To ITB foam roll or not to ITB foam roll
To ITB foam roll or not to ITB foam roll
Thanks to Daina Clark (senior podiatrist and Bootcamp Instructor) for this great article.
Do you have pain on the outside of your knee when you run or ride? It could be your ITB is the cause; read on to learn why it happens, how to deal with it and what to do to stop the pain from coming back.
The Iliotibial band (ITB) is a thick, dense fibrous band of tissue that runs down the side of your thigh from the hip to the knee. The ITB basically acts as a tendon for the tensor fascia lata (TFL) a small muscle of the lateral hip and nearly three quarters of the gluteus maximus tendon, the biggest muscle in the body, blends into the ITB. The ITB’s main function is to stabilise the pelvis over the knee and to control inward movement of the knee.
Iliotibial band syndrome (ITBS) is the most common injury of the outside of the knee in runners, with an incidence estimated to be between 5% and 14%. It is also the major cause of lateral knee pain in bike riders. And in the old days the way we treated it was to jump on a foam roller and inflict as much pain as possible to ourselves as we tried to “stretch” the ITB and roll out the ‘adhesions’ in the tissue. The thing is that as you self-inflicted some major pain with the roller your knee pain often didn’t get any better. The reason is possibly because the ITB is a non- contractile tissue that cannot physically change length and by compression the ITB with a foam roller you are actually making your knee pain worse…..
Early research into ITBS suggested that it was a frictional condition that caused inflammation where the ITB attaches to the lateral femoral condyle ( think outside bone of the knee) but recently this theory has been challenged with suggestion that ITBS is more likely caused by excessive compression of the layer of fat between the ITB and the bone. So that last thing we want to do to a tissue that is painful because of a compression issue is to compress it further. You might be better off addressing the tightness in the TFL with a massage ball instead.
If you are experiencing lateral knee pain on the bike check that your saddle is not too high or set too far back behind the bottom bracket causing reaching at the bottom of the pedal stroke which can increase compression of the ITB on the bone. Also check that your cleat position is not causing an increase internal rotation at the bottom of the pedal stroke by being angled aggressively inwards.
For both runners and riders focusing on strengthening your hips, think crack a walnut, is paramount. A great glute strengthening exercise program for the adventure racer could include the single leg half squat, Romanian single leg deadlift, rear lunge focusing on maintaining an upright torso and the single leg hip bridge. A 15 minute strength routine, completed twice weekly with 2 sets of 15 on each will get you some buns of steel and bomb proof future ITB pain. And remember the old adage of not increasing training load too quickly is also vitally important.
So there you go, my advice if you’ve got lateral knee pain is to ditch the ITB roller, stretch the TFL and start strengthening those glutes to get back to training and racing pain free.
Train Smart. Ride and Run strong
Daina Clark (Senior Podiatrist and Bootcamp Instructor)