Many of my clients suffer from knee pain, hip pain, or a tingling sensation that radiates down their legs, and they’ve been told that tight IT bands or lateral rotator muscles are to blame. So, a common question I hear in my office is:
“How can I stretch my IT bands and piriformis muscle?”
Since I get asked this question so frequently, I’m going to go ahead and address it in depth here today. Before we get into stretches that work (and don’t work, because there is a lot of conventionally accepted and oft-repeated bogus info floating around out there), let’s take a moment to define the problem so that we’re all on the same page.
What Are Your IT Bands?
Your iliotibial bands are dense strips of fascia that run down the outsides of both your thighs, so named because they stretch from your ilium (crest of your hip) to your tibia (your shin bone).
They’re not actually a muscle, but are the tendon of a small auxiliary hip flexor called tensor fascia latae, or TFL. Your gluteus maximus muscle also exerts some indirect force on your IT bands. IT bands work to stabilize your knee, especially in lateral movements such as skiing.
What Is Your piriformis Muscle?
Your piriformis is a small muscle belonging to a group called the “lateral rotator muscles.” These muscles twist your femur, or thigh bone, externally in the hip joint, as a ballet dancer would do to turn their toes out. The piriformis extends from your sacrum — the triangular shaped bone at the base of your spine resting between your pelvic bones — and your femur. The longest nerve in the body, the sciatic nerve, runs beneath the piriformis and in some cases innervates the muscle.
What Causes Them to Get Tight?
Generally speaking, the IT band doesn’t become “tight” because it isn’t a muscle — it’s fascia, or connective tissue. But it can become thickened or even inflamed with overuse. Skiers, for example, tend to have extra-thick IT bands due to the lateral force exerted by carving turns in the snow. Runners also put quite a lot of strain on their IT bands, especially when running downhill. Poor biomechanics can exacerbate IT band inflammation. Medially rotating the femur — toeing in — puts extra pressure on the TFL muscle which in turn exerts more force on your IT band.
Lateral rotator muscles including the piriformis become tight when they don’t move. Since many modern humans have a shocking lack of diversity in their movement — read: we sit too much, and always in the same way — these tiny muscles don’t get much stimulation. So, they lock up to support your hip joint, especially if your gluteus muscles are weak. While you’re probably familiar with your main glute muscle, gluteus maximus, you actually have two more as well: gluteus minimus and gluteus medius.
Gluteus medius supports your pelvis in standing, so if it lacks stability (strength) your piriformis will be forced to compensate by taking up the slack1. This stabilization develops a very thick piriformis that loses its elasticity due to chronically holding an isometric contraction in order to support your hip.
Symptoms of IT Band and Piriformis Issues
Tight IT bands can result in an awful condition called runner’s knee where there is pain and inflammation on the outside of the knee that worsens with activity2, especially walking up or down stairs, but there can be issues with the tensor fascia latae muscle long before you develop symptoms of iliotibial band syndrome (the medical term for runner’s knee).
Many of my clients with hip and back pain groan with discomfort and relief when I apply pressure to the TFL muscle, which often feels tight to the point of being almost wooden beneath my elbow. What I have noticed over the years of doing hundreds of sessions with clients who largely spend their days working in front of computers is that our sitting-based lifestyle results in weak and inhibited gluteal muscle function, which weakens the hip and allows the femur to turn inward.
(And yes, standing desks are better, but they don’t magically give you glute strength especially if you have built up years of patterning tight quads and hip flexors by sitting before you got your standing desk.)
When the femur turns inward (medial rotation), the muscles along the outside of the leg tend to be more active in normal gait. What that means is that a person who toes in relies on strength from the TFL muscle and vastus lateralis — the quadriceps muscle that runs along the outside of your leg — when walking.
The vastus lateralis is actually not a hip flexor. It runs from the femur — thigh bone — to below the knee and its primary function is to extend the lower leg (straighten the knee)3. It also absorbs shock in walking and running, so if your femur is turned inward due to weak glutes, that lateral quad muscle starts to get pretty bulky with repeated concussion and a misguided attempt to aid in walking.
A tight piriformis muscle can be harder to pinpoint. Because this muscle is such a small little guy deep in the back of your hip, it can be hard to palpate on your own. If you experience tingling or pain radiating down the back of your leg, this can be a symptom of piriformis syndrome, where the muscle impinges on your sciatic nerve. But it can also be a symptom of true sciatica where the nerve is occluded higher up at its exit point from the bony housing of the spine. It’s a good idea to get a firm medical diagnosis before proceeding with any exercises or stretches to fix the problem.
In my experience, people with lower back pain often have a tight piriformis. I find that the muscle (along with several others, it’s never just a single muscle problem) restricts the movement of the femur in the hip socket, effectively fusing your thigh to your pelvis. I don’t mean that the joint is actually fused, but a lot of times it may as well be for how little it’s able to move due to the tense, braced muscles around it.
In that case, the muscles of your lower back have to take up the job of lifting your hip and leg, swinging them in walking and running. They’re not meant to do this work along with also stabilizing your spine, so they become overburdened, fatigued and sore. If you have a chronic ache in your lower back of indeterminate cause, you may want to address your tight piriformis.
Do You Really Need to Stretch Your IT Band and Piriformis?
This is where things get a little cloudy. Everyone who’s anyone with knee, hip or back pain has likely been vaguely recommended to stretch or foam roll their IT bands. You may have been given some specific exercises by a physical therapist or read about them on the internet. But do they really work?
The evidence is pretty weak, actually. First of all, if you’re suffering from IT band syndrome, or runner’s knee, the problem might not actually be the iliotibial band at all. It appears that a bundle of fat and connective tissue beneath the IT band may be the actual inflamed component4, in which case stretching your IT bands is essentially useless as a fix because doesn’t address the root problem.
But even if you don’t have the painful runner’s knee condition and you do suffer from hip or back pain, should you be stretching your IT bands? I would have to say no.
For one thing, your IT band isn’t a muscle; it’s a tendon. Stretching tendons doesn’t really give you much in the way of elasticity, and this is the longest, largest tendon in your body. Studies have repeatedly shown that the IT band will only lengthen about two millimeters with careful stretching — even when the tissue has been completely isolated and force directly applied5.
Previously thought to only be attached at its origin (the TFL muscle) and insertion (below the knee), later studies found that the iliotibial band is tethered along the length of the femur6 so that even if you could stretch it (which is hard to accomplish due to its location on the outside of the leg and the fact that it’s a tendon), it wouldn’t do much to actually elongate the tissue. And anyway, the IT band isn’t very stretchy, as I mentioned before.
Since your IT band is a tendon, stretching tight muscles that exert force on it — your tensor fascia latae and your gluteus muscles — may give you some benefit. But stretching is actually pretty overrated in general7 (I know, I know, blasphemy!), and the locations of your IT band and tensor fascia latae muscle make it difficult to effectively exert force on them.
Because the TFL is primarily an abductor — meaning it pulls your leg away from the midline of your body, as you would do in a karate kick out to the side — to stretch its tissue, you’d have to pull your leg toward the midline in order to elongate both the TFL and your IT band. Unfortunately, you can only move your leg so far before it runs into the other leg. Additionally, it seems that flexing the knee is imperative to a proper IT band stretch, and even then it’s hard to precisely target the right tissue5.
So, “stretch your IT band” is generally vague and less than useful advice.
As to your piriformis, the same stats about stretching apply; however, I have found benefit to posterior hip stretches that target the lateral rotator muscle group.
Wait, what? I thought stretching was useless? Well, it’s not entirely without benefit.
One of the reasons for this is that novel sensory input (moving tissue in a new and different way) serves to wake up your brain, reminding it that you need movement in this tissue. One likely factor in the presence of painful conditions in the body, especially in cases of chronic pain, is a phenomenon called central sensitization.
Basically what happens in cases of central sensitization is that your body is getting very loud pain signals with no apparent cause — almost as if you were “hallucinating pain.”8 The novel sensory input generated by stretching may serve to “drown out” the signal that your brain interprets as threat, and thus turns on the pain alarm (pain is actually generated in your brain, not in your body, but that’s a whole different article).
To get an idea of how this would work, imagine one person standing in a football field singing God Save the Queen. With a single singer, that’s all you’re going to hear. But if you add a hundred thousand other folks standing in the same field singing The Star Spangled Banner, the sound would drown out the single person singing the original song9.
Stretching is kind of like this. The brain is getting one signal from your body, but then you move some muscle tissue that sort of went to sleep, and suddenly the brain is flooded with more sensory information that dissipates the sharpness of that original signal, and possibly clarifies that there’s actually no threat here.
Sometimes, as happens in cases of central sensitization, the brain gets stuck in on mode. We can interrupt this loop and get the pain signal to calm down by providing novel sensory input (stretching the muscle, for example). There is some conjecture that the sensation generated by stretching is actually more productive than any purported lengthening happening in the muscle tissue.
What About Foam Rolling?
Ah, foam rolling. People seem to have an addiction to their stubbled logs that exert force on trigger points within the tissue. And when I say addiction, I’m not exactly exaggerating.
Before we get into that, though, let’s talk about foam rolling and the IT band specifically. You see, due to the blunt force applied by a foam roller and the vector at which it has to actually exert force on your IT band specifically, it’s unlikely that foam rolling is going to effectively lengthen the tissue of your IT band, even if it could lengthen (which, as we already covered, it just doesn’t do).
Foam rollers press inward, toward the bone of your thigh. They do not elongate the tissue downward, away from your hip, toward your knee. So, not exactly practical.
Additionally, foam rolling has repeatedly failed to demonstrate any lasting tissue tone changes (i.e. it doesn’t make your muscles looser or longer) in formal studies10. It would take around 1,000 pounds of pressure to distort the thick fascia along your leg or the bottom of your foot a mere 1%11.
And then there’s the biochemical component to foam rolling. You see, when you lie across that nubby log and feel that pain that “hurts so good,” your brain starts producing some nifty painkillers like endorphins, dopamine, serotonin and even its own morphine that’s more potent than synthetic, laboratory produced pharmaceuticals12.
Remember how I said that foam rolling is addictive? Every time you grind away at your IT bands, you’re getting a hit of natural opioids directly delivered by your own brain. And it turns out that when there is an expectation of relief, i.e. someone with authority, like a physical therapist or personal trainer whom you have paid money to advise you, tells you that this painful experience is therapeutic, there is a greater reduction in body-wide pain10.
So, it seems that foam rolling may make you feel better due to biochemical changes in your body and brain, but there’s not really any lasting benefit, any more than taking an Aspirin helps calm pain long term. As soon as the drugs wear off — whether they’re produced internally or a synthetic pill that you swallow — you need another hit of your painkiller to feel good again.
It’s quite possible, also, that your body needs ever increasing quantities of pressure to generate the same levels of neuro-chemicals, which would explain why often people start off with a soft foam roller and move up the chain until they’re mashing with spiked logs and wooden rolling pins.
The Stress Component
One thing I see almost nobody talking about when it comes to tight muscles is the effect of stress and trauma on tight tissue. There seems to be this “blunt object” approach to releasing muscles and fascia that have become bound up, with some therapists applying measures bordering on barbaric in order to “break up” scar tissue and increase mobility.
As we’ve already discussed, those methods don’t work like we think they do. There is an effect, sure. But are they really transforming tissue? Unlikely.
There is definitely a nervous system component, though, as we can see through the processes of central sensitization and the benefits of novel sensory input in reducing tension and pain.
Well, your nervous system does a lot of things. It’s important to note that your brain is part of that nervous system, in case that’s not obvious. Your brain and spinal cord comprise the central nervous system, but where we consider the brain to be separate from, yet connected to, the body, this division is illusory.
Your brain is distributed throughout your body13. The bundle of gray matter inside your skull extends down your spine and branches into billions of nerves that terminate in your muscles, tendons, organs and bones. There is no thought without a corresponding physical reaction. And, in fact, your brain does not “tell” your body what to do. The body-mind relationship is reciprocal.
Your body sends signals to your brain at least as often, and in some instances more frequently, as your brain “talks” to your body. The heart, for example, contains sensory nerve bundles that send information to the brain about nine times more frequently than the brain sends signals to the heart14.
It seems that whenever a muscle is tight, we want to yank on it and force it to be longer like pulling taffy, irrespective of neural activity. The fact of the matter is that modern lifestyles require constant levels of neural activation because we are always in go mode.
This chronic, low-level stress creates activation in the sympathetic branch of your autonomic nervous system — your fight or flight response.
When your sympathetic nervous system is activated, one of its primary functions is to prepare you for action. It does this by tensing muscles and mobilizing blood away from digestive organs and into your periphery, supplying your arms and legs with oxygenated blood in preparation to fight or flee.
So, stressed out people with tight muscles go to gyms with loud music pumping and trainers shouting and are told to lie across firm logs of foam thus causing more pain, more threat and more activation in their nervous systems…
You can see why this is a never-ending cycle of pain and tension.
In my view, it’s imperative to address this neural activation to get to the root cause of tight, braced muscles.
(I devote an entire chapter to nervous system regulation in my book, Perfect Posture for Life, complete with how-to exercises and practices that will help you harness the benefits of discharging activation of your fight or flight response).
So, What Do We Do About Tight IT Bands and Piriformis Muscles?
I can hear you saying, “Okay, Sukie, this is all great, but my hips are tight and what can I actually do about it?”
Great question. First, I’d return to your original inquiry: “How to stretch IT bands and piriformis muscles.”
And, I’d ask you in return: what is it you’re trying to accomplish? You’re not stretching that tissue just to stretch something. You’re looking for a result, likely to loosen your hip joints or stop tingling from traveling down your leg.
So then, the problem is no longer how to stretch IT bands or how to loosen your piriformis muscle, but how to loosen the hip joint or reduce impingement on your sciatic nerve. This is a much more approachable and realistic question.
There are a variety of therapies that I find useful for accomplishing both of these goals. Despite the fact that stretching has fallen under scrutiny of late, some stretches may actually be helpful due to the novel sensory input that they generate. This is particularly applicable when it comes to the piriformis as it’s much easier to exert force upon than the IT band.
Many urban humans never stimulate their piriformis muscles due to single-planar movement — we only swing our legs front to back with little rotation or lateral movement as would be required in a more organic environment with lots of stooping, squatting, crouching, bending, shuffling, etc.
But stretching just one or two muscles is short-sighted at best. Joint restrictions don’t happen because one muscle randomly decided one day to become tight. Movement of the joint throughout its full range of motion is imperative.
I’m a big proponent of cultivating diversity of movement. The more motor pathways you use, the more options you have available, and the less wear and tear you place over the course of your lifetime on one single movement path (so, you’ll be using the full range of motion of each joint rather than wearing a groove across one single line).
Whereas most people only use their hips in sitting, standing, and walking, incorporating low center of gravity movements can help engage all the muscle tissue around your hip joint, both waking it up and developing balanced strength. These movements include (but are definitely not limited to):
- side lunges
- squat shuffles (crouching low and then shuffling side to side)
- sitting/standing without using your hands
- sitting cross legged
Manual therapy can also be a helpful adjunct in loosening up tissue of your hip and thigh. While you might think of bodywork as just paying a therapist to foam roll for you, this isn’t exactly how it works. As I mentioned, foam rolling has shown limited benefit to long term tissue change, but I can tell you that after nearly fifteen years working with clients and receiving bodywork myself, manual therapy is somewhat different.
There are a few reasons this is true. For one, a therapist has sensitive fingers that can target just exactly the right tissue at a precise vector. Those same fingers can feel when the muscle actually releases tension as opposed to just initiating a cascade of chemical reactions inside your brain. The therapist is, in effect, training your body to yield, to dissolve tension.
Releasing muscular contractions is one way to reduce activation in your sympathetic nervous system — your stress response. A good manual therapist is doing more than “mashing tissue.” She’s having a dialogue with your nervous system, saying things like: hey there, body, did you know you’re tight here?
And: what if you let go of all this tension, how would that be?
Additionally, when I see people foam rolling in the gym, everything about them says tension. Their teeth are gritted, jaws clenched, frantically mashing away at their quads and IT bands…gotta crush those flexibility goals!
A good hands-on therapist will encourage the tissue to soften. Often, I notice clients holding their breath, squinting eyes and tightening their chin muscles when I target uncomfortable tension. It’s this body-wide response to tighten and push away that can be dissolved through intelligent bodywork.
Manual therapy is also another form of novel sensory input, often at vectors and with specificity that are difficult to achieve on your own. While I don’t think bodywork is the only ingredient in healthy posture and movement, it certainly can be a helpful adjunct.
These are just a few effective methods for loosening your IT bands and piriformis muscles through increasing hip mobility, but if you’re looking for a more DIY approach, I cover specific practices that will help you improve body-wide flexibility in my book Perfect Posture for Life. You can check it out and order the book here.
11. Chaudhry, Hans, et al. “Three-Dimensional Mathematical Model for Deformation of Human Fasciae in Manual Therapy.” The Journal of the American Osteopathic Association. (2008). Web.
13. Blake, Mandy. “1.1 Distributed Brain” Body=Brain.
14. Blake, Mandy. “1.2 Heart Brain” Body=Brain.