Is it normal to have a tight IT band?

Everyone has a tight IT band, right?

Anyone who has had massage or soft tissue work done on a tight IT band will know exactly how tight and tender this area can get. It really is quite horrible.

For those of you that haven't heard of the IT band before it is simply a piece of connective tissue that runs down the outside of the thigh. The IT band is short for the iliotibial band (sometimes also known as the iliotibial tract). Along with a muscle called call the tensor fascia lata the IT band helps stabilise the knee, from the outside, in weight bearing activities such as running and hiking.

A tight IT band can cause a number of problems such as anterior knee pain and IT band syndrome. It can get tight for a number reasons, however poor bio-mechanics in walking and running as demonstrated in the video in this blog post are most often related to increased tension in the IT band.

The two major tests that we use in the clinic to assess the tension in the IT band are:

Obers test

Thomas test 

In a significant number of cases we will find these tests show 'positive' results, indicating that the IT band is overly tight. There are many reasons for this including poor bio-mechanics as mentioned above. However, one aspect that must not be missed is that many people simply put their body under huge load without taking the appropriate measures to offset this load. High training volume, with poor postural patterns (e.g. poor sitting position at work), can lead to imbalances, increased tension and specific weaknesses in the tissue. If your training volume is high, and you are not carrying out regular basic maintenance on yourself, then it is very likely you will end up with a tight IT band and consequently injuries can occur.

So, back to the original question, 'Is it normal to have a tight IT band?' My answer, NO, it is not normal however it IS very common. For this reason it is hugely important to carry out regular self maintenance e.g. Foam rolling, mobilising, self trigger point work, stretching, glute and core strengthening exercises, balance and proprioceptive work as well as regular massage will all help reduce your chances of developing a tight IT band. 

Have you got IT Band Syndrome (ITBS)?

ITBS is more commonly known as 'Runners Knee'.

The Iliotibial band is a thick, very strong section of connective tissue that runs from the top of the hip down the outside aspect of the leg. It connects to the bottom of the knee at the fibula bone, with some of it's fibres running into the patella.

In the case of IT band syndrome rubbing takes place at a bony point called the lateral epicondyle. If the IT band is tight it will rub over this bony point when walking, running or jogging.

If you have ITBS you will find pain on the outside aspect of the knee, which is caused by the band rubbing on the bone. If left for a long period scar tissue will develop in this area.

Downhill running and high impact activities will typically cause the most problems.

As with many injuries you will most often find that there is some underlying bio-mechanical issue or inefficiency in the body. An example of this is that there may be a specific weakness in the hip musculature. This weakness is likely to cause tension to build up in the IT band. If this is the case then the treatment must focus on addressing both the painful knee area AND the issue in the hip too.

If the painful knee area is treated without 'fixing' the underlying weakness (or bio-mechanical problem) elsewhere then this injury will re-occur almost straight away on returning to training.