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.
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.
Background Reading
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. 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.
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.
-Super last, I am open to being convinced that it is worthwhile. Perhaps, rolling your IT Band has some other benefit.
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.
http://saveyourself.ca/tutorials/iliotibial-band-syndrome-stretch.php
http://saveyourself.ca/tutorials/iliotibial-band-syndrome-tendinitis.php
http://saveyourself.ca/blog/0039.php
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.
http://strengthcoachblog.com/2012/04/12/is-foam-rolling-bad-for-you/
2. Mike Nelson provides an argument against foam rolling:
http://miketnelson.blogspot.ca/2008/01/get-off-foam-roller.html
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.
http://www.elitetrack.com/blogs/details/6897/
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.
http://ideasforbasketball.com/2012/04/18/myofascial-release-foam-rolling-contractile-muscle-properties/
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.
http://digitalcommons.sacredheart.edu/masterstheses/2/
Thanks,
Greg
Not logged in
Why don’t you start your own research study on foam rolling if no one else has done it yet?
I’d love to do that research but I am not a researcher nor do I recommend that individuals use a foam roller on the ITB.
I like your reasoning about the ITband. I have commonly had patients describe medial knee discomfort when I am trying to stretch the ITband (in Ober’s test position), and found that if I maintain internal tibial rotation, this discomfort goes away and their feeling of stretch is intensified. I wonder if component of tibial rotation is often an overlooked problem in those with patellofemoral and IT band problems.
After running a marathon, my IT bands were pretty uncomfortable. If not foam rolling, what do you suggest I do to help them feel better. I have to admit, I have been foam rolling, and it has seemed to help.
I’m not an expert on ITB, nor am I an expert on fascia. But I have done an awful lot of reading and research into the stuff! I believe anything related to ‘facial manipulation’ be it massage, scraping, trigger point work, rolling etc. is mostly neurological! I firmly believe it has almost nothing to do with fascia, and almost certainly mostly to do with the central nervous system (CNS).
I don’t deny that you can or can’t manipulate fascia, because, I don’t know! The above is just my belief and I agree with this article, rolling ITB is just pointless and damn painfull, but, if you feel you got results from it, then good for you! I’m just saying, I believe it’s a mental thing, rather than physical. Because you’ve used roller before on other areas, and you’ve heard of rolling ITB after strenuous work (marathon etc) you did it, and believed its going to work, and so it did!
Hope this makes sense, I must stress, this is my opinion, and not based on anything other than what I have found out and learnt from speaking and working with other industry experts, I stand to be corrected at any time if somebody can show me proof!!
Charlie
Thanks Charlie,
It does make sense. I suppose a component of the debate is how do we best influence the nervous system.
G
After running a marathon, my IT bands were pretty uncomfortable. If not foam rolling, what do you suggest I do to help them feel better. I have to admit, I have been foam rolling, and it has seemed to help.
Hi Seth,
Congrats on the marathon, I hope you killed it. For recovery I would take it easy for a bit. Gentle massage, heat, general exercise and light jogs can all help. And maybe even foam rolling if you find it helpful. My post is more of a debate with myself than an absolute scream against doing it. I just write with a little too much hyperbole. I am even open to foam rolling helping in some way, I just question the mechanisms that us therapists typically put forth.
Glad to hear it has helped but time may have been a factor as well. I would recommend you figure out what you can do to prevent your ITBs from screaming the next marathon you do.
Good luck,
Greg
Cool post, certainly some food for thought.
Regarding your point about adhesions, do most, if not all foam rolling exercises act as a compressive force to ‘pancake out’ a muscle to improve its tissue quality? Or does this differ between what I guess are similar to zones of convergence, in particular the ITB and VL as mentioned here. My thought process is a bit hazy here in my own mind so it’s difficult to convey it properly!
I guess ultimately if the ITB is symptomatic then it becomes a case of establishing if and why the TFL is dysfunctional through facilitation or inhibition, which in turn would theoretically drive adaptations along the ITB to compensate?
Hi Alex,
Don’t know why or how foam rollers might help. And don’t trust the tests on the TFL for facilitation or inhibition. Thanks for making me distrust my own existence.
How do you know your pain was related to your IT Band? If you just ran a marathon, you put your body through a great amount of stress. Pain is a defense mechanism from the brain to protect tissue which it believes IS injured or has the POTENTIAL to be injured. This discomfort was likely simply a communication from your brain to your hip due to the significant amount of stress it just endured. It does not signifiy injury and if it does, how can one differentiate the discomfort as the IT band vs. other structures in that region. The only test that I ever learned was the OBERs test which has never been validated due to a lack of a gold reference standard to identify the IT band as dysfunctional.
I am in agreement with you, most mechanisms that are used to justify this are not backed by literature. I personally feel that the foam roll has an effect to the muscles deep to the ITB and its ‘sock’. By altering tissue tension and affecting trigger points the overall tension of the sock can be altered due to decreased global tone and pull. Any thoughts?
Maybe we don’t even need to or even can alter the tension in the ITB. Staying with your line of reasoning maybe the therapeutic effect is just influencing the “trigger points”. If so, I then wonder if we need to beat the shit out of “trigger points” to make an effect. If trigger points are sensitized nerves (or AIGs) then why bludgeon.
Thanks Eric, I am happy you gave me the chance to write many words and provide little, if any, insight. I feel like a politician. F35 anyone?
[...] Stop Foam Rolling the IT Band, It’s Not Tight and It Won’t Lengthen [...]
Great post Greg. I’ve wondered these same things. I also try to give folks the benefit of the doubt and speculate as to how it theoretically could be helping…maybe relieving trigger points in the vastus medialis? Anyway, great job with the post.
Hey whats up Ass man,
Your right. I meant to attach a rider of doubt (benefit of the doubt as you called it) to the blog. I guess I just felt ornery.
I am still open to the notion that it might have clinical effectiveness, just don’t know the mechanism. Can we foam roll without pain? Would this be as effective? Or when we our told it is going to hurt, we make it hurt, we then fulfill an expectation and derive a clinical benefit from that?
Greg
You might be interested in:
http://saveyourself.ca/tutorials/iliotibial-band-syndrome-stretch.php
http://saveyourself.ca/tutorials/iliotibial-band-syndrome-tendinitis.php
http://saveyourself.ca/blog/0039.php
and/or referring your patients to these articles for easy to understand explanations about your view on the matter.
Thanks,
I will link them in the body of the blog. Soon. promise
Nice one. I always think people with IT “tightness” or IT pain may also want to check the position of the fibula (and any related imbalances in ankle and foot). Do you agree? They may also want to check whether vast lat or TFL is “tight,” and why: has it tightened because it’s inhibited, or because it’s overworking?
Hi Suzi,
Don’t know about this. I think it is good to check everything but I personally (as an opinion) have never been someone that believes STRUCTURE IS DESTINY. Meaning, tight this, weak that, drop foot, knock knees never seem to add up to pain, at least consistently or simply.
But for sure look for “tightness” somewhere else in a tissue that is related to the ITB. Some times these muscles are tight just because there is a pain state going on.
greg
Intersting debate. I was taught that the main benefit of foam rolling was Autogenic Inhibition, i.e. = Aplacing pressure via a foam roll helps to stimulate the Golgi tendon organ to create autogenic inhibition which ends up releasing the “bundled up” muscle and helps to straighten it out. Is this not the case with the ITB because of its particular structure that you have described?
Don’t know Matt,
Which muscle would we be affecting? Distal or proximal. Anterior or posterior. If proximal we would inhibit the TFL and the GMax and then we would never be able to rotate our legs! Just kidding. I don’t know if autogenic inhibition works at a sustained level. I see it more as a transient reflexive thing. Otherwise when we contract our muscles we would always be limiting the strength of that muscle during a prolonged contraction.
However, this is more in line with how I think anyway. Maybe a gentle foam rolling (non-nociceptive) good stimulate a relaxation in the muscles which attach to it. I think this is much what Robert Schleip suggests I just don’t know if its via the autogenic inhibition mechanism.
Thanks Matt.
I’ve got nothing to add other than a slow clap and the heads down admittance that I too told my clients to foam roll their IT bands no longer than a year ago. This is a massive dogma that needs to be changed in the personal training industry. I’m going to share this with my network and help you get the word out. Thanks Greg.
Thanks Jon,
I change what I do on a weekly basis. No shame in that. I think. Wait, maybe there is. I don’t know. I reserve the right to change this opinion.
I find foam rollers helpful in reducing muscle tension but as you have pointed out, the IT band is not a muscle! I recommend to clients complaining of tension in the IT band that they stretch their glutes thoroughly. And a deep tissue massage to the glutes and tfl muscle usually decreases their sense of tension in the IT band.
Thanks for your article!
Sam Colverd
Remedial & Sports Massage Therapist
I remember many years ago I observed in a clinic that specialised in “lengthening ITB’s with their elbow….. The athletes were normally in tears screaming for them to stop before limping out of the room.
A couple of weeks later I caught up with one of the patients (victims) down the track and asked how it was going.
“hurt like hell for 5 days, had to stop running, but now feels much better thanks”
I wondered how long it would have taken to feel better if they had had a cup of tea and a nice chat, taken 5 days off running then resumed. We are a funny bunch.
Maybe pouring hot tea on the ITB band would help. It would certainly create an inflammatory response. “Infusion therapy”
This rationale is flawed. The foam roll on the ITB or anywhere else does not stretch, about that-you are correct. It is a direct pressure tool which in time (stationary/sustained 3-5′) elicits the piezoelectric effect and creates a phase transition to soften Myofascial restrictions in the tissue. Treatment should be stationary not rolling. Watch my YouTube video (wholisticvideos) for further instruction. I don’t need research, I need and get results… That’s what counts, even if we’re
not EXACTLY sure how or why it helps. It’s a lifesaver for post marathon legs, try it properly and see!
Hi Scott,
I guess what you said about changing myofascial restrictions might be a plausible explanation but leads us to the question of whether we can mechanical cause change in this type of connective tissue. I don’t want to misquote Robert Schleip but I believe he said it was not possible in a paper he published in 2006 with Chaudhry as the first author. The paper is here:http://www.jaoa.org/content/108/8/379.abstract
So here is a fantastic fascia researcher suggesting that we can’t deform this wonderful bit of tissue.
Assuming you can soften myofascial restrictions (again, I don’t really know what they are) why is this beneficial in a strap that does not stretch.
I can even see a rationale (maybe) for rolling a tissue in uninjured legs with the arguement that this might improve some fascial strength with long term loading but I can’t understand why you would roll a tissue that is healing after you have insulted it with a marathon.
Anecdote is cool but we need more.
Scott, thanks for your response. Generating input like yours is a great benefit of making these posts.
Last, I hope it didn’t come off like I know everything. That would be wrong.
Greg
I cringe every time someone comments on ITB”frinction” syndrome. Great to see your citing the anatomical research. There’s no way the ITB can strum over Gerdy’s tubercle.
PIR seems to resolve restricted hip adduction in about 60 seconds, setting the stage for locomotor stability training.
You question the role of the roller for ITB and I agree w/ your premise, in deference to the fact that banging on the sore spots will not give any long term benefit. It’s sore for a reason, so we should assess to figure out why it’s sore.
i am a pilates + fitness instructor. i like the way you think. hi5. bookmark.
My take is that the only benefit is that moving around on the floor in an unusual position is a mobility drill, and the pressure of the roller against the tissue doesn’t matter.
Steven,
I’m with ya. I think this is a good explanation.
Greg
While I agree that foam rolling with stiff foam is painful (from personal experience), and compressive in nature, thereby eliminating any tissue shift that might contribute to adhesion breakup, my experience in working with people has me convinced that there is absolutely merit in working the ITB. After stripping with fists/ forearms and mfr techniques, there is almost always a palpable change in the tissue toward being more supple. Chances are the muscular tissue under the fascia latta is affected more than the ITB, but if change is achieved, I’m a happy guy.
I recently experienced a “kinder, gentler” roller called Melt, AKA OPTP, which was softer than the standard rollers, significantly less painful, and felt like it achieved that myofascial release I was looking for.
I am all for kinder and gentler. Interestingly, I know that I can change tissue suppleness, restrictions or tightness with what I say to patients as well. It is not always the tool we use that must cause a mechanical deformation. The “release” we feel can certainly be mitigated by the nervous system. You will hear people who manipulate the spine report finding changes in tissue texture after spine manipulation. These changes can occur at sites distant to the manipulation. Am I blowing your mind?
I guess I am most interested in the mechanism…and I tend to think the mechanism is the nervous system and less so something we mechanically do to an adhesion.
I am not even sure what an adhesion is. I really do want the “Adhesions for dummies” book.
Thanks Greg,
Greg
I never thought of foam rolling as trying to stretch the ITB but as more of stimulus for “microtear” or myxoid degeneration repair. Similar to how edge tools work on lateral epicondylosis. It might be causing a neurological deafening as you mentioned. Since the ITB is really the thickened outer layer and penetrates deep to the linea aspera, it is greatly affected by the anterior and posterior thigh muscles. In addition, it is not just reliant upon femur length but crosses and attaches to the tibia as well as connections to the TFL and thus the pelvis. It is definitely a debate, but if you are going to make a general statement like this make sure the research or at least some clinical anecdotes show it to be harmful vs the clinical indications that it can help.
Hi Michael,
I just pounded out a detailed reply to you and lost it. Here goes again.
The microtear idea is interesting - it assumes that our treatment for an epicondylosis is to damage the tissue with the tool, cause an inflammatory cascade and then hope it reheals properly this time. But for an otherwise healthy ITB why would we do this. People don’t advocate just rolling the IT in terms of injury just for tissue health. Related, is the whole ITB under a state of disrepair like the tendon of the elbow? I doubt it, then we need a different mechanism.
I’m a totally with you on the importance of the other attachments to the ITB but I was only commenting on beating up the ITB itself. Your points actualy support my argument. Thats why I think our therapeutic interventions should be directed at these other areas that we might have a better possibility of actually influencing with therapy.
As for the question of research, your totally right and that is why I am open to changing my mind. A lot of my article is opinion and I can certainly stress this more. BUT, I don’t know how I would be balance my opinion that questions the clinical utility of using the foam roller when I don’t think there is any research supporting “the clinical indications that it can help”. I don’t know what these. But I am totally open to hearing about them.
Thanks for your comments, I do appreciate them.
Hey Greg,
Nice article. Do you use the foam roll for other areas of the body? Or do you just not support it’s use for the ITB?
Good question Kyle,
I don’t use it for other areas of the body but I’m open to it, and certainly open to it if you aren’t precipitating a pain experience. I would definitely use it on the ground and work on jumping over it. So I guess this counts as the legs.
Greg
I’m also a runner who has lateral knee pain that has presented me from training. I rolled out my it band for all of two weeks nothing changed. Muscle testing Revealed vastus medialis weakness and hyper tonic vastus laterals. So my thought is to roll out my lateral quads do you have any opinion on whether that would work or not? Thanks for the paper links though makes me think about what I tell patients.
Hi Breanna,
Sorry not sure what you should do without looking at your knee (I know what a copout). I would not rollout but do something that is more likely to settle the pain. I think weakness stems from pain. I don’t know how to tell if a VMO is weak or VL hypertonic (I’m not sure anyone can) so I would not hang your hat and pin your rehab just on this.
Good luck and hope you can keep running.
g
Greg,
Thank you for this post (although I’m a little disappointed you beat me to it because I’m working on something similar).
Every since hearing Robert Schliep talk about fascia I have been looking for alternatives to foam rolling. He talked about similar things to your post including how the roller just removes fluid from the tissue like ringing out a sponge, thus reducing the effectiveness of the tissue at producing force/providing stability.
Thanks again, can’t wait to see what you come up with next.
Thanks Luke,
I’d like to read Schleip’s stuff on that. As for the post, just change 12.5% of it, erase my name and repost it. Isn’t that what perpetuates the internet?
Greg
I understand your anatomical reasoning, the density/thickness of the connective tissue wouldn’t seem to lend it to an excess of viscoelastic properties… but does that necessarily mean there is NO lengthening, or just a small amount (ignoring your views on stretching for the time being)? I couldn’t find a number in the literature (and would be skeptical about such a quantification anyways), but surely even a slight loosening of a structure that is already under considerable stress would lead to benefits (reduced patellofemoral symptoms, increased hip adduction, etc.). This small change could be what you call short-term deformation, which could be why rolling daily (or twice daily) is recommended, but if you did that daily, and your patient sees benefits… where is the “evil” in that? It’s certainly not a replacement for massage/ART/Graston/etc, but I still see it as useful.
Also, the nervous adaptations you refer to… are you referring to pain receptors which would be crushed by the pressure? If so, and maybe I’m off here, this would dampen the pain that you would feel, reducing sensitivity to a “charlie horse”, but how would that describe an incidence of reduced low back tightness, decreased knee pain (and other patellofemoral symptoms), etc. over time, which are routinely reported and are incidences of what I would consider improved overall function and not simply a nervous adaptation of the IT band area? While I’m not necessarily disagreeing, I’m just wondering if you disagree with it’s excessive promotion as a miracle cure for runners (which it’s not), or whether you truly believe it hampers your training as you seem to indicate? Interesting post.
Thanks Spencer,
I have few answers here a less time. We could answer half your questions in a nice MSc study. The other half would be a failed PhD. I am with you that people definitely perceive some benefit. I guess I just question the mechanism. I am also against it being a rampant panacea or miracle cure for all runners. Also with you on questioning whether it does hamper training, probably not but is there a better way to spend your time.
As for lengthening I think it could lengthen viscoelastically (via creep) if it wasn’t tethered to the femur its whole length. We would have to somehow loosen all of this tissue as well.
As for the pain I tend to lean toward not amplifying a pain state. I don’t want to crank up a sensitized nervous system. Although, I know that many make a case for treatment via creating some pain I am not that conversant with this mechanism.
Greg
I am not so big on the rolling as the use of the roller as a big pressure point “trigger point” that being said. I find people “”cheat ” with rolling anyway. If they put all their body weight on the roller and the it area they are more helpful. I would like to point out the anatomy research lately about small amount s of skeletal muscle fiber in fascia. It is not an inert unchangeable plastic like band
Sure it has some smooth muscle but this does not necessarily mean it can “lengthen” just like it is difficult for a muscle to lengthen. If it is “lengthening” it would have to be “shortened” due to the nervous system contracting (not that I think this is really possible given the small amount of muscle cells in the fascia) and therefore any mechanism that creates lengthening would be from manipulating the nervous system. I don’t think the nervous system responds well to getting the shit beat out of it. (that would make the foam roller a loan shark)
thanks
Thank you for this! One of my biggest peeves when I go to the gym is the trainers and their use of the rollers on their clients. I want to ask them if they are licensed to massage people, because that is technically what they are doing, and they’re doing it wrong! And especially on the IT band. I tried it once and the pain about killed me. How can ANYONE think this is good for you? I’m sharing this on my FB page.
It’s my thought that when the roller is used (I also have one), some trigger points that may be in the Vastus Lateralis (both anterior and posterior to the ITB) may be massaged into submission, at least temporarily. This may be the ‘relief’ that some users of the roller claim to have felt. I have noticed that the points that are painful are the same known trigger point sites that are well known to exist. Exploring with the fingers confirms the TrPs (or adhesions). I am in total agreement with your position, Greg. I never advise my clients to use that torture tool. Using a knobble is a very effective way to address the TrPs or adhesions with XFF and/or static pressure (I use both). Thanks for an insightful post.
So what if we take a look at why it is tight in the first place? Or should I say appears to be tight….??
I would assert the tightness is not the problem but rather a symptom of a break down in neurological loop somewhere else in this complex system called our body.
Foam rolling in most clients is going to cause more muscular inhibition then not. How do you know if it will cause more weakness with a client, check your work using Muscle Activation Techniques.
I think it is awesome that people are starting to take a look at foam rolling on a more science based platform. Exciting thing to come I am sure! Thanks for starting the conversation Dr. Greg!
Hey Greg,
Great post and thanks for presenting the contrary to popular belief. I believe this only strengthens our treatment approaches. To question why we do everything we do as physiotherapists is vital to staying ahead of our game.
Here are my 2 cents since you kindly asked:
Any therapist that believes that the foam roller is the cure to ITB pain should be stripped of their license.
Here is why.
Connective tissue doesn’t wake up one morning and decide to be tight. ITB is no exception. Regardless of whether the foam roller causes an inflammatory response, lengthens tissues, or creates a magnetic field that causes you to levitate (*hint of sarcasm) the foam roller hasn’t addressed the most critical question WHY?
Why are they having this pain?
After working with hundreds of ITB cases and being able to resolve most within 1-3 sessions, I have found the primary culprit is usually a movement dysfunction of SI joint, poor hip girdle recruitment, and poor ground reaction force absorption. ITB pain is merely a symptom of these dysfunctions.
In plain English: “Your knee hurts because you hips are out of whack and your nervous system is not firing correctly. Good news is I can fix it.” LOL
*Side Note: I do utilize the foam roller as part of my treatment to help me achieve my ultimate goal of restoring SI movement and re-activation of neuro patterns. Do I know exactly what happens with the foam roller when someone rolls on it? NO. I do know it allows me to achieve my goals and my clients goals to return to doing what they want without pain ASAP. At the end of the day that is what our clients want.
Just my thoughts…and yes I have used the analogy of kneading dough when foam rolling because it helped to make what my clients are doing easier to understand.*
*Your post has caused me to revisit my position on this though. Thanks for making me question my assumptions. Looking forward to exploring it more.
Cheers,
AC
Hi AC,
Thanks for the insights. One question, what methods do you use to find altered SI joint mobility and poor hip girdle recruitment? Do you think the hip girdle recruitment dysfunction is the cause of pain or the consequence of having pain?
Thanks,
Greg
Greg,
I check SI movement dysfunction in standing first at the PSIS. I look at Sacral to illium movement on single leg stance with knee lift to determine SI integrity. I also check in supine. I also check joint and capsule integrity, End range feels…
I perform different muscle activation tests in supine, prone, and most importantly in functional patterns to determine level of neural recruitment.
As for the age old question which came first the chicken or egg? Not sure.
Are they not firing correctly secondary to movement dysfunction or vice versa? Again not sure. Both may be correct in different instances. Regardless one needs to restore movement , then flip the on switch on the nervous system.
I am not about complicating things. In my practice I have done away with more than 90% of what most physical therapists do because it wasn’t yielding results quick enough (I still view them as useful just not necessary). I value my time and my clients so I set out to find the 10% of things I can do to give 90% of the results. My goal is to reduce pain and increase function by 90% in the first session. Simplicity works wonders…Sorry for the rant.
What is your experience with ITB and what has worked for you?
Cheers,
AC
PS- Looking forward to reading you provided. Thanks again.
Hi Greg - So I keep seeing you say stretching the IT Band as your issue with the rollers. However, the purposes that I have always understood it to be for was for inhibition of the muscle, not stretching. In NASM’s corrective exercise protocol, which is used at some of the major universities (ie the one where I received my Master’s) explains that you need to inhibit, lengthen, strengthen and integrate. So, with that protocol you use the roller to inhibit the overtight muscle, then you use a stretch to lengthen it, then it allows you to strength the opposing muscle with another exercise, and then integrate use of both, etc. NASM promotes the use of rollers and they have numerous studies they refer to for the reason you use the roller for inhibition. So, I’m just wondering what your thoughts are regarding NASM.
Thanks!
Lori
Thanks Lori,
I am not familiar with this protocol by NASM. I will look into it. As a skeptic I would probably question every step in this line of reasoning though. Here goes:
1. I can’t see how rolling which creates a noxious stimuli would result in inhibition of a muscle that is assumed to be “tight” because of some altered neural drive to the muscle. Related, what is the muscle around the ITB you would target? Last, if you roll a healthy muscle does this then inhibit it? Would this not be bad?
2. Lengthen: I don’t think we ever lengthen any muscle with stretching. The research suggests that we merely increase our stretch tolerance rather than changing stiffness. I can only make a muscle longer if I break a bone, stretch that bone with spacers thus increasing the distance between origin and insertion.
3. Strengthen the opposing muscle: Is the opposing muscle weak? Why? I guess I am arguing that this is the fallacy associated with reciprocal inhibition. I haven’t seen anything showing this exists (i.e. a supposedly tight muscle causes weakness in its antagonist).
4. Integrate: Why do we need to wait? Just start integrating right away.
As I write all this know that I also believe that this treatment protocol could also work with patients pain and with their strength or performance. Hows that for sitting on the fence. I question all the steps of the proposed mechanism but I still believe it can be clinically effective. Meaning, I bet we could do all the components of the NASMs protocol, in any order, maybe even a skip a few components and then still get acceptable results.
Thanks Lori, send my any NASM stuff you have if you think I’m missing the boat here.
greg
Thank you from someone who discovered she has impaired lymph drainage in her legs (probably only slightly aggravated by foam rolling of the upper leg). I think I was on my way to compartment syndrome in my shins when the intervention hit. Graduated compression stockings are in my (at least, near) future (and not as unbearably hot in the gym as the first week of 10 meter bandage compression was) I will treat future leg tissue tightness very gently!
[...] Here is an excellent article on foam rolling the IT band, along with insightful comments beneath the actual article. [...]
When my left knee starts to hurt and I can actually hear the ITB snap when I walk, the only thing that fixes it is foam-rolling.
When I was suffering from severe pelvic pain, the only thing that helped it was foam-rolling.
Your article and insights are meaningless to someone who has benefited from foam-rolling.
Touche(with accent on the e)
Yup, positive stories are good to hear. Again, curious what this mechanism is and how to exploit it.
[...] to Knee Pain - The Manual Therapist Does the Bench Press REALLY Matter? - Zach Even-Esh Stop Foam Rolling Your IT Band. It can’t Lengthen and it is NOT Tight - Greg Lehman How Stress Wreaks Havor on Your Gut - Chris Kresser Rack Pull Tidbits - 70′s Big [...]
[...] there will be many in the online world that would say “foam rolling doesn’t work, it doesn’t break up muscle adhesions or lengthen the I… and they make good points but I love the foam rolling benefits that my body receives. It has stop [...]
Tensor fasciae latae. Not fascia lata. Use those E’s bro. Makes me question you.
I think fasciae is the plural and fascia is the singular. You can still question me though.
How do you treat knee pain then? I jump a lot and have tendinitis / chondromalacia patella. I have been foam rolling too and it doesn’t help with the pain much.
Another copout response but you really need to see a physio, strength coach, massage therapist, chiro, osteopath or someone you can trust and get looked at. Chondromalacia patella is not related to symptoms and is not tendinitis. Once you hammer down a diagnosis or some functional deficits than I think someone can help you. Good luck
Hi,
After having read extensively on the topic of ITB syndrome, I thought I would add my two cents worth, for what it is worth.
Very few papers have shown any statistically significant results relating to actual lengthening of the ITB itself. Those papers that have, have also admitted that the methods used may have contributed to the effects seen i.e. one study was conducted on cadavers.
Several papers (mostly by the same contributing author, Fredericson et al) have advocated strengthening the hip abductors as weak abductors have been purported to lead to a greater strain upon the ITB. Like most research, this has been disputed by one author (Grau et al) that states that there is no relationship between ITB syndrome & weak hip abductors. As mentioned in the article Greg has posted, rather than trying to lengthen the ITB via a foam roller or soft tissue technique, paying greater attention to reducing any hypertonicity in the TFL/Glutes complex may help to reduce the tensioning effect of these muscles on the ITB itself.
For those interested, the below link contains a excerpt from Robert Schleip’s paper ‘Fascial Plasticity - a new neurobiological explanation’, which contains some very interesting insights into how myofascial work may influence a change in soft tissue via the CNS. I think some of what he writes could help explain some of the positive benefits reported by those using a foam roller on their ITB. I’ll let you make up your mind.
http://www.fasciaresearch.com/InnervationExcerpt.pdf
Thanks,
Great link.
Greg
Hi Greg,
I apologize if this questions has been asked and answered as I did not read all of the comments! I was wondering (as I found your article very interesting), do you recommend good, deep tissue massage on IT bands? Also, what are your thoughts as to why the IT band area is brutal on some people and not so intolerable on others?
Good questions Alyson,
1. Deep tissue massage: same idea as the roller. I would recommend working everything around the ITB rather than the IT itself. I shifted through the years and feel like we can get great results without using a lot of force in general. BUT, I still have some doubts here based on anecdote. I know too many athletes who respond well to deep tissue work. I don’t think it is right for everyone but perhaps there is a subset of individuals who can benefit.
2. Brutal on some: I think in general it is brutal because we are compressing the crap out of this tissue right onto a bone. I think there are tonnes of areas in the body that are tender when we compress tissue against the bone. Think the upper traps where people press in, call it a trigger point, but are really just compressing those tissues against the first rib. Second (and probably more accurate), I think some people just have more sensitive nerves in the area of the ITB. What drives nerve sensitive is too big for this response but I would suggest reading Explain Pain or The Sensitive Nervous System by David Butler and Lorimer Moseley.
Thanks,
Greg
Hi Greg.
Interesting article. I’ve had quite a few patients where I’ve “found” tight and tender ITBs. But as you say, most physical therapists are taught to find it. I personally don’t test it with Ober’s test - as you say, there’s so many structures being stressed during this test that it’s irrelevant. I just palpate it, and can usually find tenderness in any patient.
I will admit I haven’t read all the comments - there’s just too many! But what you didn’t point out in your article is that most people have very weak glutes, and therefore limited lateral stability of the hip. That “tight” ITB is then the only lateral stabiliser. So what I prefer to do is concentrate on glute strength and correcting faulty hip extension firing patterns. I also believe that the majority of work done to ITBs doesn’t affect the band itself, but actually helps reduce down the sub-dermal fascial adhesions.
Also, I fully believe your assertion that manual therapies work mostly on the neural connection rather than the actual tissue itself. But then I’m a chiropractor, and that’s what we do!
Hi James,
Completely off topic but since you mentioned chiropractic and neural connections I would suggest you look into the work of David Butler and Michael Shacklock (I thought their separate work, specifically the Sensitive Nervous System, would have been a great adjunct to chiro college). These Two physiotherapists really go after neural connections and the health of the nervous system and the pain neuromatrix (see noigroup.com) . While we talk in chiropractic about “nerve interference” I think these physios are really providing another way to address those angry irritated nerves. Their work stemmed from the initial work of Elvey (Physio) and Alf Breig.
Another side note, I was one of many authors who just finished a publication for a special issue in the Journal of Electromyography and Kinesiology on the effects of Spinal Manipulation. There will be a tonne of great research reviews that look at SMT and its neural effects highlighting the work of JD Dishman, B Murphy, E Suter, J Pickar and a slew of others. I mention them because they really consider and provide nice evidence to shift the commonly held mechanism of spine manipulation from “bone out of place equaling nerve interference” to spine manipulation doing some pretty neat neurophysiological stuff (changes in alpha motoneuron pool activation, H-reflex changes, TEMS changes, changes in muscle inhibition/facilitation). I think it is coming out this summer.
You mentioned reducing sub-dermal fascial adhesions. This is a pretty consistent comment here but it is still something i am skeptical about (although I wish I wasn’t since it is an easy way to explain why we do what we do). Its one of those themes that are so prevalent yet no one has every really explained to me exactly what an adhesion is. Can you see it on an Ultrasound, histochemically or with an MRI? I work with an Ultrasound tech and she says she has never seen one…and she is excellent. When I took an A.R.T course a decade ago and heard all this talk about “adhesions” I kept thinking that it sounded just like “subluxations” but in a different context. No one could nail down what it was nor could they explain how rubbing it made it disappear. The best answer was that you just feel it…sounds like the answer you hear when someone tells you that L3 is laterally bent on L4 and therefore the facets aren’t sliding properly. The interlayer adhesion notion and the idea that we can disruption these adhesions by making tissues slide better past one another (rather than an adhesion in a muscle) seems more plausible but the idea of an adhesion in a muscle needing to be cleared I have trouble grasping.
Adhesions ain’t scar tissue or we would never influence it. I then hear they come from immobility but are gone once you move. Then I hear they come from over use and I then think doesn’t over use lead to adaptation and increasing strength? Why would our architecture be so fragile that we develop adhesions when we use our body? Why do we need such interventions are we so evolutionarily weak?
Sorry, rambling. I question all these things and then probably do the same treatments as everyone else here minus the foam rolling.
Thanks for your comments,
Greg
[...] [...]
Hey Greg,
Interesting point of view, I am actually working on publlishing an investigation on foam rolling and its effect on ROM and various performance measures ( MVC, Tetatanic force production ect). We found that foam rolling the rectus femoris muscle led to a icnrease in ROM that lasted for 10 minutes (did not investigate longer time intervals. We also found that this had no effect on force production or any other perfomrance variable we measured leading us to believe the change was not neurological (see static stretching effect of force production literatreu). We hypothize that mobilization of the facial ground substance from a solid state to a more gel like state aswell as a possible breakdown of “adhesions” in the tissue. I agree with the ambiguity of adhesions but ltierature suggesting myofiacial realease done manually increased ROM leads me to believe it must be doing something. The obvious difference is our investigation looked at the quads vs IT band. However, I would think that at least at the level of TFL foam rolling the IT band would have similar effects.
However, I can see your point of view and I think it should be used like most of our PT interventions in a N=1 fashion. Try it and see on indivdual patients, and if it works who cares wby what mechanism. Sadly, untill a reliable method for assessing length of the it band and TFL is estblaished this will be a diffiuclt topic to research!
Cheers
Mike Penney
One quick question, how do you explain the literature showing increased ROM following myofacial relaease (not stretching).
Thanks,
Mike
Hi Mike,
Is that the ART paper done by Clayton Skaggs in JMPT a few years ago? I wasn’t sure that the difference between the two techniques was that robust. I know for sure that most studies would not have followed people for the long term…any research would have just looked at the acute effects of stretching on ROM. I would have to know exactly which papers to really comment on this. But without seeing those papers, and assuming that there is a greater ROM change with MFR than stretching we could chalk this up to a greater influence on the nervous system. It definitely does not have to mean we are breaking up adhesions, although this is still a possibility. That type of research would be fantastic and I would love to see it.
Let me know what you have and if you have the papers I would love to have copies.
Thanks Mike,
Greg
Hi Mike,
Awesome study. When and where are you publishing it? I would love to see an initial draft if you are open to that. No change in strength with a change in ROM is very interesting. What was the control? Would manual massage with the same intent do the same thing. Its interesting that no research has ever said it could but your stuff suggests that a foam roller can do something that massage doesn’t. Super cool.
Thanks,
Greg
[...] I found an article today questioning whether you should foam roll your IT band (ITB). Well, it was actually a blog post, but it’s here. [...]
[...] Off the Foam Roller - Mike T Nelson Stop Foam Rolling Your IT Band - Greg Lehman Is Foam Rolling Bad for You? - Michael [...]
Thanks for adding those two links. I was not familiar with them. If everyone wants to read another article questioning foam rolling from Mike Nelson and an article supporting foam rolling from Mike Boyle please click on the link from this comment.
Greg
[...] “Stop foam rolling your IT band” Greg Lehman (be sure to read comments by author) [...]