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 fall short
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.
Lily
October 13, 2015
why do you have to say ‘this sucks ass’ how crude. Learn more descriptive English
reddyb
October 16, 2015
Nasir
October 17, 2015
Hi Brian. I would like to know the differences between this stretch and the hip flexor Thomas test/stretch. When you recommend a regression (holding one knee up, instead of arms being up) it ‘seems’ too similar to the Thomas test. Could you please explain a bit the difference in (a) the down leg being hanging straight and loose (b) when the knee of the hanging leg is bent, and (c) when the knee of the hanging leg is bent and foot is pointed up. Is the slight adduction of the hip the only difference? Please throw some light on the comparison of the Best Dam IT Band Stretch and the Thomas Test. Thanks
reddyb
October 18, 2015
The Thomas Test is a TFL length test. There are clearly instances where what I go through in the post is very similar to a Thomas Test. Which is the point. The test becomes the stretch / exercise. This is how I approach most corrective exercise work. The test is the exercise.
I refined some things, such as with dorsiflexion, focusing on some external rotation of the femur, and talking about the upper body.
I’m not sure what you’re referring to in (a). I didn’t go over a scenario where the down leg is straight. If you mean during the Thomas Test, if the leg is straight you aren’t fully tensioning the rectus femoris, so you can rule that out if things are still stiff. The TFL can have a lesser role in knee extension as well. (RF has a bigger role.) In the Thomas Test when the leg is straight, people are usually looking at psoas tightness as the other hip flexors aren’t fully tensioned. I don’t use this version of the test. Instead I lay people on the ground, with their legs straight, and see how that goes. (Lower back pain? Lower back arched off floor? Support the knees and things feel better? Probably some psoas stiffness going on there.)
For (c), I go over the rationale for dorsiflexion thoroughly in the article.
Hope that clarifies things.
Nasir
October 19, 2015
Thanks for the clarification. Just one more question. Please correct me if my understanding is wrong: you wrote, “focused on some external rotation of the femur”. If everything is in a nice straight line does the external rotation happen due to pressing and keeping the lower back down on the bench?
reddyb
October 20, 2015
The foot would need to be inside the knee some to achieve some external rotation. I wrote in the post this is hit “a tiny bit” in the one video. You could hit it more if you wished.
Kevin Gibbs
November 3, 2015
Hi again!
I’m trying to get someone to get the pic of my legs as you wanted, so be patient! (got two kids and I easily forget things).
Anyhow, I have a client who exhibits TFL tightness and gluteal weakness in so far as I can tell (her foot really goes out and knees in). However, you also said that TFL pull the hip down and EO pulls it up. Her right hip is way up and left hip down. Problem is… it’s the left side with the TFL tightness being worse (both have some tightness). So, how do I know if her right hip is up OR is it that the TFL on the left side is actually pulling it down?
Thanks so much!
(Btw. I’m hoping that my inquisitiveness gives you a better picture of PT’s in general)
Kevin Gibbs
November 3, 2015
And, just realized, should she in the case that her left hip is being pulled down but right is ok, actually do this exercise on both sides? I’d say yes as both tibias are externally rotated, but I want to be sure.
Thanks again
reddyb
November 3, 2015
I pretty much always exercise both sides. I may not always give both sides equal volume (I usually do), but I never only work one side. I have reasons for this that I haven’t thoroughly written about yet, but it’s something I feel pretty strongly about.
reddyb
November 3, 2015
Hey Kevin,
Why not have it be both? For instance, maybe the left TFL is stiff relative to the right side, and the abdominals, in some fashion, are stiff on the right side relative to the left, pulling it up?
Regardless, the best way to handle this is to cue the person to have their hips level during various movements, opposed to saying “we need to loosen the left TFL.” Or “we need to loosen the right abdominals.”
This way you not only hit these two musculatures, you hit everything else, including the nervous system. Hit the movements and the muscles automatically get hit. Hit the muscles and it doesn’t mean the movements will be changed. e.g. You can stretch the left TFL all you want, but once that person stands up, it doesn’t mean their hips will be level. Have the person stand with their hips level? TFL automatically gets put on some stretch as does the abdominal region in question.
(That doesn’t mean one should ignore targeted exercise; it can be valuable, but it should only be one (usually small) piece of the program.)
I appreciate your inquisitiveness, but our profession has a ways to go :). Out of curiosity, where are you located?
Kevin Gibbs
November 3, 2015
Heya.
aye, we need to learn a damn lot still. I’m from Finland, so I don’t know how things are done in America, but here our PT schools suck for the most part. Heck, they didn’t go through ANYTHING but the main moves. And poorly. And that school is one of the best in Finland. Well was, there’s a new one that just opened. I hear it’s damn good.
Anyhow, true… it could be both. But that makes me think… why? What could cause something like that? Holding a child on one shoulder at all times? Should probably tell her to switch sides as often as possible.
I’m having difficulties thinking of how I would cue that. how do you level up your hips in any movement without activating one side more than other? I mean, won’t that cause needles activation of the opposing side’s muscles and cause them to become stronger in the long term?
reddyb
November 5, 2015
This might be helpful: http://b-reddy.org/2012/12/27/thoughts-on-correcting-a-lateral-pelvic-tilt/
Holding a kid on preferentially on one side can definitely be a factor.
I wouldn’t think of cueing in terms of muscle activation too much, but more in terms of movement. If one hip juts out to the side, I’d cue something like “right hip never outside of right shoulder.” Or “right hip never higher than left hip.”
JK
December 6, 2015
This may very well be one of the most informative sites on the IT band I’ve come across. Thanks for this wonderful information. Question: Does this stretch also help with issues with the bicep femoris? Shortly after running my 7th marathon, I experienced symptoms very similar to ITBS. I had a pain in the outer part of my right knee that would only come on about 0.5 miles into a run (Otherwise, no pain walking, or going upstairs/downstairs). All of the physical and massage/muscle therapists from whom I sought help said that it was IT band-related. But I’ve always suspected otherwise. Part of the reason for this suspicion was that none of their suggested treatment seemed to work (e.g., the Graston technique did not evince the pain I was told to anticipate). At any rate, my suspicion seems to be confirmed when the pain recently shifted below to the upper right area of the calf (where the short head of the bicep femoris inserts). After rolling the muscle belly of the bicep femoris with a lacrosse ball – and in doing so, relieved several extremely sore spots – the pain now does not come on until about 1.5 mile into the run. Somewhat of an improvement but still not injured.
When I did the stretch you discussed here (prior to the realization that it might be something related to the bicep femoris), there was serious pain in the left side of my right knee (felt like there was serious pressure, like a significant torque on the left part of my right knee) and I could also feel a trace of the pain felt on the run. After rolling the bicep femoris, however, the pain on the left side nearly all vanished though I can still feel the trace of pain on the right part of the knee when I do the stretch.
My question is: Is this stretch appropriate for the injury I described above? If not, can you please let me know what you think is the best strategy for dealing with it? Thanks.
reddyb
December 8, 2015
Hey JK,
Thank you for the nice words.
It’s common to feel some pain around the knee during this stretch. I discuss the why around this in the comments some if you want to see more about that, and what to do about it.
The biceps femoris can have an external rotational pull on the tibia. This is a common pattern as described in the post. So, during the stretch, we internally rotate the tibia some / prevent that external rotation. So yes, it can influence the biceps femoris to some degree.
The fact you feel pain during the stretch often means it’s something you want to be focusing on, albeit while towing the line between a stretch and pain. However, whenever someone is having pain move around the leg like that, the lower back needs to be carefully looked at, as it’s common for referred nerve issues from the lower back to cause people to think they have a knee / leg issue.
This stretch does work on the lower back in that it minimizes motion there in favor of loosening up other structures, but it’s quite a passive movement in this regard. When assessing the back you want to be looking at moving the limbs in a variety of ways, and seeing what happens with the back. My IT band manual hits on more exercises of this nature: http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
I wouldn’t read so much into what happened after foam rolling and when you did this stretch again. When rolling you can very much turn down the pain response. It’s like warming your body up so that the next batch of whatever isn’t as painful, opposed to you really loosening anything up. For instance, flick someone in the face and it hurts. Next, punch them in face before flicking them, and their face probably won’t hurt as from the flick. (More technical discussion of this here: http://www.bettermovement.org/blog/2013/how-does-foam-rolling-work )
Liz
December 8, 2015
This is so confusing I have no idea what exercise I should be doing
reddyb
December 8, 2015
I’m assuming this is supposed to be a question. While starting a question to a person by insulting the person isn’t the best move…
The post is called “The best damn IT band stretch ever” and there is a video in the post titled “The best damn IT band stretch ever”…
It might be more helpful if someone had a manual on exercises to loosen the IT band, with sets, reps, days per week, to go along with this post… http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
Mike
December 19, 2015
Hi – In the video is the dropped leg totally ralaxed or is she intentially creating some extension? It looks like she’s far enough down the bench that the dropped foot would want to naturally drop further than the video demonstrates. I’m sufferning from about 3 issues in my upper right leg/button/hip area which I’m sure are related (and just had a medial meniscus tear repaired on my right knee Nov 18). The issues are: 1. an extremely tight IT band, especially close to the knee as diagnosed by my current PT; 2.tenderness I feel when I apply a decent amount of pressure with my thumb to the higher portion of my IT band around where the end of the greater trochanter line is in your first diagram…but a little bit further posterior (and the tenderness begins to dissipate if I massage that spot), and 3) if I get on the floor on a lacross ball under my butt but out around to the side, near that tender area but a bit more inside closer to my sitz bone, I have a prominent “guitar string” that I can feel the ball getting “on” and “falling off” as I roll my butt over the ball. When the ball is on that “bump”, it is really uncomfortable and my left side has nothing like it in that same area – it’s like an inflammation or something. The doctor thought my piriformis was fine as well as the sciatic nerve from a lengthy mri examination. The PT person is my 2nd one I’ve seen for this, I’ve seen 2 doctors, had an MRI, and the 2nd doctor who referred me to my current PT has suggested abductor/glut exercises, ITB Flex/myofascial release, and stretching of the hip external rotators/quadratus. I have sort of self-diagnosed via the internet that I’ve done way too much adducting (via some core stuff on a foam roller running the length of my spine with an exercise ball between my knees I need to squeeze to keep in place) and not enough abducting stuff and it’s unclear to me whether that’s what put me in the state I’m in. I do know that when I squat my right knee wants to cave in but that’s better since the arthroscopy on the 18th. It’s maddening trying to figure out how to cure the ailments, particularly the tenderness behind the greater trochanter and the guitar string area which is close enough to the sciatic nerve that the doctor that examined the MRI thinks it’s getting pinched a bit on occasion, as I can get some weird feelings in general down my right leg if I overdo things. I stopped running 3 months ago but things really haven’t improved. If you could answer my question about the video and if you have any thoughts about my condition, I’d really appreciate it. thanks
reddyb
December 22, 2015
Hey Mike,
In the video the leg is relaxed in terms of hanging. Gravity is doing that work. It will depend on the person whether they need to voluntarily keep the leg straight. (Whether it flares out to the side.) The foot is being voluntarily pulled upward. I’ll often have the person voluntarily pull the lower leg in enough that it’s at least a tad inside the femur as well.
Not everyone will drop all the way. That’s the point of the stretch. For those who aren’t dropping to parallel to the floor, they’re stiff!
While the adductors *can* be weak, and that can be something to work on, doing so in the fashion of being in a squat with a ball between the legs, and squeezing the ball, is not the way to do things. That’s not a pattern anyone wants to be working on. Feel free to let me know what your PT’s rationale is on this. I would be interested as none of the rationales have worked in my opinion.
(Many with a knee history will already turn their knee(s) in when bending them, as you’re mentioning. Doesn’t make sense to reinforce this!)
Anything traveling down the leg like that is almost always coming from the lower back. How you move your back, how you sit, how you go through your daily life, is what I’d be looking at.
Hope that helps. I do offer remote services should you end up interested: http://b-reddy.org/2013/06/20/the-remote-client-process/
Connie
January 19, 2016
Hi, I found a similar stretch to this on your 8 weeks to a Looser IT band program, which I purchased (thanks for making it available online)! I have already felt a strengthening in my lateral hips and somewhat less tightness when I use the Roller R8 to massage my upper thighs. I have a question about this stretch though: When I did it on my left side, with my first 8 reps, I had a deep clicking sound coming from somewhere (psoas?) on the first few reps and then it went away. For my second set of 8, I heard the click on every rep.
Am I extending my hip (i.e. dropping my leg too far down) for what my left side can handle, or is this OK to hear a click? It is a strange sensation, but there is no pain. I also hear it sometimes when I go down into a prone position and I extend my back from the hips. I’m thinking tight psoas?? Am I perhaps not engaging my abdominal muscles enough?
reddyb
January 19, 2016
Hey Connie,
The best school of thought on this sensation seems to be the psoas catches momentarily, causing that clicking (or some feel it as a catching). That the psoas isn’t relaxing like it should. This of course isn’t the only scenario in which the hip will make a sound, but in this case with the hip extending (stretching the psoas (it needs to relax)), it would support the theory.
All I do in this case is cue the person to try and relax some more. Often, it goes away, but it can take some time i.e. weeks. Even if it doesn’t (there might be another reason for the clicking; some people are noisy), so long as there is no pain, it’s not typically worth worrying about.
It’s rare the leg is being dropped too low. However, if the knee is getting obviously below the hip, with the lower back flat on the surface, that’s not necessarily too low, but it means the stretch isn’t something needing much attention. The person is already loose enough on that exercise.
Thanks for purchasing the manual!
Connie
January 19, 2016
Thanks so much for this feedback. Makes complete sense. I actually felt a release during the Prone Hip Rotations (week 2, Day 2) this evening in that left hip. Amazing. I also realized, however, that I didn’t read your manual carefully enough and all last week (Week 1) I did the Supine Hip Extension when I should have been doing the Supine Hip Flexion!! The directions for the Supine Hip Flexion are a modification to the Standing Hip Flexion description for Exercise 6 in the PDF manual. I think since I did it wrong on Day 2, week 1, excitedly looking for the word “Supine” in the manual, I just carried the error the whole week. You may want to give a heads up to other readers in case they get the manual and make the same mistake.
But anyway perhaps once I finally progress to the Supine Hip Extension in Week 3 that click will have resolved. Should I stick to Week 2 for another week to make up for my error?
reddyb
January 22, 2016
Yep, that’s a common sensation. Doing things right, but maybe still stiff, doing things right, still stiff, then one day, “Oh, that just got easier.” Good sign!
That’s a good point about possibly mistaking the two. I will keep an eye out for that. Thank you for bringing it up.
I would stick with week 2, then move on, yep.
cb
February 8, 2016
Hey There,
I found your post while scouring the internet for some answers on some pain I’ve been having and I was hoping you could clarify some things for me. I’ll give you some background first though:
female, 28, I play soccer a few times a week and I just got over a bout of post tibial tendonitis and peroneal tendonitis with pain points in the ankle during eversion and plantarflexion. Doc said it was caused by flat foot so I started wearing orthotic inserts to correct and did a round of PT for strengthening. Of course solving one issue, a whole new one crops up. While playing the other day I tweaked my knee, noticed it but didn’t have any continued pain that disrupted play so I kept playing. But over the next two days the pain got so bad it was hard to walk. it’s calmed down a lot (can walk without a limp) but the trouble is I can’t figure out if its my knee, my it band, or coming from the peroneus longus area (or if thats all one in the same which your article seems to say?). I have no pain when bending my knee while sitting, no swelling or tenderness, I roll out on a foam roller and with one of those stick thingys. But when I bear weight (especially after first getting up from sitting) on the leg and when I go down stairs I get pain on the outer portion just below the knee. Previous things I’ve read on IT band symptoms make me question whether this is truly an IT matter but your blog post explains IT band problems in a way that illuminates the matter much more. Your breakdown of the two different imbalances of overactive/underactive muscle groups that cause IT band pain was helpful. But I’m wondering a few things…
1. could just one muscle pairing have an imbalance/weakness and not the other (i.e. TFL is overactive and TA is underactive BUT peroneus and glutes are balanced and glutes are not underactive?) or is it a package deal (imbalance on both anterior and posterior sides). The reason I ask is I’m just wondering if the location of the pain is dictated by a more specific weakness/imbalance OR changes the way to address it.
2. what are the best exercises recommended for strengthening and correcting the imbalances?
The other thing I’m wondering is how postural imbalances play into this and what resources or professionals (if any) I should seek out (as a background to that question, all of my overuse injuries are on my right side- PTTD, peroneal tendonitis in the ankle, now this right knee situation, hip pain, and I have a tendency to throw out my lower back only on the right side.
I’d appreciate any thoughts you have as you seem very knowledgable beyond just categorizing symptoms.
reddyb
February 9, 2016
Hey cb,
-I don’t believe I asserted the muscles which connect into the IT band are all one in the same. I go over their connectedness, but I wouldn’t view it as that strict of a relationship. For example, I cover how when the knee turns in the foot typically turns out. But there are plenty of times the knee may turn in, like during walking, but the foot doesn’t. Or the knee can remain straight, and the lower leg turns out. The article is covering more a general case, and showing how often they’re connected. That doesn’t mean it’s always one way though.
-I would view this more from a movement perspective. So, if the knee is for example turning in too much, too often (TFL is typically overactive here), then some other movement is not occurring often enough i.e. the prevention of the knee turning in. In which case yes, some muscles (and habits) are more active than others.
-There is a manual referenced often here dedicated to loosening the IT band. http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
-Location of pain can be dictated by a myriad of things. For example, outer leg pain, as well as knee pain, can be coming from the knee. It can also be coming from the lower back. This is where a solid assessment from someone, like a physical therapist or someone similar, is needed.
-Posture wise, as an example, if you sit or stand with your feet turned out and knees turned out for hours and hours everyday, that makes it more likely you will do other activities that way, and that you’ll make the muscles which turn the knee in and feet out more active.
-I have a remote client process here: http://b-reddy.org/2013/06/20/the-remote-client-process/
Crop
February 14, 2016
Hi,great article..
I’m wondering if this stretch can get me rid of clicking/snapping at side of my hip, which I get when I’m walking or tilting my pelvis in standing position.
And also when I do hip rotations my hip/femur catches and releases. Happens only on one side. When I rotate and hip abducts, just as it’s about to move behind me it looks like it catches and then releases. It also feels like that. My doctor told me it’s caused by tight IT, what do you think?
reddyb
February 16, 2016
Hey Crop,
If you take a look at the comments, you’ll I mention this is not usually a good stretch to be doing for hip issues.
That sounds like your psoas snapping. The IT band, if it’s going to be catching or snapping anywhere, is going to be at the knee. The band doesn’t go up to the hip in a way snapping would really happen. In other words, I’m assuming you mean the catching and such is at your femoral head. The IT band doesn’t connect there. The psoas does.
Violet
March 9, 2016
This is really great info!!!
I have been having some discomfort and pain on the lateral part of my knee (really a little lower than the knee cap on the outside). It started happening when I started a long distance job for the summer, about 120 miles a day. It eventually got so bad that I had to take some time working from home and go to PT. I just finished my first round of PT, about 6 sessions. The PT was great and I thought everything was getting better then I drove to work once and bam, it was back. The side of my right knee hurt when I would feel it and right under my knee cap I would get some pain as well. This all happened during the last visit so my therapist asked for more visits.
Then, I read all this and I really think the pain is my IT band. When I put something like a rolled up towel under my knee when I drive the pain on the outside of the knee goes away and my hip starts to feel tense.
I’m going to try these stretch and see if it helps, since I’m kind of up to trying anything at this point.
Mind you I am only 24 and used to be athlete untill my last couple years of college. I guess the not exercise during college years really weakened my muscles.
Anyways, thank you for the detailed explanations!
reddyb
March 11, 2016
Hey Violet,
Thanks for the nice words. Do you have a picture you could send over to show what you mean by rolling up a towel under the knee? Would be curious to see this.
JD
April 16, 2016
“This is because the TFL is tight and doesn’t like being stretched”.
I have just recently started sleeping on a hard surface (bamboo mat), no pillow & realized it solves numerous problems with the body (low back, tight psoas >>> leading to glute activation, posture, balance) etc. With regards to the TFL, by rolling from side-to-side, the TFL ‘digs’ into the hard surface & eventually loosens it up.