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108 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 6 technique MYOFASCIAL TECHNIQUES Rethinking the Iliotibial Band By Til Luchau In recent years, the iliotibial band, a seemingly unremarkable anatomical structure, has been the subject of sometimes-intense debate by academics, athletes, bloggers, hands-on practitioners, researchers, and physical trainers. Can it be stretched? Should it be rolled? The ongoing debates have ensued from a more complete understanding of this structure's anatomy and function (which I will briefly review here), and from updated views on how fascia does and doesn't change (a topic that has been discussed in detail in this column, as well as elsewhere). Conventionally, the iliotibial band (or ITB; also known as the iliotibial tract, IT band, or Maissiat's band) has been depicted as a fibrous strap of connective tissue along the lateral side of the thigh, running from the iliac crest to the tibia (Image 1). What isn't obvious in conventional muscle-based illustrations is that rather than being a discreet band, the ITB is simply a thickening in the fascia lata, the fascial wrapping that encases the entire leg (Image 2). And the ITB isn't just on the surface of the leg; it dives deeply into the thigh as an intermuscular septum, where it attaches along its entire length to the femur (Image 3). 1 The ITB can be involved in numerous client complaints, such as those listed in "Indications" on page 110. Much of the research related to the ITB centers on iliotibial band syndrome (ITBS), which is the most common lateral knee injury in runners, often worse when flexing the knee or running downhill. Conventionally thought of as an overuse injury, and experienced by an estimated 5–14 percent of runners, the exact cause of ITBS is not well understood and there is little agreement on how to treat or manage it. 2 Usually pictured as a band on the side of the thigh, the iliotibial band ( ITB) is a thickening of the fascia lata, the connective tissue wrapping that encases the entire leg. Image 1 courtesy Primal Pictures, used by permission. Image 2 courtesy Manuel d'Anatomie Descriptive du Corps Humain, Jules Cloquet, 1790–1883, public domain. 1 2 CONTROVERSY While there are diverse views about the ITB's precise role in all the conditions we list here as indications, some of the more strident controversies have been about ITB self-care via foam rolling, or working the ITB in hands-on manual therapy. Articles and blog posts with titles such as "Don't Stretch Your IT Band!" and "The Mechanical Case Against Foam Rolling Your IT Band. It Can Not Lengthen and it is NOT Tight," cite research showing that the ITB's length probably changes very little (perhaps 0.5 percent) as a result of stretching (and make the point that simple