Was asked a question recently “Do we need to massage the ITB?"

It's a common thing to see gym members rolling the outside of their thighs on a foam roller wincing in pain

As a sports massage therapist this raises for me a similar question along with others

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Why?

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Do they know what they are doing? Or have they ever seen a qualified sports massage therapist? Is something so painful the right thing to do?

Is there really any benefit to doing this? Is there a better, less painful or safer option?

Now in my experience controversial topics are usually very reasonable ideas taken out of context so I did bit of my own research around this area and would like to offer some thoughts from my findings. However I always encourage you, the reader, to do a bit of your own research and feel free to come back and offer your thoughts so we can all learn from each other.

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So firstly lets look at the anatomy of the ITB or iliotibial band;

The iliotibial band (ITB) or tract is a lateral thickening of the fascia lata in the thigh. Proximally it splits into superficial and deep layers, enclosing tensor fasciae latae and anchoring this muscle to the iliac crest. It also receives most of the tendon of gluteus maximus. (Standring, 2004 Grays Anatomy; the Anatomical Basis of Clinical Practice)

Due to the angles of pull and its attachment sites it is a knee stabiliser in both extension and partial flexion of the knee joint. This means it is in constant use during gait, walking and running. It is in fact one of the main supports of the knee against gravity

So this raises a clear point for me, if the ITB is a knee stabiliser and its role is as the main support on the knee against gravity then surely it requires a good amount of tension running through it to do that. We also know that the whole point of manual therapy, massage, foam rolling, trigger pointing etc is to create blood flow by releasing tension.

This therefore might tell us that actually for a fit and healthy individual foam rolling the ITB is not good news as it may well reduce that tension and create problems of stability around the knee joint.

Ok so I know what you are thinking, most people do it because they have knee pain or ITB syndrome or they ‘feel tension’. Well this is different again because we should consider WHY they have these issues before assuming any are in relation to the ITB. Well let me share with you a couple of quotes from Karel Lewit a world renowned manual therapist way ahead of his time and unafraid to challenge current thinking and also open to change from his own original views:

“He who treats the site of pain is lost”, “Where do you have pain? On my MRI” Karel Lewit <a href="http://www.rehabps.com/DATA/Karel_Lewit.pdf">http://www.rehabps.com/DATA/Karel_Lewit.pdf</a>

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So back to the question: “Do we need to massage the ITB?”

Point one: Not everyone and particularly if you are fit and healthy.

What about those who are diagnosed wit ITB syndrome?

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What is ITB syndrome?

it is commonly known as inflammation of a bursa from overuse during running, cycling etc. However there are recent studies showing it could be more related to deep fat to the ITB. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100245/

Ok well what would we do about ITB syndrome then considering both suggested causes once again I would ask WHY? Since not all runners or cyclists suffer ITB syndrome. So my train of thought is well if the ITB inserts into the TFL &amp; Glutes should that be somewhere to consider assessing? Sure thing! I certainly know some screens that involve understanding if this muscles are dysfunctional. In fact due the body being an Integrated System I would suggest that is probably a good places to start combined with the research that states 60% of dysfunction does for the pelvis.

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We might also consider that if this tension in the TFL, Glutes is present then maybe that would be a less painful more sensible places to massage, foam roll etc.

To my mind the biggest problem that might occur from gym members foam rolling their ITB is they are not a sports massage therapists and therefore may no be aware of the anatomical structures they are pressing on, what pressure is appropriate, the risks and contraindications. Sports Massage Therapists are skilled at being able to modify for that individual, for that particular day and how the client feels and presents from the biomechanical assessment they should be making prior to the treatment.

Massage should NEVER be painful but let me define pain.

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0/10 = No pain

10/10 = Excruciating like having the arms ripped out of the sockets.

0/10-7/10 = Discomfort which the client is able to tolerate.

8/10-10/10 = Inappropriate level of pain which is likely to increase tension thought the clients body.

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This model is in my opinion - happy to hear other professionals ideas on this.

You might have someone argue they feel better after doing foam rolling on the ITB.

Point one - The Integrated System = what you feel may not relate to the area you feel it (see Karel Lewit quote above)

Point two - By influencing one area of the body you may well have released another i.e. You released TFL, Glutes rather than the ITB itself- so which would be the sensible option? Foam Roll the painful fascial bit that is supposed to be tensioned or try the muscles higher up that can be better controlled for discomfort during rolling?

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Summary

If we are totally honest nobody really knows what is happening inside our bodies during these methods, even with evidence and research some projects contradict others and so it is always case by case.

FOAM ROLLERS DO NOT REPLACE HUMAN HANDS!!

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With this in mind I would suggest the most sensible would be to visit a recommended, qualified manual therapist over and above any form of foam rolling as by far a much safer, hopefully less painful and much more logical option. Ask them lots of questions about self management and then do what they advise rather than ignore it.

If part of what they suggest is to self massage in some form then it should be clear what you do and how you do it, if not ASK!

If you are not happy then see someone different but research their background and ask to look at certificates and insurance papers. We gain them for a reason and no client has ever asked to see mine.

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Happy to discuss …

Tell us what you think?