My ITB is ALWAYS tight – you’re a physio, HELP!!

June 28, 2016

A seriously common phrase. Almost as common as “what do you think about chiropractors” (short answer is – not much). Everyone has at least heard of the ITB, and therefore has some concept of what it is and certainly where it is. Check out the picture, front and back view stripped down to muscle only. Pinky red = muscle belly, grey/white = connective tissue (tendon, ligament, fascia). When most people think of “muscle stuff”, they think of the pinky/red bit. Fair enough too. And it’s all connected, but they behave very differently. The grey/white bits don’t shorten or lengthen, or contract/relax, like the muscle fibres on the inside of the pink/red bit.

The ITB is the long grey bit that Gluteus Maximus runs into on the outside of the right picture. It starts up on the pelvis bone and finishes at the knee. On the way your big glute joins up with it, as does TFL, a little muscle at the FRONT of the outside of your hip. TFL does pretty much the same thing as your bigger, better Gluteus Medius (middle glute) which is at the BACK of the outside of your hip. The position of your spine and hip determines which one you tend to use. The positional loading is often the real cause of your tight ITB, knee pain or running trouble.

As the ITB isn’t made up of contractile fibres, it can’t get shorter. The feeling of “tightness” is an accumulation of load and tension, which can then irritate a whole heap of structures in and around your knee – “runner’s knee”, “bursitis”, “patellofemoral joint pain” – different manifestations of a similar cause.

If your ITB is “always tight” then something with HOW you do what you do is causing it. It’s not just bad luck that you have tight ITBs. And it is, therefore, fixable.

Now I’m not talking about your roller – don’t get me wrong, I love my roller – but if you are crying on your roller it’s already too late. Whether it is technique, weakness, load or some other reason, force going through the outside of your leg and hip is not being directed where your tissues, and your brain, would like. Invariably your middle glute is not firing, your TFL is getting SMASHED and the poor old ITB gets wound up like a big E string on your guitar.

So then – the roller. If it works for you then knock yourself out (not with the roller) – but remember, there’s no prevention in a roller. Theoretically, the ITB is already wound up and angry, then you jump on the roller. Doesn’t quite make sense. Getting a hard ball into the muscle belly is probably more what you are after with the roller. Check the picture again, aim the ball for tensor fascia lata.

If you’re stuck in ITB hell we need to be assessing HOW you are doing what you do. At Newcastle Performance Physio we test your strength, muscle ratios, athletic technique and management strategies. We develop a strength program specific to your demands, and get you combining a much more effective caboose with better technique. So cut your ITB some slack, and find the real culprit for your knee pain after park run.

Until next time