SCW Spotlite: Issue 72

To roll, or not to roll? Foam rollers, massage guns, cupping… when it comes to chronic IT band tension, your clients have likely tried it all. Yet, that pesky tension acts like a boomerang; after a few hours of roller relief, the IT band issues return.

The reason the rolling, vibration and massage strategies seldom provide lasting relief is that we are treating a symptom and bypassing the root cause. When we want lasting results, we need to identify and target the root cause instead. Not sure where to begin? Follow the three steps below.

Step 1: Fix excessive functional navicular drop

Navicular drop is a measure of foot pronation. You are probably familiar with the idea that overpronation contributes to IT band syndrome, so clients need arch supports or pronation control shoes. While this can be true, this over generalization masks the necessity for individualization. Instead of generalizing, perform a functional navicular drop test to see if your individual client may benefit from a pronation control shoe.

How to perform a functional navicular drop test

The functional navicular drop test checks how much feet roll into pronation when weight bearing. All you need is a marker and ruler. Follow these steps:

1. Have the client sit in a chair with their bare feet flat on the floor.
2. Make a tiny mark on the navicular of each foot.
3. Measure the height of each mark from the ground while sitting.
4. Have the client stand on one foot, then re-measure for each side. If your client is not able to stand on one foot, perform the measurement standing on two feet.
5. The difference between the seated and standing measure shows how much the arch drops in weight bearing.

Interpret & Fix

If there is more than 10 mm of drop on either side, pronation control shoes or arch supports may be helpful. When changing footwear, wean into them slowly. Start with no more than two hours/day in new footwear. Gradually add an hour every few days as tolerated.

Why correcting excessive navicular drop matters

With every step, the foot absorbs the force of the foot contacting the ground. The posterior tibialis courses up the inner part of the lower leg to control over pronation. These muscles are balanced by the outer lower leg muscles, the peroneals. The peroneal muscles act like a sling as they course from under the foot up to the fibular head. It is no coincidence that the fibular head also attaches to some fascial elements from the IT Band. Controlling overpronation balances the posterior tibialis-peroneal sling to provide a base of support. A solid base foundation decreases the need for IT band compensation from above.

Step 2: Inhibit excessive tension

Foam rollers, roller sticks, massage guns and cupping are great tools to inhibit the neurological tension in muscles that tend to pull too much on the IT band. Usually the lateral hamstrings, lateral quadriceps and tensor fasciae latae are the culprits.

Before applying a one-size-fits-all approach, perform two tests to see if your client may benefit: Ely and passive straight leg raise.

How to perform an Ely test

The Ely test checks for excessive quadriceps tension. Follow these steps:

1. Have the client lie face down on a stretching table.
2. Coach the client for pelvic neutral throughout the test.
3. Passively flex one knee, bringing the client’s heel toward the client’s backside.
4. If the client compensates with an anterior pelvic tilt, or hip abduction, back out of the movement, reset and cue to prevent compensation.
5. Repeat on the other side.

Interpret & fix

If the client’s knee does not flex at least 90 degrees without compensation, the client is likely to benefit from techniques like lateral quadriceps and tensor fasciae latae foam rolling and static stretching for 3-4 sets of 30 seconds daily.

How to perform a passive straight-leg raise test

The passive straight leg raise checks for excessive hamstring tension. Follow these steps:

1. Have the client lie face up on a stretching table.
2. Coach the client for pelvic neutral throughout the test.
3. Coach the client to completely straighten their knees and keep the ankles relaxed.
4. Passively raise one leg upward as if stretching the hamstring.
5. If the client compensates with a pelvic tilt, or knee bend, back out of the movement, reset and cue to prevent compensation.
6. Repeat on the other side.

Interpret & fix

If the client’s straight leg raise doesn’t reach at least 70 degrees without compensation, the client is likely to benefit from techniques such as lateral hamstring foam rolling and static stretching for 3-4 sets of 30 seconds daily.

Why correcting excessive lateral thigh tension matters

Think of a bed sheet. If something is always pulling the bedsheet in a certain direction, it will never be straight on the bed. Over-active muscles are no different. Setting up nervous system activation balance of the IT Band’s surrounding muscles helps neutralize the chronic excessive pull.

Step 3: Teach the IT band how to respond to movement

You may be familiar with exercises like glute bridges and monster walks to “wake up the glutes,” indirectly decreasing the need for IT band compensation. To some extent, these are helpful exercises. If the goal is decreasing IT band tension, however, these exercises often fall short.

The real fix lies in teaching the entire lumbo-pelvic-hip-foot complex to work in concert. After you assess and address steps one and two, follow with the single-leg triple deadlift to re-educate the movement coordination for lasting results.

How to instruct the single-leg triple deadlift

1. Without any external load (except a dowel rod), teach the client a basic Olympic style deadlift scaled to their abilities.
2. If the client is able, perform the Olympic style deadlift on one leg. Focus on triple flexion (flexion of the hip, knee, and ankle) on descent, and triple extension (extension of the hip, knee, and ankle) on ascent.
3. Once the client can perform the movement for step 2, add a very light weight loop band just above the knees. Since the goal is movement re-education, a light TheraBand is ideal. Heavy booty bands often lead to compensation instead.
4. Have the client perform 6-8 repetitions on each side focusing on quality versus quantity.

Why functional training works

Assuming the foot has been provided enough support for effective pronation control, and the neuromuscular tension of the thigh has been normalized, muscles can be taught to work like an orchestra to fine tune movement patterns. The single-leg triple deadlift helps refine the movement patterns needed for single-leg loading, which presents frequently throughout everyday activities from walking and running to lunging and squatting. Once the body learns how to move efficiently, it has no need for excessive compensatory tension throughout the IT band.

Next steps

Help your clients find and fix the root cause of their chronic IT band tension with this 3-step approach:

1. Assess and address functional navicular drop
2. Neutralize excessive thigh tension
3. Re-train movement.

While no fix is instant, careful attention to detail can provide not only immediate, but also long-lasting relief when practiced over time.