Beyond Foam Rolling:
Foundations of Deep Tissue Self Bodywork for the IT Band
Roman Torgovitsky, Ph.D.
Founder and Master Instructor
IT Band (iliotibial band) tightness is a prevalent issue amongst athletes and is often attributed to pain in the hips, outer thighs, and knees. To address this, many athletes, trainers, and physical therapists have been using foam rollers to “roll out” the IT Band with varying degrees of success. For decades, foam rolling has been utilized along with tennis and lacrosse ball rolling as a method of emulating our intuitive desire to rub out a body part that is hurting; it is often perceived as a self administered massage or even manual therapy. However, the effectiveness of foam rolling is far removed from that of professional grade bodywork and manual therapy.
This article will lay out the basic concepts to transition from foam rolling to deep tissue self bodywork – a more informed and in-depth practice.
Why do we pay $100-$200/hour to see a professional bodyworker, when a friend could also give us a massage or the much desired shoulder rub?
Professional bodyworkers have spent years developing sensitivity through their hands in order to feel the different textures of the myofascial tissues within the body. This allows them to feel the subtle changes in the body tissues, thus providing feedback on the manual intervention. Just as seeing the road is essential for the driver as it provides visual feedback, feeling the subtle changes in the body provides tactile feedback necessary for guiding effective bodywork. These professionals have devoted their time and careers to acquiring knowledge that helps them to develop strategies and techniques to most effectively help their clients.
Just like a bodyworker, a practitioner of deep tissue self bodywork needs to develop sensitivity to guide their practice. Instead of developing sensitivity in the hands however; self bodywork requires the practitioner to develop sensory awareness of their own body. This helps the practitioner to identify the problematic regions as well as moderate the intensity for optimal benefits. With deep tissue self bodywork, more is not always better.
This leads us to present two of the most important foundational concepts of the soma system® method of deep tissue self bodywork:
Concept 1: Building sensory awareness, the full body tension map and being gentle
Most people have a very low level of body awareness. Even athletes, who may have great proprioceptive (movement or position based) awareness, may have poor sensory (compression or tactile based) awareness. Regular professional therapeutic bodywork can help to increase sensory awareness. Practicing self bodywork without sensory awareness is akin to receiving a massage from a therapist who does not pay attention to the needs of their client. Neither is very effective or pleasurable.
Therefore, at the initial stages of practicing self bodywork, focus should be placed solely at improving body awareness and building a detailed compression-based map of the body in the brain. Digging in deep and having an intense and painful experience is not the goal of deep tissue self bodywork. Instead, it should be gentle and exploratory, allowing the body to accept the manipulations and permit access to the deeper layers as the superficial layers release.
Concept 2: Understanding structural anatomy and anatomy palpation
Understanding anatomy, including knowing the locations of the muscles, what movements activate particular muscle groups and what movements can help differentiate between muscles, is an essential part of developing body awareness. In self bodywork, it helps the practitioner to identify the location of the tightness within a muscle group, and allows for more focused work.
Knowledge of anatomy also helps to make the self bodywork practice more effective, by identifying the root of the issues rather than just targeting the painful region. For example, many athletes may complain of pain in the upper back and neck regions, and while the intuitive approach of foam rolling through the back may indeed feel good, the benefits are often very short term. Instead, understanding that the postural imbalances that contribute to the tightness and pain in these areas actually stem from shortening of the muscles in the chest and fronts of the shoulders, would change the focus of the self bodywork practice and make it more effective. In fact, releasing the muscles in the front of the shoulders can result in a decrease in upper back pain with more lasting effects. More information on postural contributions and the effects of the myofascial chains can be found in Tom Meyer’s “Anatomy Trains” and his KMI trainings.
To illustrate these foundational concepts, I am providing several introductory soma system® self bodywork exercises addressing potential contributing factors of IT Band issues using the myofascial chains of the body. We will begin with developing body awareness through self palpation exercises (Part 1). This will help identify the key bony landmarks and muscles to acquire a kinesthetic sense in our fingertips of how these tissues feel. Afterwards, we will demonstrate several self bodywork exercises using the soma system® tools (Part 2).
We will look at the two lower body portions of the myofascial chains as described in “Anatomy Trains”. The first chain along the outer leg consists of the fibularis longus, IT band, gluteus maximus, and tensor fascia latae (TFL). The second chain starts along the front with the tibialis anterior in the lower leg and then extends to the same myofascial structures as the previous chain in the thigh: IT band, gluteus maximus, and TFL.
Tightness along these myofascial chains may develop from a variety of reasons. Runners and cyclist may develop tightness in the TFL due to overuse of the hip flexors. The tissues of the IT band, gluteus maximus, and TFL all overlay the gluteus medius beneath them. The gluteus medius is one of the primary muscles that stabilize the pelvis and allow us to balance whenever we stand on one leg, such as during walking, running, or sideways movements during athletic activities. Tightness and weakness through these structures along the outer hip and thigh may pull on the IT band and ultimately cause the knees to fall inward, contributing to other issues including lower back pain and plantar fasciitis.
The self bodywork exercises demonstrated below utilize the soma system® tools, which can be purchased here: soma system® Basic Package
Part 1: Self Palpation
Exercise 1: Bones of the Lower Extremities
- Patella (knee cap)
The tibia becomes familiar to most of us when we accidently hit our leg against something hard. It is the “shin” bone and the larger of the two lower leg bones.
To palpate it, place your hand on the front aspect of your lower leg. As you press in, you will feel a hard ridge – this is your tibial crest. On either side, you should feel the relative softness of the adjacent muscle tissues.
Continue to palpate along the edges of the tibia up towards the knee. Stop when you feel a protrusion along the front edge – this is your tibial tuberosity to which your quadriceps muscles attach. Move your fingertips along either side of this to find the outer and inner portions of the tibia – the lateral and medial condyles, respectively.
The fibula is the smaller and thinner of the two lower leg bones and makes up the outer ankle bone (lateral malleolus).
To palpate it, place your fingertips on your lateral malleolus, the bony protrusion at your outer ankle – this is the lower aspect of the bone.
Next, place your fingertips just below your knee and glide towards the outside until you run over a bony protrusion known as the head of the fibula – this is the upper aspect of the bone.
Femur & Patella
The femur is your thigh bone and the patella is your kneecap. The patella glides along a groove at the end of your femur as your knee moves along its axis like a hinge.
To palpate the patella, simply cup your hand over the front of your knee. Try to feel for the borders of this superficial bone. Use your fingers to push the patella down and up as well as side to side. Patellar mobility is important for proper pain free knee movement.
To palpate the femur, begin from the medial and lateral condyles of the tibia that we found earlier. As you slide upwards, you will feel the small divot of the knee joint, followed by another protrusion on either side of the knee – these are the medial and lateral condyles of the femur.
Starting from your knee, move your fingers slowly upward along your thigh while intermittently pressing into the femur and then releasing. Try to differentiate between the hardness of the femur and the softness of the overlaying quadriceps muscles.
Place your fingers on the outer side of your knee, above the head of the fibula. Glide your fingers up along the outer thigh, gently pressing in to feel for the femur. At the top, you should feel a large bony protuberance – this is your greater trochanter. Confirm this by rotating your thigh in and out, which should cause the greater trochanter to move under your fingers.
Exercise 2: “Hips” (Pelvic Girdle)
The upper ridges of the pelvic girdle is commonly referred to as the “hips”. However, it should be noted that the anatomical hip joint is actually formed by the attachment of the femur to the pelvis – located closer to the greater trochanter than the “hip crest” or iliac crest.
Place your hands on either sides of your “hips” with the ridge of the “hip crest” (iliac crest) lying between your thumbs and fingertips. Feel along the crest towards the front until you ultimately fall off at the bony protrusion known as the anterior superior iliac spine (ASIS).
Next, follow the crest towards the back. You should feel, more subtly, two protrusions known as the posterior superior iliac spine (PSIS) before coming upon the sacrum at the center. The PSIS is also the region of the “back dimples” that are visible on some people.
Exercise 3: Tibialis Anterior & Fibularis Longus
The tibialis anterior lies along the front of the lower leg to the right of the tibial crest, and is responsible primarily for pulling the foot upwards. The fibularis longus lies along the outer aspect of the lower leg on top of the fibula, and is responsible primarily for moving the foot outwards. Both of these muscles are important for balance by stabilizing the ankle joint.
To contract the tibialis anterior, keep your heel on the ground as you lift the front of your foot up (dorsiflex) and then shift the foot slightly inwards (invert). You should feel this large muscle pop up under your front hand, just to the outside of the tibial crest.
To contract the fibularis longus, lift the outer aspect of your foot off the ground and shift it slightly outwards (evert). You should feel the muscle tighten under your outer hand, on top of the fibula.
If you wave your foot inwards and outwards with the heel grounded, you should feel the two muscles activating alternately, allowing you to differentiate them.
Exercise 4: Tensor Fascia Latae (TFL) & Gluteus Medius
The TFL is a small muscle that attaches to the IT band and functions primarily as a hip flexor, resting just to the front of the outer hip. The gluteus medius is a larger flat muscle that rests underneath the top of the IT band and is responsible for lifting the leg out to the side or keeping our pelvis level when standing on one leg.
To palpate these muscles, place one hand at the side of your hip between your hip crest (iliac crest) and greater trochanter. Place your other hand just to the outside of your ASIS, near where you would place your hand to enter your front pocket.
To contract the TFL, turn your knee inward (internally rotate) and feel the muscle tighten under the front hand.
Perform these movements several times, swinging your leg inward and outward and feel the two muscles activating alternately, allowing you to differentiate them.
Exercise 5: Gluteus Maximus
The gluteus maximus is the largest muscle in your rear, spanning from the outer edge of your sacrum to your greater tuberosity. It primarily acts to extend your leg backwards while rotating it outwards (external rotation). In our modern culture of prolonged sitting, the gluteus maximus is often shut off due to inactivity, tension in the hip flexors, and pelvic positioning.
To palpate this muscle, place a hand over your rear on one side of the sacrum. Extend your leg back behind you and feel the muscle contract under your hand.
Part 2: Self Bodywork Exercises
Exercise 1: Tibialis Anterior
To target your tibialis anterior, position a Double Track Roller horizontally on top of a chair or other platform. Rotate your lower leg inward slightly and place it on the tool with your tibial crest in between the two balls.
Roll along your tibialis anterior in small segments – lower, middle, and upper. Make sure that the compression is not too intense and continuously observe the sensations generated by the compression and movement.
Now select a particular spot that felt like it needed more targeted work and place the Double Track Roller under that spot. Gently and slowly flex (dorsiflex) and point (plantarflex) your foot, while observing the sensations generated by these movements at the target spot.
Exercise 2: Fibularis longus
To target your fibularis longus, lie on your side with your hips and knees bent in front of you. Support your head on a Foam Support or pillow, and position a Double Track Roller beneath your lower leg with your fibula situated between the two balls. Roll along your fibularis longus in small segments – lower, middle, and upper. Once again, make sure that the compression is not too intense and continuously observe the sensations generated by the compression and movement. You may use an additional Double Track Roller placed parallel to the first to decrease the intensity.
Now select a particular spot that felt like it needed more targeted work and place a Double Track Roller under that spot. Gently and slowly move your ankle inward (invert) and outward (evert), while observing the sensations generated at the target spot.
Exercise 3: Gluteus Maximus
To target your gluteus maximus, lie on your back with your knees bent. Lift your hips and place two Double Track Rollers under your rear, parallel to your spine – one to each side of your sacrum. Rest your hips down onto the Double Track Rollers and slowly move your hips from side to side, allowing the tools to roll along the muscle fibers and promote circulation to these often neglected muscle tissues.
Exercise 4: TFL & Gluteus Medius and Maximus Attachments
To address these muscles, we will first begin with the TFL and then gradually work backwards along the iliac crest to target the attachments of the gluteus medius and maximus. Begin lying on your side with your head supported on a Foam Support or pillow. Flex your lower hip, bringing the thigh almost perpendicular to the trunk. Position the third smallest ball from the Myofascial 5-pack just below and to the outside of your ASIS.
Confirm the proper positioning of the ball by slowly lifting the lower knee of the ground while maintaining the foot on the ground. This internal rotation motion should activate the TFL.
Take a couple deep slow breaths while drawing for attention to the tissues around the ball. Feel for a release and relaxation. Gradually shift the ball to a new spot, tracing just below the hip crest or iliac crest.
As the ball shifts towards the back, you will eventually transition to lying on your back with your knees bent. Continue to shift the ball down along the edge of your sacrum towards the tailbone. At any time, feel free to change the size of the ball to adjust the desired level of intensity.
Exercise 5: IT Band
Lie on your back with your knees bent and feet on the floor. Position the inflatable Big Orange and up to three (or four if you have longer legs) Double Track Rollers along your side, next to your legs. Increasing the number of Double Track Rollers will help to moderate the intensity, especially if this is your first time performing this exercise.
Lift your hips and rest them on top of the Big Orange, between your iliac crest and greater trochanter. Next, lower your thigh and position it on top of the Double Track Rollers such that your IT band would rest between the two balls of each tool. Turn to your side and support your head on a Foam Support or pillow.
At this point, you can remove one or two of the Double Track Rollers to increase specificity and intensity to your comfort level. Perform small rolls along segments of your outer thigh – upper, middle, and lower – while paying close attention to the sensations generated. If you find that you are tensing your thigh muscles, the intensity is likely too high.
You may also choose to simply close your eyes and breathe as you draw your attention to the tissues beneath the tools and seek a release. Intermittently reposition the tools to target different areas along the IT band.