To roll, or not to roll, that is the question
How common is this sight in gyms up and down the land ?.... shattered souls rolling their thighs over a giant foam rolling pin and grimacing wildly whilst doing so. Perceived wisdom is that it is a form of massage, helping break down adhesions, stretching the ITB so it's not short and preventing injury ....... it also bloody hurts ! But does it work ? And what does it actually do ?
What is the ITB ?
The ITB is a broad band of inelastic fibrous tissue called fascia, running from the crest of the hip to below the knee, passing along the length of the outside of the thigh. It's not muscular but instead a tough, band of tissue, strongly attached to the length of the thigh bone with many muscles feeding into the band.
As the muscles contract and shorten they pull the ITB taut - rather like a drumskin - loading the tissues and giving valuable stability to the knee and hip joint whilst not being so rigid it prevents movement. Kind of like the springs on your car suspension, it absorps load, deforms and moves a little but is tough enough to support.
Having been able to see and handle the ITB on a cadaver it's immediately apparent that there is no way a foam roller is going to stretch this baby ! It's solid, tough and very inelastic.
So if the ITB is so tough and inelastic and not meant to stretch then why are we stretching it and is it worth putting ourselves through the masochistic hell of foam rolling ??
So what does foam rolling do ?
Now I should come clean about foam rolling..... as a therapist I don't like it and rarely use it myself or give it to my patients. I find it too masochistic, quite aggressive and to my mind it just feels wrong that my patient hobbles out looking worse then when they came in, even if they have got a bit more movement temporarily. But I accept that many do like it and find it useful so just what does it do and does it actually stretch the ITB ??
Pain relief - a small study recently demonstrated a short term relief in pain in both ITB's after a foam rolling session..... on the non-painful side only ! This would seem to suggest that rather than altering the structure of the fascia or breaking down adhesions there is an effect on the central nervous system which alters the way pain is perceived in the brain.
Increased flexibility - again there are small increases in flexibility at the hip after stretching ( particularly in adduction - crossing the leg across the body ) but these increases are short term and appear to arise from changes in the length of the muscles feeding in to the ITB rather than the ITB itself.
So to foam roller, or not to foam roller ?
I still don't plan on making it a priority in my personal clinical practice but let's not throw the baby out with the bath water here. Yes, it does appear that there are some short term benefits using a foam roller for ITB in some people. If you find that it helps reduce your pain and you feel better for doing it, then go for it. But if it's pure torture, makes you squeal like a stuck pig and feel tender for the rest of the day then you're not losing out on anything and I wouldn't make it a priority for you !
Whether you choose to use it or not it's important that you don't use the foam roller as a short term solution to a long term problem. I find that for the majority of runners the roller and stretching can become like a sticking plaster over a sore spot. It doesn't get to the root of the problem which for ITB is almost always load management i.e doing too much that exceeds the capacity of the tissues and they get sore. Whether that management may be looking at muscle strength, walking/running patterns, training plans they all have a role to play and the foam roller can have it's role in reducing your pain and allowing your therapy and training to be more effective.
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