IT Band Syndrome…Lets Roll-Part 2

Part 2

*Please read Part 1 of IT Band Syndrome…Lets Roll to fully understand this treatment section.*


So how do you treat IT band syndrome?

Since we now know that treating the actual IT band is not the best way to treat IT band syndrome, lets progress to ways we can treat the offending structures.

Ober’s Test
We will first start by assessing the tissue to see if there is indeed restrictions in the TFL and external rotators of the hip (mainly gluteus maximus)and vastus lateralis. The most important test you can do for this is the Ober’s test which assesses the ability of the hip to adduct fully which indicates shortening of the TFL/ IT band. In the majority of IT band syndromes, this test will be positive and show decreased ability to adduct the hip towards the midline of the body when the patient is lying on his/her unaffected side.

Next, we will simply palpate the tissue of the affected muscles to see if we feel any restriction. Never underestimate the power of palpation. Usually, the TFL will feel very fibrotic and hypertonic. This is especially true if there is chronic glute weakness. Also, the vastus lateralis will feel fibrotic and potentially overdeveloped due to it overcompensating for weak glute muscles. Gluteus maximus may not present with much fibrosis, in fact, it may be atrophied, but it will certainly be shortened and hypertonic.

We will start by releasing the TFL since this is most directly connected to the actual IT band and will usually resolve the pathology fastest. Start by having the patient lay on their unaffected side. The patient should be directly on the edge of the table with your hip supporting their pelvis keeping them from rolling backward (and off the table…that wouldn’t be good). This allows for the patient’s leg to adduct fully.

 

TFL Treatment- Starting Position
Start by abducting their hip and place your thumb with pressure on the TFL while supporting their leg as much as possible in order to relax the TFL. While continuing to hold pressure on the TFL, adduct the patient’s hip until it reaches end range of motion and you feel the tension in the muscle under your thumb. This may occur quickly or take a bit more motion depending on the hypertonicity of the muscle. Slightly extend the patients hip and apply a gentle force towards the floor to increase adduction. Make sure the patient’s knee is straight.

PIR with resisted Abduction
Hold this position and wait for the muscle to release and the hip to adduct further. Once some release has occurred, have the patient gently abduct their hip and contract the TFL up into your guiding hand for a 5-7 second count. Once done, have the patient relax and allow the hip to adduct further toward the floor. Maintain pressure on the TFL throughout this process. Repeat this method 2-4 times as needed.

Once this treatment has occurred the patient’s hip should be adducting the leg past the table towards the floor. This has now slackened the IT band because of lengthening the TFL allowing for less friction to occur at the lateral knee and thus improving the pathology.

We will treat the vastus lateralis with firm gliding strokes to with the intention of separating the IT band from the VL. You are not actually going to physically separate these two structures since they share fascia. However, the intention of differentiating the two tissue where they come together can be beneficial; especially distally where the IT band does become independent of the VL. We can also apply a pin and stretch modality to the VL in order to lengthen and break up adhesions within the tissue.

Lastly, we will release the gluteus maximus. Personally, I find that stretching is the best therapy for this. Yes, you can massage it for increased circulation and some adhesion removal but the real problem is a chronic shortening and atrophy. Applying a post-isometric relaxation stretch to this muscle with the patient lying supine is a great way to lengthen the tissue. It may take 4 or 5 contractions/ stretches to get any real lengthening to occur. This is also where home care for the patient comes into play.

Home care:

The patient should have a stretching regimen for the external rotators (including gluteus maximus) to be performed daily. I would also recommend they do some foam rolling as well. Wait, what?! Joel, didn’t you just make the case for not foam rolling the IT band? While foam rolling the IT band is not beneficial, applying it to the TFL and vastus lateralis is beneficial. This can help break up adhesions and increase flexibility. This will be quite sore for the patient so warn them accordingly and have them take there time.

A glute strengthening regimen would also benefit the patient long term. By strengthening the glutes (this includes glute medius and minimus), the correct firing sequence occurs when running, lunging, squatting…etc.. and will transfer unneeded stress off of the TFL, vastus lateralis, and IT band, reducing the chance of IT band syndrome returning.

I hope this tutorial helps clarify IT band syndrome and gives you a better way to treat it.


 

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