and in (Good). If you do this last you’ll notice a difference in the intensity of the stretch between letting your foot fall to the ground (plantarflexion) and pulling it up (dorisflexion). Many people will exclaim they get a better stretch all the way up in the hip just by pulling the foot upward. Further evidence the dorsiflexion and supination is helping to stretch the TFL / IT band and the TFL and TA are connected. Also, because of the self-feedback mechanism of laying on a bench or table, you always know whether or not your lower back is arching (in lordosis). Therefore, you are guaranteed to know how hard you need to be squeezing your external obliques to make sure there is no compensatory movement at the spine. Next, by lifting the arms overhead we can also generate a nice stretch in the lats, pecs, and rectus abdominus (all commonly tight). Not really necessary for a stretch aimed at knee pain, but it sure isn’t hurting anything. BOOM. How’s that for bang for your buck? With that said, here are the common ways people may mess this up: 1) Letting the foot plantarflex and pronate You HAVE to make sure your foot is not pointing down and out to the side. 2) Not fully contracting the abdominals If you’re not feeling any stretch in your hip / thigh it’s almost guaranteed you’re not fully squeezing the abs. Watch the difference in thigh position when the abs are fully squeezed and when they are relaxed: Notice the thigh elevates, bringing the hip into flexion, each time the EO are fully contracting. This illustrates tightness in the TFL because when the EO fully contract and posteriorly tilt the pelvis, the TFL is put on stretch. And when it’s put on stretch you can see the tightness by the thigh being pulled off the bench. One sure fire way to know whether or not your abs are squeezed tight enough is if you’re lower back is flat on the bench. If it’s not, you’re abs aren’t tight enough. It’s worth noting that for those with a fair amount of fat on their body, and or lower backs, sometimes they give themselves the “feel” of their lower back being flat when it isn’t. It’s just that their adipose tissue is thick enough to give them that illusion. If you’re watching someone, it’s best to look at the top of their hips. Do they look angled downward? Like an anterior pelvic tilt? Then the abs aren’t squeezed enough. It’s hard to describe, but you can spot it. If you’re having trouble with your abs (this is just a sign they’re weak and not strong enough yet) grab your opposite knee and pull it into your chest. This will allow your upper body to help posteriorly tilt your pelvis. Then you can progress to one arm holding the knee in and the other arm overhead: And then to both arms overhead. 3) Letting the hip abduct This will happen due to the TFL not wanting to be stretched and thus pulling the hip into abduction. For some people adducting the hip to a certain point will cause them to feel pain / pressure in their knee. This signifies that when the TFL is on stretch, knee pain arises. This is verrrry common. Simply only let your hip adduct to the point where you don’t feel pain. Over time as the TFL loosens up you’ll be able to adduct further and further. 4) Poor posture at the upper body A lot of people may not be ready to put their arms overhead when they first start doing this stretch. Many just do not have the thoracic mobility yet (or EO strength) to lay their upper back and head fully flat on the bench. Look at the difference in head posture here: By making sure the chin is tucked you help insure the external obliques are posteriorly tilting the pelvis and not the rectus abominus. When you have that forward head posture and thoracic flexion the RA is in a shortened position. We do not want this. We want to stiffen up the EO, not the RA. One final note: Don’t expect to feel an insane stretch when you do this. It’s not like you’ll feel like your TFL or thigh is going to rip apart from such a good stretch. Be much more concerned with doing it properly. Often times the biggest thing people feel is a hell of a lot of abdominal work. This is good. Remember, stiffening up the external obliques will indirectly loosen up the TFL. Hold the stretch for at least 30 seconds. And I’m out. – Please note the “best” element of this stretch is meant to be a sarcastic play. Understandably, sarcasm doesn’t always land through text. There’s no one magical exercise or stretch for every situation. See the comments for more. For a more comprehensive look at stretching the IT band see: 6 Exercises to Loosen the IT Band For a look at meshing this with a running program check out: 6 Weeks To A Healthy 10k Here are some related things I’ve written: Standing version of the best damn IT Band stretch My visit to the Washington University in St. Louis Sleep positioning and knee pain – Original article and pictures take http://b-reddy.org/2012/03/04/the-best-damn-it-band-stretch-ever/ site
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