Why Stretching Doesn’t Relieve Iliotibial Band Syndrome

Iliotibial band syndrome is a painful inflammatory condition of the knee joint that often plagues runners, hikers, and cyclists. Stretching is typically recommended to lengthen the iliotibial band and relieve the condition, but as you’ll learn in this post, static stretching has little to no lasting effect on the length of the iliotibial band.

Read on to learn why pandiculation is the most effective way to release chronic tension in the iliotibial band and change habitual posture and movement patterns that may be contributing to the condition.

What is the iliotibial band?

The iliotibial band (IT band, ITB) or iliotibial tract is a long, thick band of fibrous tissue. The IT band starts at the hip and runs down the outside of the thigh, attaching below the knee joint on the outer edge of the tibia (shin bone).

The IT band is composed mainly of densely packed collagen fibers arranged in straight lines, giving it a great deal of tensile strength. The tissue also contains some elastin proteins, which give it a degree of elasticity. The IT band provides important stabilization for the knee during movement.

As you can see in the diagram, the IT band is connected to three muscles: the tensor fascia latae, the gluteus maximus, and the gluteus medius (through an aponeurosis, a flat fibrotendinous tissue). Tightness in any of these three muscles will pull on the IT band, making it taut.

iliotibial band syndrome

What is iliotibial band syndrome?

Iliotibial band syndrome (ITB syndrome, ITBS) refers to inflammatory pain felt at the lateral (outer) part of the knee as a result of overuse. The pain may begin as a pricking or stinging sensation. Some people may also feel pain above or below the knee, or up the outer thigh to the hip.

Typically, the IT band glides smoothly over the lateral femoral epicondyle when the knee is flexed and extended. But if the IT band is tight and then becomes overused, the friction created during movement of the knee joint can lead to painful inflammation of the IT band.

Some people with iliotibial band syndrome may feel a snapping or popping sound at their knee as they flex and extend it. As iliotibial band syndrome progresses, people may feel extreme pain when walking, climbing up and down stairs, and whenever their heel strikes the ground.

iliotibial band syndrome

What causes iliotibial band syndrome?

Several factors affect whether or not someone will get iliotibial band syndrome. The first is having a tight iliotibial band. As mentioned above, chronic tightness in any or all three of the muscles that attach to the IT band—the tensor fascia latae, the gluteus maximus, and the gluteus medius—will pull on the IT band, making it taut.

The second factor is overuse. When the IT band is pulled taut due to muscle tension and it is then overused, ITB syndrome can easily occur. The most common cause of overuse is athletic training that involves repeated flexing and extending of the knees, like running, hiking, cycling, and playing soccer.

The third factor in developing iliotibial band syndrome is having an imbalance in posture or movement. Functional leg length discrepancy, overpronation of the feet, and bowleggedness are all associated with increased risk of ITB syndrome. Likewise, running on a horizontally banked surface, like the shoulder of a road or an indoor track, stretches the IT band against the lateral femoral epicondyle of the downhill leg and can cause ITB syndrome.

Getting out of pain: How to relieve iliotibial band syndrome

If you’re trying to heal from ITB syndrome, you’ll need to address all three factors that are playing a part in it.

First, you should reduce or take a break altogether from the activity that is overusing your knee joint in order to allow the inflammation to subside. While it can be difficult to take time off from an activity that you love, you must give your body a chance to heal—otherwise you will continue to make your pain worse, and potentially cause permanent damage to your knee joint.

As you gradually resume physical activity, I strongly recommend cross-training: doing two, three, or more different types of workouts that use your body in different ways (like running, swimming, and yoga). Cross-training is the best way to achieve a high level of physical fitness while avoiding repetitive-use injuries.

Second, you must address the chronic tension in the muscles that attach to your IT band. This is why static stretching is often recommended to relieve ITB syndrome. Unfortunately, due to the stretch reflex (myotatic reflex), static stretching will have little to no effect on the level of tension in these muscles. If you’re not familiar with the stretch reflex, be sure to read What is the Stretch Reflex (Myotatic Reflex)?

In order to release the chronic tension in the tensor fascia latae, gluteus maximus, and gluteus medius, you must pandiculate them. Pandiculation contracts and releases muscles in a specific way so that accurate biofeedback is sent to the nervous system, allowing the resting level of tension in the muscles to be reset.

Pandiculation also addresses the third factor in ITB syndrome: imbalanced posture and movement patterns. Imbalanced use of the body is caused simply by muscle memory. As we repeat certain postures and movements over and over, our nervous system gradually makes the muscular contraction involved in these patterns automatic. This is why people who spend long hours at a computer develop rounded posture, and why weightlifters have tight lower backs; it’s all the result of muscle memory. If you’d like to learn more about this topic, check out The Pain Relief Secret.

Using Clinical Somatics exercises to relieve iliotibial band syndrome

Clinical Somatic Education is a method of neuromuscular education developed by Thomas Hanna. Hanna created many self-care exercises that use his technique of pandiculation to release chronic, involuntary muscle tension and retrain the nervous system.

You can learn Clinical Somatics exercises in the online Level One & Two Courses. These two courses together include all 40 exercises that I teach, allowing you to thoroughly address the muscle tension and imbalances throughout your body.