The push and pull on our underlying tissues can create some pretty big disturbances up on the surface. In this episode, Allison takes a closer look at the IT Band and explores how to approach a chord of connective tissue that acts more like an earthquake than it does a tendon.
Contact Allison Denney: firstname.lastname@example.org
Allison’s column in Massage & Bodywork magazine:
“Buddha’s Six-Pack: Serratus and Intercostals, with a Diaphragm Chaser,” by Allison Denney, Massage & Bodywork magazine, May/June 2021, page 86, www.massageandbodyworkdigital.com/i/1358392-may-june-2021/88.
“The Muscle, the Beast, and a Cup of Tea: Conquering Sternocleidomastoid Fears,” by Allison Denney, Massage & Bodywork magazine, March/April 2021, page 80, www.massageandbodyworkdigital.com/i/1338685-march-april-2021/82.
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Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.
At Structural Elements, we view ourselves as Body Engineers. We evaluate the human body according to its structural integrity and establish proper balance between compression and tension elements. Through identifying patterns in the body, we are able to locate areas of compensation to treat the cause of the imbalance, not the site of pain. Our patients achieve lasting results as we reduce structural imbalances, improve connective tissue health, and reeducate movement patterns. Now, we have taken our education, operations, and communications infrastructure from our franchise company and made it available to the industry through (se) Connect.
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0:00:00.2 Speaker 1: With SE Connect, you can learn a 15-minute comprehensive manual therapy treatment that will set you apart from other massage therapists. SE Connect is the only multi-disciplinary platform with practice tools, business tools and a community of practitioners speaking the same language. Check it out at network.structuralelements.com.
0:00:25.7 Speaker 2: Anatomy Trains is happy to announce our return to the dissection lab in person, January 10th through the 14th, 2022 at the Laboratory of Anatomical Enlightenment in Boulder, Colorado. We are thrilled to be back in the lab with Anatomy Trains' author Tom Myers and master dissector Todd Garcia, join students from around the world, and from all types of manual, movement and fitness professions to explore the real human form, not the images you get from books, this is an exclusive invitation, email email@example.com if you'd like to join us in the lab.
0:01:08.2 Allison Denney: Hi, my name is Allison Denney, and this is the Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow, but the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart. But this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peek at what's under the surface.
0:01:55.8 AD: If spots and wrinkles and scars in our skin tell a story, well, then I've got a full library, and at the risk of sounding like an Aesop fable or Charles Dickens, those stories are written into the layers of our human existence, like the Earth itself, we look at the passage of time, the internal digestion of how we live, and the external bumps and bruises from what we have seen, these wrinkles and scars appear over long stretches of time as topographical markings that tell the tale of our history. I'm not horrified by my wrinkles and age spots, although I will say that the struggle to love what I see takes a lot more internal deep diving than it used to.
0:02:36.1 AD: My reaction is more about the passage of time, how in my head, I'm still seven years old or 17, or even 37. It's funny how our minds tease us into feeling young when our outsides are clearly moving along without any consideration of asking us first if we are okay with this whole aging thing. Sometimes I like to imagine that our planet shares the same sentiment, it was a billion years ago, but it seems like only yesterday that it was young and bubbling with new energy, and now after all this time, all I can see are mountain ranges and canyons. But we know that every crevasse, every cliff and every lake holds the amazing truth of how it got there, and we can choose to get frustrated with how awesome life used to be and how hard things are now, or we can celebrate the story of who we are.
0:03:29.3 AD: The similarities of our human bodies and this incredible rock that we live on are eerily abundant. Here is what I mean. Let's look at the tissues of our planet, tectonic plates are the subcutaneous pieces that make up the earth's crust, they are separated into said plates because what lies underneath is liquid, fluid and moving and needing to be able to push and shift at the layers that surround it, these plates bump up against each other and move apart from each other, and most of the time, this is not a big deal, but sometimes those collisions and separations can mean some pretty big disturbances up on the surface, over the course of millions of years, these interactions have produced large mountain ranges and the joining or division of large masses of land, and they have formed the map of our world as we know it today.
0:04:22.6 AD: Our geography though is constantly changing, it may seem like it's not, I look outside my window every day and I see the same trees, the same hills, the same scenery, but if we take a step back and look across that vast expanse of time, our map has changed dramatically. Imagine a time-lapse video of the earth from its beginning, or even just a creek bed morphing into the Grand Canyon, the passage of time has formed the global wrinkles and scars that we know and love today. Now, let's look through a similar lens at the human body, at its core, we are looking at a molten fluid collection of elements, the internal organs, blood, interstitial fluid, that need to constantly shift and change. We've got this crust or connective tissue that surrounds the molten insides in an effort to hold it all in place, and on the surface, our skin, we can throw on that time-lapse effect and watch how our appearances change, as the tectonic plates need to settle in every once in a while, our connective tissue has very similar needs, there are areas where it is thicker and areas where it is thinner, there are areas that over time have bound two large masses together, and there are areas where it has gotten weak and separated.
0:05:45.7 AD: There is this day-to-day perspective of how our tissues act and feel, and then there is this lifetime overview where we can start to see how a wrinkle or a scar might have formed. Let's take, for example, the iliotibial tract, more commonly known as the IT band, it is possibly the most famous chunk of connective tissues in our bodies, rivaled perhaps by the plantar fascia of the foot. This long stretch of fibrous tissue serves multiple purposes, but also has the tendency to cause a lot of strife.
0:06:17.3 AD: I chose this particular cord of chaos because it is famously interruptive and problematic, but the coolest part about it is its similarity to a tectonic subduction zone. A subduction zone, if you've forgotten your eighth grade lab science class, is an area on the Earth where one of the large crusty plates has the tendency to slide under another large crusty plate. When this happens, it can result in an earthquake, and we all know what earthquakes do. Here are some IT band details that might help shed some light on this comparison. The hamstrings, as you probably already know, are the thick and famously tight group of muscles in the back of the upper leg, they originate up at the sitz bones otherwise known as your ischial tuberosities and shoot down the leg, split apart about two-thirds of the way down, cross over the back of the knee and attach on to either side of the posterior tibia, the funny thing about this muscle though, is that it never really attaches onto the femur, well, part of one of them does, but it's the short head of the biceps femoris, which is only part of one of the muscles of this group of three, you would think it would though right? It's a huge upper leg muscle, but it's also superficial, which means that there is something lurking underneath.
0:07:37.1 AD: This is where the quads come in. The quadriceps located at the front of the thigh have a lot of attachment sites up at the hip and down at the knee, but they very greedily eat up space all around the leg, they pretty much have latched on to the entire femur, front and back, they reach all the way around and basically hug the femur, like a hippie might hug a tree, latching on to the linea aspera, which is the slight bony ridge that runs its way down the back of the femur, so if you think about it, the quads have subducted themselves under the hamstrings, the quads with all of their efforts to flex the hip and extend the knee and the hamstrings with all of their efforts to extend the hip and flex the knee are clearly at odds with one another, in anatomical terms, they are called antagonists, meaning they fight in opposition to each other, like Hannibal Lecter taunting Clarice Starling in The Silence of the Lambs. It makes for a great story. But not so great anatomical communications.
0:08:43.5 AD: Not only is there some subduction going on here, but if you think about it, there is also a fault line. Looking again at our earth science facts, a fault is where two of those tectonic plates slide back and forth next to each other as opposed to one sliding under the other, same result though, earthquakes and mountain ranges and all sorts of land creation fun, and with the quads sliding under the hamstrings and the hamstrings frictioning against the quads, it's no wonder they seem to have formed a small mountain range of their own, mount IT band.
0:09:17.1 AD: Clearly, we don't have the Himalayas protruding from our upper thighs, but we do have this thick band of connective tissue that for all intents and purposes, can feel like a volcano erupted there, and although it is the source of much irritation, mount IT band also serves a mighty purpose. The IT band is technically a tendon, which just means that it attaches muscle to bone, and in this case, it attaches two muscles, the glute max and the tensor fascia lata, also known as the TFL to the tibia. And if you're envisioning this now, and it sounds weird, you're not alone, usually the attachment site for a muscle is on a bone, very close to that actual muscle, here though, you've got two hip muscles, one in the front, the TFL, and one in the back, the glute max, and then you've got this tendon that reaches all the way down the lateral leg and wraps itself on to the top of the shin bone. What gives? The answer as in everything in anatomy is complicated, this incredible strap of robust tissue we call the IT band has come to be what it is, for many reasons.
0:10:30.0 AD: The answer as is everything in anatomy is complicated, this incredible strap of robust tissue, we call the IT band has come to be what it is for many reasons. In the broader view of the evolution of human biology, it creates stability in how we stand, it mediates the tension between the quads and hamstrings, and it acts as an assistant in our walking or running gait, this last titbit is true because the IT band has also subducted its way under the hamstrings, on top of the quads and anchored onto the linea aspera that line down the back of the femur, so when we put one leg forward to walk or run, it helps to sling our leg back to neutral, essentially assisting the entire gait process.
0:11:16.6 AD: Cool, right? And in the more immediate scope of your individual life, it serves to indicate when things are not working well. The IT band can, as tissues tend to do get inflamed. It can get tired and weary from all the wear and tear, and if you've ever suffered from IT band syndrome, you'll know that it can also create an enormous amount of pain. Near the lower tethers of its attachment to the lateral tibia, it crosses over the lateral epicondyle of the femur, which is a bump on the outside of the lower end of your femur. If your gait system is not working properly, it will friction over that bump, like it's trying to start a campfire and leave you on the couch and out of activity if it gets bad enough. Not fun, but a good indicator that we need to try something new.
0:12:08.1 AD: What techniques work then? Working on connective tissue in general is tricky, it doesn't contract and relax like muscle tissue does, so the approach must be different, more than anything though, I must first address the foam roller, I believe the fad is fading a bit, but there is an obsession with people rolling out their IT bands, and I, for one, am not a fan of this approach, I'm definitely not here to argue against it, if this is what you are currently doing and it's working for you, but theoretically, the IT band with having to manage the quads and the hamstrings and the glute max and the TFL has earned some respect and should be treated accordingly.
0:12:49.3 AD: My first method is usually one of calming the two muscles that form this tendon in the first place. Client side-lying, the affected side up off the table, position both knees slightly flexed towards the chest and bolstered between the knees. Standing behind the client, start with slow compressions into the glute max. Using a soft fist or a broad palm is usually the best first contact. You are in sciatic nerve territory here, and shocking the client into a surprise attack doesn't help anyone. The work here should be relieving, the IT band is most likely tight because its attached muscles are pulling at it like the springs on the end of a trampoline. Ease the tension here with slow rhythmic compressions, slow it down even more with the static compression if you come across a clear area of tension or if you stumble across a trigger point. Have your client breathe and envision the unwinding traveling down the lateral leg, release and repeat this approach into the anterior hip, crawl your fingers across the top of the hip and sink into the softened TFL.
0:13:56.7 AD: Oftentimes, this work will do the trick and attacking the IT band is unnecessary, but if the IT band is still screaming for attention, friction is your best friend. Client side-lying with the lower leg extended straight and the upper leg bolstered with both the hip and the knee slightly flexed. Imagine that you're stuck in the wilderness and using two sticks to start a fire, palms together with the pinky sides on the IT band, spin that stick rapidly back and forth, generating enough heat to get that spark, maneuver up and down the IT band, letting the warmth, sink in. The best part about this move is that you can make it whatever you want it to be, start from the hip and work down or from the knee and work up, place your palms on the IT band instead of facing each other, anchor one hand in place and make the other do all the work. However you apply it, the IT band will thank you, plus, you get a little workout in, it's a win-win.
0:14:53.9 AD: I should mention that there is a lot of controversy about whether or not connective tissue can "melt" with this kind of work, it is theorised, that the thixotropic effect is real, which means that the plasticity of this stuck band begins to liquefy when friction generated heat is applied, and you can find data supporting both sides of this argument. But I will say this, my opinion on the subject is based on years of doing this work and finding pretty awesome results, there is just something about heat that relieves what is stuck. So do we continue to resent the IT band for all the tension and pain, or do we honor how it came to be and all it has to do? This biological marvel has certainly caused a lot of grief, but just like those who have conquered Mount Everest, once we see what it has to offer, we look at it in a whole new light. If you ask me, I say, we celebrate it.
0:15:52.6 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears, and if you wanna get any of your words into my ears or more accurately into my brain via my eyeballs from a computer screen, drop me a line at firstname.lastname@example.org. That's R-E-B-E-L-M-T@abmp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else, I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there, and other Rebel Massage dabblings. I'm impressed you've made it all the way to the end, but because you have, allow me to offer a glimpse into our next episode. Tune in next time as we explore the identity crisis of the gluteus medius and examine how thinking outside of the box can be a much better approach.
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