little known “muscle” series: IT band

This is a guest post from my cherished Hailey Paton, Physical Therapist Extraordinaire! (Her business card really says that! True story.)

I know you have heard people say, “maybe your IT Band is tight.” You nod your head in agreement and wonder what the heck he/she is talking about. You wonder if there truly is a band in your leg? Is it a muscle, tendon or ligament? What does “IT” mean anyway?  Well, let me set the facts straight!

The Iliotibial band (ITB), also referred to as the Iliotibial tract, is actually a fibrous band of fascia or connective tissue. The fascia acts as a reinforcement or protective layer to the muscles of the lateral leg. It is one of the thickest pieces of tissue in the body. In layman’s terms, the ITB connects at the top of the pelvis on the side and runs down the leg to insert just below the knee on the outside. At the insertion site, the band moves back and forth as we straighten and bend the knee. So you can visualize that when the band gets tighter the friction and rubbing at the knee will be more intense. The rubbing irritates the band and causes inflammation and pain at the knee. This pain is diagnosed as ITB syndrome. The causes of ITB syndrome include:

  • Overuse of the knee on hard surfaces or uneven terrain
  • Tightness of the ITB and surrounding hip musculature (ie. tensor fascia latae, gluteus maximus)
  • Leg length differences
  • Pronation of the foot
  • Knocked knees

You can grasp the importance of stretching and maintaining the flexibility of the ITB and surrounding musculature of the hip. The best two stretches I have found are seen here. In the first exercise you lay on your back with a band or towel wrapped around the foot and pull the leg straight up. Then, slightly cross the leg over your midline keeping it straight. Hold for 20 seconds and repeat three times.

The second stretch is performed in the standing position. Cross the tight leg behind the other and bend forward from the waist. Hold this position for 20-30 seconds and repeat 3 times on each side.

Susan here again: I always pay attention to the IT band during massage sessions. It’s tighter than it should be for many of us. And massage strokes aimed at loosening the IT band can help increase flexibility. I am always reminded my IT bands are tight when my son jumps on them when we’re wrestling. He always thinks it’s funny what a big reaction he can get from mom. Kids are helpful in so many ways, right?

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Under the Hood

With recent car repairs on my mind, I’ve been reflecting on a statement I’ve had on my massage brochure for years. “A lot of us walk around in our bodies the way we drive around in our cars – without a clue how they work and only paying attention when they break.”

When my car broke down in Quartzsite, AZ and I popped the hood up, I had a familiar feeling of dismay looking at the mystery under the hood. Although I can name a few parts, I must admit I really don’t know how the engine works or which of the million pieces of the puzzle could be causing problems. When we do need a repair it’s often some obscure part I’ve never even heard of that’s the root of the problem. How many dang parts are there anyway?

My favorite parallel in terms of the body is connective tissue. How many people know what connective tissue is and how it functions? Probably not many. We all know the names of muscles, bones, and organs in our bodies. Sometimes we become quite an expert on one part of the body, if only temporarily, when we have a break, sprain, or illness profoundly affecting it. Just like in a car, we can, through an injury, become downright amazed at the importance of a small part of the body when it’s on strike or out of commission. Yes, we are connected “under the hood” in ways we’ll never fully appreciate.

So what is connective tissue? It’s a tissue type in the body that binds everything together, holds everything in its proper location and does a lot of other groovy things. Both blood and bone are in the connective tissue family. Ligaments, tendons and even scar tissue are connective tissue. Connective tissue varies in substance depending on it’s molecular composition. In terms of massage’s impact on the body, I focus more on the spectrum of connective tissue that includes ligaments, tendons, and fascia. Clearly ligaments and tendons help stabilize muscles to bones and aid in keeping the integrity of joints. Fascia is a close cousin. One way to think of it is as a web that encapsulates each organ, each muscle, each nerve fiber. Fascia has a Saran Wrap type function in the body; it shrinks to fit our common posture and movement patterns. Here’s what some smart people say about the importance of connective tissue.

The muscle-bone concept presented in standard anatomical description gives a purely mechanical model of movement. It separates movement into discrete functions, failing to give a picture of the seamless integration seen in a living body. When one part moves, the body as a whole responds. Functionally, the only tissue that can mediate such responsiveness is the connective tissue. Schultz, L, Reitis R. The endless web. Berkeley: North Atlantic Books; 1996: vii.

Reminds me of what Obi-Wan Kenobi said of The Force. “It’s an energy field created by all living things. It surrounds us and penetrates us. It binds the galaxy together.” (movie IV) I won’t try to draw an analogy here because I’ll fail. But I love Alec Guinness’ voice. What a Jedi! (from a more civilized time…)

So, why is it important? As we age, we naturally lose some of our flexibility as the molecular composition of our connective tissue changes. If you’re engaged in some sort of activity that encourages continued flexibility, that’s great (yoga, Pilates, stretching). If you’re not, you will lose some degree of flexibility. Massage includes both intentional stretching and the natural stretching of tissue that occurs because you’re manipulating it. Getting a massage is the lazy person’s way of stretching. If stretching isn’t usually included in your massage session, ask for some. It feels great to have your limbs moved through a full range of motion.

Aside from the aging process, connective tissue is important to engage because of its “shrink-to-fit” quality. If you slump in front of a computer 40+ hours a week, chances are pretty good that your connective tissue binds you in that posture to some degree. You may not feel it at 23 years old, but you probably will at 43, 53 and 73. It will be harder to stretch your arms back behind you, open the chest with a deep breath, and fully extend your neck. Decreased range of motion or ease in movement can lead to injuries, especially when you engage in an activity you’re not accustomed to, like lifting furniture during a move, playing volleyball at a family reunion or  roughhousing with your grandchild. I ask my clients about weekly activities to discover clues about how posture patterns might need to be counteracted. I pay close attention to this in my clients because I want them to have ease in their bodies, not strain.

So there’s a little primer on a piece of the puzzle “under your hood.” And it didn’t cost you $438 like my latest education on a part in my car did. You’re welcome.