Massage Tutorial Myofascial release for IT band pain
Hi everyone, i’m ian harvey, massage therapist.This is my friend summer.Today, we’re going to be talking about iliotibial band pain and lateral knee pain, which often cooccur.Especially in runners! summer is a runner, and we were doing a halfmarathon.For some reason.Last sunday, and she was having some pain along her right leg here.This can feel like it’s in the lateral knee, it can feel like spasm going down the side of the leg, it can even feel like this lateralmost hip.Let’s look at some of the relevant landmarks, and.
Then how to do some myofascial release for this area.The it band originates up here, it runs down the side of the leg, and it inserts here, on the most proximal portion of this lateral tibia.The it band is a thick, white band of fascia.It’s primarily collagen, and it is strong as steel.What i see with some massage therapists is trying to roll, or rub, or stretch out this it band when that would be next to impossible without some sort of cutting tool.Which i don’t suggest that you use.The it band has a muscular attachment.
Via two muscles.By the tfl, the tensor fasciae latae.You’ll be able to find the tfl if you first palpate for the asis, the anterior superior iliac spine, and then come inferiorly just a bit, just under that asis, you’ll feel a soft muscle.If you want to make sure you’re on the tfl, you can restrain your client’s knee and have them press outward, this way.So, summer, go ahead and press outward against my hand.And, relax.And you should feel a big muscle jump up right here.The other muscular attachment is gluteus maximus, which runs.
Around back.So, the placement of these two muscles, these two muscular attachments of the it band, should tell you what the it band accomplishes.When these two fire at the same time, they provide a powerful abducting force.They can bring the leg outward.But, acting alone, this tensor fasciae latae can create a bit of flexion at the hip.Acting alone, the gluteus maximus can create a powerful extension.Now, what these are usually doing is acting as a brake.They’re stopping you from collapsing over sideways every time you.
Take a step.And that’s when the it band gets irritated, is having to act as that brake over and over and over again, especially in runners.Every time this has to put on the brakes to prevent the runner from collapsing sideways, it’s yanking right here, on this lateral proximal tibia.And it’s rubbing along here.There’s not a lot of movement in the it band, but there is some play between the it band and the muscle that it runs over.The muscle that it lies over is vastus lateralus, one of your quadriceps muscles.The most lateral.
Quadriceps muscle.So, it band can be irritating vastus lateralus.Because the it band is collagen, it does have living cells in there that are constantly remodeling it, but there’s not a lot that we can do to change its length.But we can change the length of these two muscular attachments, so that’s where we’ll primarily be focused.So, if you client can take the pressure, i definitely will work with this lateral portion of the femoral region.I’m not going to avoid it because, oh, i know better, and i think the issue is up here..
No, i think that there’s definitely some good stuff that you can do here.We can do some nice fascial traction of this entire lateral leg.You can use open fist, you can use the palmar surface of your hands.I don’t recommend an especially sharp tool here, like carving knuckles, or fingertips or thumbs.But, i certainly recommend warming up this lateral leg.But as you do so, think origin to insertion and beyond.I’m starting distal to the knee, and as always i’ve got my elbow anchored into my side, so that that’s providing this locomotion.
Rather than me trying to muscle my way through this.When i need to move a bit more, i’ll shuffle my feet a bit toward the head of the table.It’s a very lazy way of doing this.So, i’ll start distal to the knee, and i’ll make my way up as close to that asis as possible.Right now, under my palm, i’m feeling the greater trochanter.The greater trochanter is definitely another landmark that you’ll want to be able to palpate for this work.And i am going under the drape just a bit.This would be a good thing to discuss with.
Your client, let them know that you’d like to go up onto their hip.Make sure that they’re okay with that.The greater trochanter is this big knobby guy right here.It’s part of the femur, so it’s going to move independently of the pelvis.So, if you want to make sure that you’re on the greater trochanter, you can place your finger tips on this knob of bone and rock the leg.If that knob moves, you’re on the greater trochanter.You’ll find the tensor fasciae latae just medial to that, and as i said, just distal to this asis.So.
Do a little bit more to warm up this lateral leg.You can do some nice swedish, don’t forget about swedish! swedish is our friend.Do some nice petrissage in this area.You can spread this fascia.Myofascially speaking, we’re going to be treating this leg and hip region as a whole.Think globally rather than locally.The more that you can get the rest of these overworked muscles to calm down, the better that the it band is going to feel.And sometimes, the tissue will be more accessible, it won’t fight back, it qon’t be quite so sensitive.
And once you’ve started to desensitize this area, and you feel that the tissue is warming and softening, you can use a little bit more of a focused tool, like the open fist.Just monitor your client’s face, make sure that you’re not causing any pain.And always go up toward this asis, and toward this lateral hippelvis region.There’s not a lot that i do with gluteus maximus right now, but that’s just because it’s difficult to access.We’ll do more with that while the client is prone.To target tensor fasciae latae specifically,.
You could undrape it, you could undrape the asis, but for modesty’s sake i’m going to work through the drape here.Place the palm of your hand on the asis, so you’re going to feel that knob of bone in your palm.And then the heel of your hand can sink just below that.You can put a surprising amount of pressure right here.So, i’m giving some of my body weight to this left hand, and now i’m going to rock the leg with my other hand.So this is creating some movement under my palm, it’s deforming the tissue a bit, and i’m going.
To stick around here until i feel a little bit of softening under my palm.Or, if this is painful at all, or if it refers sensation for your client, you can wait until that sensation subsides a bit.And this is what i do during the first session.During subsequent sessions, if i felt like being a little bit more aggressive, i could switch to finger tips and thumb tips, and do that same thing.Ask about any possible pain andor referral and wait for that to subside.Next, i want to bring some movement into this picture, into this iliotibial band.
And to do so, i’ll bring the client’s heel onto the table.If i want to stabilize it even further, i can do so with my knee, if we have that kind of therapeutic relationship, which we do, isn’t that right summer yes, of course.Fantastic! so next, i’m going to work with this knee in a more mobile position.I’m going to allow it to come into adduction as i do this myofascial stripping.You can do this with open palm, you can do this with open fist.And as always, my other hand is going to be doing a bit of work.I’m going.
To be gently rotating this knee away from my other hand.This is going to change the angle of the tibia just a bit.I can even sink in with my thumb here if they can tolerate that kind of pressure.And while i have the leg up like this, i can work directly with tensor fasciae latae.You can rock this leg as you work with it, allowing the rocking to do much of the movement for you.So, keeping your lower hand relatively still and gliding away by moving the leg.And finally, don’t forget about the knee, so this is going to.
Be similar to how i worked with the knee in the anterior knee pain tutorial.I’m just going to do some nice myofascial traction upward, so anterior for your client, up toward the ceiling for you, using a duck grip.Around here, at the level of the insertion site, the it band becomes quite thick, and you should be able to easily palpate it down here.Some clients, perhaps not, but this client yep.And i’m going to allow my thumbs to gently strum over that as i traction this fascia northward.Work your way distally until you’re.
On the knee joint itself, and then get a little bit onto the tibulafibula region.Finish with another nice myofascial stripping up the side of the leg, and allow this leg to internally rotate.This complex, and it band, are primarily external rotators, so allowing it to come into internal rotation as i work on it is going to give it even more of a stretch.With your client prone, start with a general warmup of the lower and upper leg, and definitely up into the hip here.This is one of those cases where you might want to have that conversation.
That, if you’ve got this it band pain, i might need you to be completely undressed for your massage.And, of course, leave it up to your client, you can do a lot of this work through clothes, but for this myofascial work, it can definitely help to have this hip region completely accessible.Get good at those crucial conversations, my friends.So, i’m not just going to instantly start whaling on this it band.With any area of pain and irritation, i’m going to kind of dance my way there.So work with the related.
Structures.Specifically, let’s work with this gluteus maximus.The glute max has a direct muscular connection to the it band, and so if it is hypertonic, or it’s overpowering its antagonists, then it’s going to be playing a big role in it band pain and lateral knee pain.Now, that said, gluteus medius and minimus, here on that more lateral aspect.So find that greater trochanter again, move just superior to that, now you’re on the ilium below that iliac crest, so between this greater trochanter and the iliac crest you’ll find gluteus medius.
And minimus.If you’re working on glute medius, you’ll be working on glute minimus as well.And while this doesn’t have a direct muscular connection, it’s definitely latched into the same fascia.Glut medius and minimus are also acting as a brake, keeping people from collapsing inward when they take a step.So if it band is ticked off, i bet you a million bucks that glute medius is ticked off, and that ultimately they’re connected because of their proximity, and their similar function.Just start with some nice broad, ironingout moves for this hip,.
Again waiting before you jump into that lateral fascia.When you’re working with gluteus maximus, make sure that you get all the way up to that si joint, the sacroiliac joint.We’ll be working more specifically with that later.And think steamrolling.To get a nice broad and deep pressure here, i like to double up my hands.So this hand isn’t doing a lot, it’s just providing extra support and extra weight to this bottom hand.Mold to the surface beneath that bottom hand.Change angles when you need to.And place some direct pressure, using.
That karate chop part of your hand, up against that si joint.Stick around here for a while, go slowly.If you find especially painful areas, or anything that broadcasts pain downward, then stick around here for a while.If your client has it band pain, they may also have low back pain.These are things that are tied together by these hip muscles.So this may also refer upward.So here on this posterior leg, you can also do some nice broadening of the fascia.You can do your petrissage.And we’ll eventually work our way to doing.
Some nice steamrolling of this lateral fascia.In some clients, this might be too tender.In that case, either lighten up, or just work with these attaching muscles for that first session.And then, maybe next session you’ll be able to apply some direct pressure to the it band region.And now that we have the client prone, we can continue these moves up over the greater trochanter.I’m just gliding past the greater trochanter, i’m not applying direct pressure to it necessarily, but i’m keeping that superior traction of this fascia, all.
The way up.As i get into this hip region, something that i can do to change things up is to use this lower hand to rotate the femur.Go all the way up to that iliac crest.You can even go all the way up onto the low back just a bit.Origin to insertion and beyond.I’ll do a couple of nice deep strokes up like that, and then i will, as usual, incorporate some movement.The body understands movement.So, this is going to, any time that you bend.
The knee, that’s going to change the shape of this it band.Palpate this lateral fascia as you bend the knee.You’ll feel it becoming a little more taut.So, this isn’t something that i’ll do initially, this is something that i’ll wait until i’ve melted this tissue a bit, all the relevant muscles and fascia.Then i’ll bring the knee into faction, and now, you can continue this work.Part of the reason that this feels more tense is because this vastus lateralus muscle is being brought into a lengthened state, and keep in mind.
That vastus lateralus might be a little irritated.So you may need to lighten up here a little bit, but you might not have to at this point in the massage.You might have done enough softening and enough decreasing of tone that now you can work on this in this lengthened state.And now, as i come up onto this hip, i can easily manipulate the angle of this femur.Remember that the gluteus maximus is an external rotator of the femur, of the hip.So, if i bring this femur, if i bring it into external rotation, that’s going to bring some.
Slack to the gluteus maximus, and i can take advantage of that and sink in just a bit more.This gluteus medius and minimus up here is going to be changing shape as you rotate the femur, and you can use that to your advantage.Sink in here, find a nice soft area, the belly of the muscle, or look for trigger points.Ask your clients if you’ve found a good one.And hang around, just stay static, while you change the shape of that muscle by moving the femur.This is a different way of interacting with trigger points than just sinking in and.
Waiting.This will work where regular static moves fail.And i like to drape the glute here, because i’m going to be drawing the leg out.I’m going to be applying pressure directly this way, directly toward the si joint.This can feel like a bit much for some people, so start slowly and stay in good communication.And finally, i’m going to do a bit of work with the it band with the leg crossed over the other one in kind of a figure4 position.So now this is in a different relationship to the hip than it was before.The glute max.
Is now completely relaxed while the tensor fasciae latae is in a bit of a stretch.So, the it band is being yanked in a different way than usual, so we’re giving the nervous system a variety of stimulus.All this tightening and tone is happening because of repetitive movements in a single plane, and of a single type.What we’re doing, as massage therapists is, giving them a bunch of different inputs.Now, what the nervous system chooses to do with those inputs, i can’t say.But, it tends to be helpful.It creates a bit of confusion,.
A bit of chaos at the level of the collagen and of the nervous system, but the body tends to be able to figure out what to do with all of that.If i’m working on an athlete, if they’re not in danger of going into spasm for instance, if they haven’t just run a marathon, then i’ll almost always do some tapotement.Athletes’ bodies tend to know what to do with tapotement.Alright, that’s about it, let me know what you think in the comments, consider subscribing, and i’ll see you next time.
Chinese Medical Massage For Sciatica And IT Band
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