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1 Jul 2010

How Important is the IT Band Muscle?

Lauren Downes MSPT
Many people ask me which muscles are important to strengthen and stretch to become a stronger or more flexible figure skater. The typical answer includes the quadriceps, hamstrings, gluteals, and psoas muscles, among others. The question most skaters forget to ask is “What muscle do I need to stretch to prevent injuries?” The easy answer is the IT Band.
The IT Band is actually a very long tendon that spans the lateral side of the upper leg, and is an extension of the Tensor Fascia Latae muscle, which begins at the crest of the pelvis. It also has an attachment to the gluteal muscles.  The distal end of the tendon eventually inserts along the lateral side of the knee. (See the white structure in picture #1)
The tendonous nature of the IT Band creates a very taut, tight structure, which is more difficult to loosen, stretch, or massage than other muscles. If you were to feel around and massage your lateral leg, you would note a stiffness, as you cannot get your fingers deep into the tissue. Compare this feeling to the front of your thigh in the quadriceps muscle, in which you can move the muscle tissue easily and get deeper into the muscle. Therefore, a tight quadriceps can easily be stretched or massaged, as the IT Band poses a tougher challenge to both.
The IT Band can be a contributing factor to many common skating injuries, most notably patellofemoral syndrome of the knee, hip bursitis, and various lower back disorders.
Patellofemoral Syndrome (anterior knee pain): Pain surrounding the patella (kneecap) is very common in figure skaters, especially between the ages of 12 and 18. It is caused by improper tracking of the kneecap when a skater bends and extends the knee. The underside of the kneecap rubs against the bone underneath it, and refers pain to various areas around the kneecap. How does the IT Band come into play? Its insertion attaches to tissue that connects directly to the kneecap, and IT Band tightness will cause the kneecap to tilt or glide laterally, resulting in a tracking dysfunction when the kneecap moves. Skaters tend to develop IT Band tightness due to the stroking mechanism on the ice, which results in excessive use of the muscle/tendon.
Hip Bursitis: The Tensor Fascia Latae and Glut Medius muscles both sit laterally over the hip joint. Within the hip is a bursa, which is a fluid filled sac that cushions the joint. Many skaters develop bursitis from excessive falling (imagine that!) on the side of the hip. The tightness of the IT Band does not cause this diagnosis, yet it makes it difficult to resolve. The compression from IT Band tightness does not allow for pressure relief on the bursa, and may cause the pain to linger longer than in a skater with a loose IT Band.
Lower Back Problems: This one comes from my own experience! I developed lower back problems as a teenager, which resulted from numerous falls. Later in life, I started to develop symptoms again, and sought advice from my colleagues. After several evaluations and hypotheses, it was determined that the IT Band tightness on my right side contributed to a positional fault of my pelvis. This, in turn, affected the movement of my lower back, causing pain. By having regular massage and stretching of the IT Band, I keep my back pain at bay. The IT Band should always be evaluated as a possible cause of lower back pain, even if the pain is nowhere near the muscle.
How to Stretch/Self-Massage the IT Band
Foam Roll Massage: Lay on your side with the lateral side of your thigh on a 6 inch diameter foam roll. Keep the bottom leg straight, and cross the top leg over the bottom leg, with the foot on the floor. Roll your bottom leg over the foam roll from your hip to just above your knee, propelling yourself back and forth by using your foot and hands. Begin by rolling 10x, progressing to 20 repetitions.
Standing Stretch: Stand with the leg to be stretched crossed behind the other leg, with 6-10 inches of space between your feet. Slide your hips laterally to the side of the leg that is crossed behind, and slightly lean away from that hip. You should feel a stretch over the lateral side of the hip joint. Hold for 30 seconds, and repeat 3 times.