The most commonly cited reason for stretching the iliotibial (IT) Band is to alleviate knee pain. Before we can state the best way to stretch it, we need to talk about what the IT band is, and then how it influences knee pain.
What is the IT band?
It’s imperative to note the IT band is not a muscle. I’m not sure if people realize this or not, but based on the way people talk about it, and talk about stretching it, I’m pretty sure people often think the IT band were like any other muscle.
It’s not.
Multiple muscles insert into the IT band. So rather than the IT band being a muscle itself, it is a band made of other muscles. The two big muscles comprising the IT band are the gluteus maximus (GM) and tensor fascia latae (TFL).
From Anatomy Trains by Tom Myers. (Get this book!)
It is crucial to understand the TFL and GM comprise different portions of the IT band. The TFL comprises the anterior portion and the GM the posterior portion.
Using the Anatomy Trains philosophy from Tom Myers, we can see while the GM and TFL insert into the IT band proximally (starting at the hip), other muscles insert into the IT band distally too (at the knee).
Credit to Anatomy Trains and Tom Myers
The anterior portion of the IT band connects into the tibialis anterior (TA) while the posterior portion connects into the peroneus longus (PL). Therefore, there is a connection between the TFL and the tibialis anterior, and another connection between the GM and peroneus longus. And all of these insert into one band.
How does it influence knee pain?
This is where it gets a little messier.
The most common cause of knee pain is an imbalance between all these muscles acting on the IT band. Specifically: the TFL is overactive and tight, but the tibialis anterior is underactive and long (remember these two muscles are connected on the anterior portion of the IT band). And then the peroneus longus is overactive and tight, but the GM is underactive and long (these two are connected on the posterior side of the IT band).
By looking at these muscles specific actions we can begin to figure out how pain arises. At the hip, the TFL abducts, flexes, and internally rotates the femur. It also laterally rotates the tibia.
Meanwhile, the GM has almost the complete the opposite effect: Hip extension, lateral rotation of the femur and some possible internal rotation of the tibia.
That is, the TFL and GM have almost completely opposing actions at the hip and knee. This is why most often when one is strong/tight, the other is weak/long.
At the knee: Peroneus longus pronates and plantarflexes the foot and has some effect on lateral rotation of the tibia.
The tibialis anterior helps to supinate and dorisflex the foot and internally rotate the tibia.
That is, the PL and TA have opposing actions at the knee and ankle. In fact, these muscles not only insert at the IT band, they actually form a band together at the bottom of the foot!
Credit to Anatomy Trains and Tom Myers (www.anatomytrains.com)
Again, indicating when one is strong/tight, the other is weak/long.
Remember, the TFL is dominant over the GM, and the PL is dominant over the TA. Therefore, in terms of movement, we have a dominance of internal rotation of the femur, a dominance of lateral rotation of the tibia, and a dominance of pronation and plantarflexion of the foot.
This imbalance at the IT band will make itself evident during movements like a squat.
This is overwhelmingly the predominant cause of knee pain for people. And this is why so many people are trying to stretch their IT band.
However, now we can tell just “stretch the IT band” is a poor remedy. We need to stretch the band in a very specific manner in order to get rid of our knee pain.
The most effective stretch is going to calm down the overactive muscles and wake up the underactive ones. We need to loosen the tensor fascia latae and peroneus longs, but tighten up the gluteus maximus and tibialis anterior. An ideal stretch will combine:
-Hip adduction (loosen TFL)
-Lateral rotation of the femur (loosens TFL and tightens GM)
-Hip extension (loosen TFL and tighten GM)
-Internal rotation of the tibia (loosen TFL and PL, tighten GM and TA)
-As well as ankle dorisflexion and supination of the foot (loosen PL and tighten TA)
Why most IT band stretches suck ass
Now that we know what makes an ideal IT band stretch to help get rid of knee pain, we can talk about why some stretches aren’t good. Let’s look at some of the most commonly used IT band stretches:
Breaking this down:
-We have lateral rotation of the femur (good)
-Possibly some internal rotation of the tibia (possibly good)
-Hip Abduction (Uh oh –This tightens the TFL)
-A great deal of hip flexion (Shit –also tightens the TFL and actually stretches the GM. Opposite of what we want.)
-Ankle plantarflexion and no pronation or supination (This isn’t good, but, you could modify this to make it better)
This is actually a fairly good stretch for the posterior aspect of the IT band. But as we’ve dissected at this point, we rarely want this. I’d say at least 95% of people with knee pain / people who need to loosen their IT band don’t want to stretch the posterior part.
Don’t forget about the abdominals
Before criticizing another stretch, this is a good place to talk about the abdominals, specifically the external obliques.
If we agree a tight TFL is a common issue in those with knee pain (if you don’t, you’re wrong), we need to also look at how a tight TFL affects the abdominals. I don’t want to go into another treatise on movement at the hip, but suffice to say much like the TFL and GM have opposing effects on the hip, so do the TFL and external obliques.
That is, the TFL pulls the front of the hip down and the EO pulls the front of the hip up (so do the glutes). In someone with a tight TFL, not only will they potentially have weak glutes, but they will have weak EO too. The result is a lordotic posture:
Therefore, a common effect of trying to stretch the TFL is an associated lordosis. This is because the TFL is tight and doesn’t like being stretched, it’s “stiffer” than the abdominals, so it pulls the hip downward to try and lessen the stretch. Not something we want when we’re trying to loosen that sucker up.
This is my long way of saying when attempting to stretch the TFL -and IT band subsequently- we need to pay careful attention to how the hips and lower back are moving. Ideally, they aren’t. Realistically, they do. This is often a pain in the ass to get people to do properly.
We’ll come back to this. Keep it in mind for now.
The next stretch:
Breaking it down:
-We do have hip extension this time (Much better than the other stretch)
-We have ankle plantarflexion (Not good. But this could be modified in the stretch. Although it still wouldn’t be ideal)
-We have hip adduction (Good)
-We have either a neutral tibia or lateral rotation of the tibia (not good)
-Femur is either in neutral or medial rotation (Not good)
At least this stretch is targeting the TFL portion of the IT band and not the GM portion. However, there are other issues. Referencing the importance of the external obliques, remember how we want the EO to be stiff when we stretch the TFL / IT band to make sure we’re generating as good of a stretch as we can and we’re not achieving movement from the lumbar spine.
You can’t see it in the video, but I guarantee the girl has a lower back arch during that stretch. Look around the internet of people doing this stretch and you find this rather quickly:
Notice the arched lower back? While the TFL / IT band is still being stretched some, we’re not doing anything to concurrently stiffen up the abdominals. Next, due to the lordosis, we’re generating a bit of stretch on the glutes. Finally, we’re also promoting mobility at the lumbar spine. Mobility at the lumbar spine is a precursor to lower back pain.
While you could cue the person to squeeze the abs to prevent the lower back arch, I find people have a really, really hard time with this. They just don’t know when they’re doing it properly, the right way it should feel, etc. It’s like coaching a 40 year old virgin.
Sorry, doctor, but you sir do not have the “world’s best IT band stretch.“
The better way
Breaking this down:
-By making sure the knee does not fall out to the side we have hip adduction (Good)
-A tiny bit of lateral rotation at the femur (Good). More can be accomplished but I find this doesn’t influence the stretch much.
-By letting the leg fall to the ground we let gravity give us hip extension (Good)
-Internal rotation of the tibia from turning the foot in (Good)
-Ankle dorisflexion and supination by pulling the big toe up and in (Good). If you do this last, you’ll notice a difference in the intensity of the stretch between letting your foot fall to the ground (plantarflexion) and pulling it up (dorisflexion). Many people will exclaim they get a better stretch all the way up in the hip just by pulling the foot upward. Further evidence the dorsiflexion and supination is helping to stretch the TFL / IT band and the TFL and TA are connected.
Also, because of the self-feedback mechanism of laying on a bench or table, you always know whether or not your lower back is arching (in lordosis). Therefore, you are guaranteed to know how hard you need to be squeezing your external obliques to make sure there is no compensatory movement at the spine.
Next, by lifting the arms overhead we can also generate a nice stretch in the lats, pecs, and rectus abdominus (all commonly tight). Not really necessary for a stretch aimed at knee pain, but it sure isn’t hurting anything.
BOOM. How’s that for bang for your buck?
With that said, here are the common ways people may mess this up:
1) Letting the foot plantarflex and pronate
You HAVE to make sure your foot is not pointing down and out to the side.
2) Not fully contracting the abdominals
If you’re not feeling any stretch in your hip / thigh it’s almost guaranteed you’re not fully squeezing the abs.
Watch the difference in thigh position when the abs are fully squeezed and when they are relaxed:
Notice the thigh elevates, bringing the hip into flexion, each time the EO are fully contracting. This illustrates tightness in the TFL because when the EO fully contract and posteriorly tilt the pelvis, the TFL is put on stretch. And when it’s put on stretch you can see the tightness by the thigh being pulled off the bench.
One sure fire way to know whether or not your abs are squeezed tight enough is if you’re lower back is flat on the bench. If it’s not, you’re abs aren’t tight enough. It’s worth noting for those with a fair amount of fat on their body, and or lower backs, sometimes they give themselves the “feel” of their lower back being flat when it isn’t. It’s just that their adipose tissue is thick enough to give them that illusion.
If you’re watching someone, it’s best to look at the top of their hips. Do they look angled downward? Like an anterior pelvic tilt? Then the abs aren’t squeezed enough. It’s hard to describe, but you can spot it.
If you’re having trouble with your abs (this is just a sign they’re weak and not strong enough yet) grab your opposite knee and pull it into your chest. This will allow your upper body to help posteriorly tilt your pelvis.
Then you can progress to one arm holding the knee in and the other arm overhead:
And then to both arms overhead.
3) Letting the hip abduct
This will happen due to the TFL not wanting to be stretched and thus pulling the hip into abduction.
For some people adducting the hip to a certain point will cause them to feel pain / pressure in their knee. This signifies that when the TFL is on stretch, knee pain arises. This is verrrry common.
Simply only let your hip adduct to the point where you don’t feel pain. Over time as the TFL loosens up you’ll be able to adduct further and further.
4) Poor posture at the upper body
A lot of people may not be ready to put their arms overhead when they first start doing this stretch. Many just do not have the thoracic mobility yet (or EO strength) to lay their upper back and head fully flat on the bench. Look at the difference in head posture here:
By making sure the chin is tucked you help insure the external obliques are posteriorly tilting the pelvis and not the rectus abominus. When you have that forward head posture and thoracic flexion the RA is in a shortened position. We do not want this. We want to stiffen up the EO, not the RA.
One final note: Don’t expect to feel an insane stretch when you do this. It’s not like you’ll feel like your TFL or thigh is going to rip apart from such a good stretch. Be much more concerned with doing it properly. Often times the biggest thing people feel is a hell of a lot of abdominal work. This is good. Remember, stiffening up the external obliques will indirectly loosen up the TFL.
Hold the stretch for at least 30 seconds.
And I’m out.
Please note the “best” element of this stretch is meant to be a sarcastic play. Understandably, sarcasm doesn’t always land through text. There’s no one magical exercise or stretch for every situation. See the comments for more.
For a more comprehensive look at stretching the IT band see: 6 Exercises to Loosen the IT Band
For a look at meshing this with a running program check out: 6 Weeks To A Healthy 10k
Here are some related posts I’ve written:
- Standing version of the best damn IT Band stretch
- My visit to the Washington University in St. Louis
- Sleep positioning and knee pain
Finally, if you’re tired of sifting through information yourself, get one on one help.
Rana
February 21, 2018
Thank You Brian. I have one last question: If the left leg has a tight Hamstring (it feels tight) and a tight calf ,a smaller Gluteal muscle and a non existant /flat spinor extensor, then single leg excercises on the left side should help I guess.
I am a 400m runner.. the best in my age group , I don’t have any pain while running. I feel discomfort on the left gluteus Media or IL only if I stand for too long . Also my left calf seems to be carrying more of the load .
The slower I walk or stand the worse it is.. the faster I run or sprint , its not a problem. Also Squats are no problem , in fact I rain 5 days a week and I don’t have a problem.
I have the scoliosis since my childhood , however have only become aware of it now and I also feel it more now that before.
b-reddy
February 23, 2018
I would first be careful about assuming something that feels tight, is tight. Example: https://b-reddy.org/2011/07/21/just-because-it-feels-tight-doesnt-mean-it-is/
In terms of a small glute, I tend to focus more on timing opposed to traditional resistance exercise. Example: https://b-reddy.org/2017/10/09/theres-no-need-squeeze-glutes-top-deadlift-swing-good-morning-hip-hinge/
I talk about scoliosis and sprinting some here, using Usain Bolt as an example: https://b-reddy.org/2017/05/08/misunderstanding-energy-leaks-when-sprinting-in-the-transverse-plane/
Rana
February 25, 2018
Thank You very much Brian !
Kevin Mai
July 30, 2018
How does this stretch your IT Band if the body is tensed up/not relaxed?
b-reddy
July 31, 2018
Hey Kevin,
Not sure I grasp what you’re getting at, but some thoughts-
-Ideally, whenever enhancing flexibility is the goal, I like people to be relaxed. If I see a client grimacing or clenching their teeth during corrective work, I often deem that as too tense. More about relaxation and exercise: https://b-reddy.org/on-the-need-for-easy-slow-relaxed-exercise/
-That said, a person does not need to be relaxed to improve flexibility. An obvious, albeit extreme, example of this is a football player reaches their arm out to tackle someone (tense activity) and their arm gets pulled back so much they tear their pec.
Their pec will be more flexible at that point. Tension is no guarantee stretching doesn’t occur.
-In regards specifically to the stretch in this post, the point is not to tense the whole body. The point is (often) to tense the abdominals while keeping most everything else relaxed. For instance, I tell people *not* to pull their leg down to try and get a greater stretch in the leg. I tell them to let gravity do the work.
-Lastly, this isn’t yoga. The point isn’t to stretch any and everything as much as possible. This post is aimed at stretching a very specific area, often necessitating tightening up another area. Relative flexibility is often more important than absolute.
Harrison Boyle
October 12, 2018
Hey question…
I do a bit of thai boxing and have pain on the outside of both knees when i abduct my legs more than 70/80ish degrees.
Believe its due to a tight TFL affecting my IT band (maybe weak glute med/mid) however unsure if the glutes are tight too.
Confused as what i’ve read suggests they work as a pair – but hypothetically if my TFL is tight – should i stretch my glutes aswell? or just stretch the TFL avoid overuse and strengthen my glutes?
(hope the above makes sense)
b-reddy
October 16, 2018
Hey Harrison,
If the pain is when you spread the legs, and while boxing, my first thought wouldn’t be a tight IT band / TFL. In my experience, many who have knee issues while boxing have it due to the twisting motions, or the rapid knee extension involved in many kicks, where I’d be thinking about boxing technique / workload first.
As the article hits on, when the legs adduct and there is knee pain is a solid sign of a stiff TFL.
That said, doing tons of abduction motion can certainly stiffen up the TFL / abductor area (glutes can play a role in abduction too). It’s just rare I see abduction by itself cause knee pain.
Regardless, you can always do the assessment to look at the musculature and see whether it’s stiff or not to be sure. And I doubt you’ll need to worry about the glutes. Just a heads up though this might not be the most relevant detail in your situation.
Harrison James Boyle
October 16, 2018
Hi Brian,
Really appreciate your response!
Yeah its stumped a few physio’s as to what it is. I believe its either ITB related or a lack of internal rotation possibly causing some sort of referred pain.
I believe my technique is fine, I have looked at it – the pains abit weird as I dont feel it when my legs are close together , i can put weight on my knees in all weird unnatural positions and it doesnt replicate – low kicks are fine no pain.
However even if I sit and adduct my legs – after about 90 degrees i can start to feel the pain, the pain increases more the more i adduct the legs. No weight is needed on the legs it will come on if i do that motion in whatever position.
Belive it might be tfl affecting ITB as if i tense my tfl it brings on the pain more. Additionally (know theres arguments on this) if i roll on my ITB i can kind of feel it in the knee as well as if i do an ITB stretch.
Pain also comes on if i internally rotate my leg but only when the legs are far apart.
I hope the above makes sense.
Been battling it for a year now with a few different theories along the way… but im 22 and have done loads of core, leg and glute work … physically fit but questions on my mobility and TFL…
Many thanks for your help!!
Cheers,
Harrison
b-reddy
October 19, 2018
Hey Harrison,
I think you may be mixing adduct and abduct? I’m also not quite sure what you mean by 90 degrees. With sitting, if you were to open the knees a great deal, such as pushing your knees to the floor e.g. “criss cross apple sauce,” there is actually a great deal of external rotation that goes with that, opposed to just abduction. It can be tough to wrap your head around the nuances when it comes to the hips.
Either way, taking a close look at you is likely what I’d need to do no matter what. If you’re interested: https://b-reddy.org/the-remote-client-process/
Cameron
October 22, 2018
Hi Brian,
I’ve just discovered this article and I love the amount of detail you go into when discussing the IT band and then again in the stretching routine. As someone who’s new to running but really enjoys the science of training, reading articles like this help me learn a lot.
As you seem to be pretty responsive, I thought I’d throw my problem into the ring and see what you think about it.
My IT band related knee pain (left side) started back in January. My knee started hurting 10k into a 35k long run and I foolishly kept running through the pain. It ended up with me not running for the best part of 8 weeks. In this time off I did a lot of reading about IT band related knee pain and felt quite clued up. I came to the decision that I needed to stretch my TFL (and improve HIP mobility in general) and strengthen my glutes. I did this for quite a while and felt like the problem had gone away, or at least I put it at bay for a while.
7 weeks ago I had a fall on my hip (left side) during a trail run. At the time I thought this would just bruise and didn’t think too much more of it. I went out 2 days later and had a minor hamstring strain (left side) – I believe located in the biceps femoris, towards the lower part of the hamstring (maybe 4-5 inchs up from the knee area). I then went to see a friend who’s a training physio and he said my pelvis was out of alignment (most likely due to the fall) and I had an anterior pelvic tilt (left side only). Apparently my whole left side was slightly up. After some work we believed we fixed that, I felt better and after a few weeks of running well I decided to do my locaI half marathon. I felt really good the whole way around, no hamstring pain, but towards 18k my hip feel tight (left side), and then at 19k I had sharp pain (similar to what I had all the way back in January).
The interest point is both recently and back in January I’m certain I could pinpoint the sharp pain being of the head of the fibular, which I believe the biceps femoris’ insertion point.
My hip still feels tight and the have the normal IT band tightness (a few inches above the side of the knee). I guess what I’d like to know is:
Is the sharp pain at the head of the fibular related to the IT band tightness, or do I potentially have two problems on this left side?
Thanks
Cameron
b-reddy
October 23, 2018
Hey Cameron,
Thanks for the nice words!
Something like this would require a thorough assessment (see here if interested: https://b-reddy.org/the-remote-client-process/) but a few thoughts-
– A pelvis which rises (or falls) asymmetrically while running is a commonly found impairment with running related injuries. (New study: http://journals.sagepub.com/doi/full/10.1177/0363546518793657 ).
This often coincides with internal rotation of the knee, which I go over in the post. A broader movement concern is likely where my focus would be with you, opposed to just thinking about stretching the IT band (though that can help the movement concern).
(When the knee is rotating / collapsing inwards, the lateral aspect of the knee is being excessively compressed.)
-Between the IT band, the hamstring and the fall, I’d be considering your workload. These kinds of ailments are typical when someone needs to backoff i.e. they’ve been training pretty hard for a while and the body is having a hard time keeping up.
-You can assess whether you get the fibular pain during the IT band assessment. If while stretching the TFL and such you get that same fibular pain, that’s a good sign stiffness is part of the problem.
However, you might not have anything which is stiff right now, and simply need to deload (run less) for a while, and work your way back up mileage wise.
MKQ
January 13, 2019
If I have leg weakness/shakiness in this position and pain, does this mean my IT Band is tight? Weak? I have had unexplained pain between my hip and knee/skin for over 2 years – no doc or PT (and there have been 10 or more) has considered my IT Band, except to say it was tight. This stretch seems to be getting at a significant area of the pain. Just wondering if that means my IT Band is the primary issue… thanks for any help you can give me, I’ve been in considerable pain a long time.
b-reddy
January 15, 2019
The way to assess tightness is, once in proper position, if the thigh is significantly elevated i.e. it is not parallel to the floor, then there is stiffness.
Weakness or shakiness could be from weak adductors trying to hold the position.
Dorianne
April 12, 2019
Brian,
I am having pain in my buttock and down the outside of my leg. When I sit for anything longer then a hour I have pain in my buttock and is it difficult to walk. My daughter who is a rower says my IT name is tight. Your article talks about knee pain and stretches was very helpful. It was very in-depth. I am wondering if there are different stretches for the pain I’m have. I’m a 62 women and in relatively good shape.
b-reddy
April 15, 2019
Hey Dorianne,
While this stretch and working on the IT band may be of some help, that’s not where my focus would be. Anything in the glute like that and you want to start with thinking sciatica i.e. to look at the lower back.
How you sit likely needs to be adjusted. Maybe a lumbar support, maybe you sit hunched over too much, maybe a new chair, etc.
But just trying to stretch is not what I would prioritize. A few minutes of stretching per day is very unlikely to make hours of sitting every day feel better.
This may be of some help: https://b-reddy.org/7-very-common-posture-issues-and-how-to-correct-them/
In my experience, pain in the butt is usually from a nerve issue, and nerve issues can be the hardest to calm down and often require a good look. If interested: https://b-reddy.org/the-remote-client-process/
Alexander Price
April 23, 2019
Hi, I’m running the London Marathon this Sunday. I’ve been suffering with IT band pain in the last few weeks of training. Since then, I have been seeing my physio and she advised to not roll the IT band. Instead, advising glute strengthening exercises and acupuncture. What are your thoughts? Also, any advice to get through the day with pain? Thanks,
b-reddy
April 23, 2019
I wouldn’t worry about rolling the IT band either. A nice, general leg massage could be helpful though.
With less than a week to go, not a whole lot can happen e.g. strengthening wise. You might be able to get the area to loosen up and relax some, but that also might not be the problem. In general, with marathon running, load management is the biggest factor.
During the day is tough. Would need to know when / where you’re having problems.