Audience: Patients and therapists Purpose: A brief argument on why attempting to lengthen your IT Band with stretching or foam rolling is a waste of time and not possible.
A note on terminology: This article talks about using a foam roller to "lengthen" the IT Band. Occasionally, this gets referred to as stretching the ITB. What is argued is that foam rolling can not "lengthen" or "stretch" this structure more than transiently. Yes, it will deform a little bit like all viscoelastic biological structures (they all have stress-strain curves with varying degrees of stiffness) but it won't get "longer".
Warning: I recently changed the title on this post (formerly Stop foam rolling your IT Band. It can not lengthen and it is NOT tight.) because a few colleagues have suggested that it is a bit strong. I agree and also think that such hyperbole will decrease a healthy discussion in the area. I don't want that.
However, I have not changed the rest of the content and again recognize that some of it is a bit salty. Much of it is how I talk to myself and entertain myself. When reading this please just consider the arguments and not HOW they written. I never expected 40,000 people to read this thing.
Please note, I have always been open to the idea that foam rolling might have an influence on our nervous system and ultimately pain. My doubts have been around what many people say foam rolling does which I always found biological not possible. This post explores those ideas.
Original Post -
I am in the minority when I cringe at the rampant unjustified use of the ubiquitous, seemingly harmless but actually evil foam roller for IT Bands. I've seen their use climb in the past 5 years and I am sure that my success rate at convincing my patients to not roll the crap out of their IT Bands is less than 10%. Those rollers are WINNING. Perhaps this post will sway the voters.
My belief has been bolstered by two old anatomy papers by the Fairclough group that showed and proposed that IT Band dysfunction is not a Friction syndrome as the IT band does not "slide around" at the knee. This perception of sliding is an illusion. This group also performed a detailed anatomical analysis of the structure. The papers are here and here. A more recent study has also lent support to these papers with a biomechanical study looking at the strain placed on the ITB - click here. One of the authors of that paper is Andy Franklin-Miller, whose sports medicine blog you can see here.
Some quick points about the IT Band
- the IT Band is not really a strap that runs from the hip to the knee. It is not a discrete entity. Rather it is just the thickest part of the fascia lata. The fascia lata being the sock that wraps around the entire thigh. The IT Band is just the lateral thickening of this sock
- the IT Band is some dense connective tissue and probably can't be permanently deformed. While it may be stretched in the short term this is due to its viscoelastic properties (i.e. adding a bit of grease or shaking out the cobwebs) rather than any means where it is actually permanently lengthened. Actual lengthening would require you to damage your IT Band to get it into a lengthened state. 5 minutes on a foam roller or 10 minutes of daily stretching would not be able to do it.
- you might be able to stretch the muscles that attach to the IT Band. However, muscle stretching is also very difficult. The changes in muscle stiffness we see with stretching and warm up are again due to the viscoelastic properties of tissue. Muscles don't become looser they just have increased tolerance to stretch. Update Nov 2015: some research has even challenged this idea! This is most likely an adaptation of the nervous system rather than any change in muscle tissue properties. See my post here on muscle stretching.
- the IT Band can't be lengthened because it is tethered to the entire length of the femur. Got that? It is tied to the leg bone. It ain't going no where.
- it is supposed to be tight. Therapist will tell you it is tight because they were told to look for it to be tight. They don't have a proper method to determine this. The test that looks at ITB tightness (OBER's test) is really just an assessment of hip adduction range. So many other factors influence this range that to blame it on the IT Band is just bullying (IT Bullying!).
-what if you could lengthen it? Then what? Could you over do it and have some jigglying IT Band that just wobbles when you run? No! This does not happen. It does not stretch.
- the ITB may be similar to tendons. Meaning it stores and releases elastic energy. We definitely don't want to length it or change its properties. There is little evidence that tendon stiffness can be changed through stretching so perhaps the ITB is similar.
Some thoughts and questions on Foam Rolling the IT Band
- I know this is popular. I know people swear by it. But that does not make it right. I don't doubt that after beating the crap out of your IT Band you feel something different in that IT Band. That is your nervous system adapting to some huge painful stress you just placed on it. It does not mean that your ITB got longer or you dug out some adhesions.
- How can a foam roller stretch an IT Band? A roller compresses the band it does not tension it. Without tension there is no stretch. Don't tell me it bowstrings it. This is negligible.
- How can a roller dig out adhesions? This is a massive question because you can even question the existence of adhesions. But assuming that adhesions exist between the sliding to two different layers of tissue how would a roller that just compresses tissue create some form of interlayer gliding. If you think you are causing the IT Band to slide better in its interface with the biceps femoris than you are completely wrong because the IT Band does abut or interface with that hamstring. If you think that the roller is freeing up the sliding between the IT Band and the Vastus Lateralis how would compression do this? I can't fillet a chicken breast with a rolling pin. I need some instrument to put between the two halves I want to separate. Same with the theory between interlayer sliding.
- The foam roller improves tissue health. Maybe. You are certainly stressing the shit out of the IT Band, neural structures, skin, bone and everything. You are probably even creating an inflammatory response. This might have some merit. But I would bet you could get a similar stress with some other movement or exercise that would have other performance or therapeutic benefit. Why not take the thumper and thump away on your leg (I actually do this for kicks)
-Last, no real research on any of the beliefs about foam rolling. I recognize that a lack of research is not proof but you would think something would come along by now. Update (November 2015: there is some research on foam rolling. Feel free to wade through the mess of it. I would only ask "is foam rolling the best use of your time?")
-Super last, I am open to being convinced that it is worthwhile. Perhaps, rolling your IT Band has some other benefit.
-when discussing foam rolling we also need to discuss fascia. I have a related post here.
Updated Last, I was given some links to some posts by Paul Ingraham. I haven't read these yet but have read Paul's other work so wanted to post these here.
Caveat of Ignorance
For those that really disagree with me and really love foam rolling try to get past my obviously hyperbolic title. I agree it is a little strongly worded. Again, I write from a place of ignorance (as should everyone on this topic) so I am open to any information
UPDATE: Below are a few links that further discuss foam rolling
1. Mike Boyle disagrees with even my hesitant conclusion and does provides a rationale for foam rolling. Basically, he believes that foam rolling prepares and individual to participate in activity as foam rolling a stress placed upon a tissue and we should expect tissues to respond positively to stress. I have mentioned that this might be something going for foam rolling I just am unsure how this would really work in practice. He provides No specific mechanism just the advice that it works so we should do it. Interestingly, he refers to me as a "muscular therapist". I am flattered, I always thought I was quite skinny.
2. Mike Nelson provides an argument against foam rolling:
3. Carl Valle provides a very interesting piece that addresses what Mike Boyle said about foam rolling. I found this blog really very informative. I've read Carl's stuff before and consistently find it interesting.
4. An interesting case study looking at foam rolling and tensiomyography by Jose Fernandez. I would be interested in learning more about the measurement properties of this technique.
5. An abstract that looks at the use of foam rolling as a warm up tool. I have not read the full masters so can't fully comment. They suggest that foam rolling decreases jump performance in the short term.
6. Here is a post by Dean Somerset providing a different rationale for why individuals might benefit from foam rolling. This stuff is a good start.