Stretching the iliotibial band
Is stretching the most effective when you have pain on the outside of the hip?
Stretching has its benefits, for sure! The tensor fascia lata (TFL) that leads to the iliotibial band (ITB) is part of a thick, broad bit of connective tissue that connects the pelvis to the knee. It spans the side of the hip and thigh. A lot of people want to stretch this area when they have hip and/or knee pain on the lateral side, but because it is so thick and made of connective tissue rather than muscle, it is more resistant to stretching.
How do you know if this area needs to be addressed? If you have pain on the outside of the hip or on the outside part of the knee, then you would need to consider the TFL or ITB as a source of pain. Typically, this pain occurs, not because the TFL is tight, but because the hip abductors are weak. The hip abductors move the leg out to the side from the hip. There are 3 main muscles that do this-gluteus medius, gluteus minimus, and the TFL. If the glutes are weak, then the TFL will try to take over and try to do the job of all 3 together. When the glutes are weak, the pelvis is not as stable during single leg activities. This can place a lot of pressure on the TFL and ITB which can cause a lot of popping on the side of the hip and on the side of the knee.
Instead of stretching to alleviate the popping, try strengthening instead. By creating stability around the pelvis during single leg activity, there will be less pain and/or popping.
Try these!
side lying hip abduction-laying on your side with your hip, knee and foot in a line, lift your top leg up with the lift coming from the side and back of your hip, not the front, try 3 sets of 8-12 each leg
lateral step ups/downs-standing at a step, turn to the side. Place one foot up on the step and slowly lift your body up onto the step. Slowly lower allowing the heel to tap the floor. Focus on keeping the pelvis level. Try 3 sets of 5-12 using only a hand to steady your balance.
split stance with one foot in front, feet are shoulder width apart. Holding a weight in the opposite hand, lower the weight down toward the foot that is in front. Keep the ribs stacked over the pelvis and the lower back in its natural curve. Try not to tuck the tail bone or overly arch the lower back as you lift and lower. The knees stay slightly bent here and keep the same knee position as you lift and lower to encourage hip engagement. Try for 5 sets of 5 with each foot in front.
bridges-laying on your back, knees bent. Lift the hips off the floor keeping the spine in its natural curve, core engaged. The lift comes from the back of the thighs and the buttocks, not pushing with the fronts of the thighs. If you feel yourself sliding upward as you lift, you are using the front of the thighs here. For a challenge, try lift one leg off the floor and keep your pelvis level. Try for 3 sets of 8-12.
Instead of stretching, try a foam roller! The foam roller can provide external input to the area we want to change. It doesn’t necessarily “release” the area or stretch it. Foam rolling can provide a new sensation to the muscles and connective tissue allowing them to respond differently. If you have tried stretching and it hasn’t been helpful, give foam rolling a try! Avoid rolling across the outside of the hip where it can be boney because there is a bursa, a fluid-filled sack, that can become irritated from the foam roller. Using the foam roller on the buttocks, outer back edge of the hip and front of the hip/thigh is a great way to start your routine. I would recommend spending about 5 minutes foam rolling the area and then doing the exercises as above.
I’d love to know how this feels for you!
Take good care,
Sharon