MASSAGE AND STRETCHING EFFECTS ON ILIOTIBIAL BAND

SYNDROME

Alin Puja Dewi Lestari1, Aqiella Fadya Haya1, Meilinda Tri Anugrah1, M Ivan
Pratama1, Tasya Salsabillah1, Vinera Yuninsi Simanungkalit1, Nyimas Fatimah2
1
Faculty of Medicine, Sriwijaya University
2
Department of Physical and Rehabilitation, Faculty of Medicine, Sriwijaya University

ABSTRACT

Iliotibial Band Syndromeis pain caused by friction of the iliotibial band on the outside
of the knee, this pain usually occurs in runners. Pain occurs when running activity is started
and gets worse when running continues.Massage is a manual soft tissue therapy performed to
clients or patients with the aim of improving health while stretching exercisesis an active or
massive body movement exercise that is useful for accelerating the healing of disease. The
research method used is a literature review with a descriptive approach based on secondary
literature from research articles. The literature search was dug through the Google site
(www.google.co.id) and Google Scholar (www.scholar.google.co.id). Based on the
explanation above, it can be concluded that the interest in running is high and the impact of
the high incidence of iliotibial band syndrome is that optimal treatment is needed to
overcome these events, namely massage and stretching as one of the services in
physiotherapy.

Keywords: massage, stretching, iliotibial band syndrome, ITBS.

I. INTRODUCTION popular sports in Indonesia (Uswanas,

Running is still one of the most 2021).
popular sports today. Based on previous In addition, running has both
research from Hulteen et al (2017), it was positive and negative impacts. Meanwhile,
found that running is still one of the sports the positive impact is the ease of access
that is often and consistently carried out by compared to other sports, the minimum
many people around the world. In the costs incurred, and the benefits for the
United States in 2016, more than 64 health of the body. But apart from that,
million people participated in running. there are also negative impacts in the form
Meanwhile, running in Indonesia has been of musculoskeletal injuries if the
a trend since 2013. During the current preparation and implementation are not
pandemic, running is still one of the most done properly. Musculoskeletal injuries
occur very commonly in the knee area
with a prevalence in distance runners of modalities that are believed to be effective
7.2-50% and injuries to the lower in reducing pain is massage therapy
extremities accounting for 30.7% through a pressure effect that stimulates
(Uswanas, 2021). large nerve fibers so that it will inhibit
Injury to the iliotibial band harmful transmissions that will be sent to
syndrome is pain on the lateral side of the the brain causing pain (Syahputra, 2020).
knee in the area of the epicondyle of the Based on the description above,
femur (thigh bone protrusion) caused by there is a high interest in running and the
friction in the iliotibial band that occurs in impact of injuries that occur, one of which
running athletes. Pain occurs when is the iliotibial band syndrome and very
running activity is started and gets worse little research on massage and stretching
when running continues. At rest, the pain on the iliotibial band syndrome. This is
will decrease and the pain will reappear what makes the researchers conduct a
when running is resumed. The incidence of study with the title "Massage And
iliotibial band syndrome injuries is quite Stretching Effects On Iliotibial Band
high at 10% in runners and ranks second Syndrome".
after patellofemoral pain syndrome
(Charles & Rodgers, 2020). II. METHOD
Optimal treatment is needed to The research method used is a
overcome the impact of the high incidence literature review with a descriptive
of iliotibial band syndrome such as using approach based on secondary literature
non-steroidal anti-inflammatory drugs from research articles. The literature
(NSAIDs) or injection with local search was dug through the google site
anesthetics and steroids as well as (www.google.co.id) and google scholar
physiotherapy using TENS, ultrasound, (www.scholar.google.co.id) with related
and kinesio taping to treat pain and keywords such as massage, stretching,
decrease function experienced (Waldman, iliotibial band syndrome, etc.
2019).
Wrong One service provision in III. DISCUSSION
physiotherapy is stretching exercise. Iliotibial Band Syndrome
Stretching exercise is an active or passive 1. Definition
body movement exercise that is useful for Iliotibial Band Syndrome is pain
accelerating the healing of disease caused by friction of the iliotibial band on
(Dwinagara, 2021). One of the therapeutic the outside of the knee, this pain usually
occurs in runners. Pain in the iliotibial
band syndrome is felt on the outside of the
knee, namely on the lateral side of the
knee in the epicondyle region of the femur
(protrusion of the thigh bone). Pain occurs
when running activity is started and gets
worse when running continues. At rest, the
pain will decrease and the pain will
reappear when running is resumed. Pain on
palpation occurs on the lateral side of the
knee just over the protrusion of the thigh.
There is weakness in the hip abduction
muscles and sometimes pain is also felt in
the patient's buttocks area (Yolanda and
Ajinata, 2016)
2. Anatomy
Iliotibial band is a band of fibrous
tissue originating in the anterior superior
iliac spine which then extends along the
lateral side of the thigh and is attached to
the tubercle of the tibia bone. The iliotibial
band is an extension of the tensor fascia
lata (TFL) muscle-tendon that attaches to
the gluteus medius, maximus, and vastus
lateralis muscles. According to Flato et al.
(2017), the iliotibial band is composed of 3
layers consisting of an outer layer, a
middle layer, and an inner layer (Uswanas,
2021).
Figure 1. Lateral view of the iliotibial
band (Source: Flato et al, 2017).
The function of the iliotibial band is
divided into two, namely the function of
the distal and proximal parts. The proximal
part of the iliotibial band has a function to
help move the extension, abduction, and
lateral rotation of the hip, while the distal
part has a function to help move the knee
during flexion and extension (Uswanas,
2021).
The iliotibial band helps the
movement when the knee flexion is less
than 300, the iliotibial band will move
towards the anterior axis of the knee which
functions as an extensor and if the knee
flexion exceeds 300 then the iliotibial band
will move towards the posterior axis of the
knee which functions as a flexor
(Uswanas, 2021).
3. Etiology
Most cases of iliotibial band
syndrome occur in patients with a wide
and anatomically tight iliotibial band,
including runners who are reported to be
particularly susceptible to this syndrome.
For example, wearing worn-out running
shoes, running on uneven or downhill
roads, running repeatedly on a track in the
same direction, or running too far. All
runners without exception, both beginners
and experienced runners can experience
iliotibial band syndrome. Another factor
that causes this syndrome is the difference
in leg length between the left and right
legs. In addition, people with weak
abduction muscles (gluteal medius) are
also prone to this syndrome. People with
flat feet can also cause the lower leg to
rotate, causing friction on the iliotibial
band (Uswanas, 2021).
4. Pathophysiology
Iliotibial band syndrome in athletes
occurs due to a combination of abnormal
anatomy with improper and good training.
The iliotibial is a muscle that has a role in
moving the knee inward, balancing the
muscles, and developing the knee when
running if there is tightness of the iliotibial
muscle when the knee moves in extension
and flexion repeatedly while running so
that the bursa will experience
inflammation and injury to the lateral knee
joint. Symptoms of this syndrome include
iliotibial and knee pain (Uswanas, 2021).
5. Signs and symptoms
Symptoms of iliotibial band syndrome are:
a. Pain on the lateral side of the knee.
This pain usually occurs in the
middle or at the end of a run.
b. Swelling on the lateral side of the
knee.
c. Sometimes tightness on the outside
of the hip.
d. Pain during activity, especially when
walking, descending stairs, climbing,
or moving from a sitting position to
a standing position. The pain is most
intense when the knee is bent or
slightly bent, just before or after the
foot hits the ground. This is the point
at which the iliotibial band syndrome
shifts excessively toward the femur
(Uswanas, 2021).
6. Management
Iliotibial band syndrome is an injury
that causes inflammation. Your doctor will
usually prescribe anti-inflammatory drugs,
such as naproxen (aleve) and ibuprofen
(advil, motrin) which may help. Drugs
without a doctor's prescription have the
potential to have side effects and
interactions with prescription drugs. In
addition, there is an initial treatment in the
form of RICE; rest (rest), ice (ice),
compression (compression), and elevation
(elevation)
a. Rest (Break): The legs are rested by
reducing activities that can overload
the knee until the knee is completely
healed.
b. Ice (Ice Therapy): Knees are
compressed with ice that is first
wrapped in plastic or cloth for
 approximately 20 minutes. Do this
several times a day.
c. Compression (Compression): The
knee is tied/supported using an
elastic bandage while leaving the
kneecap open to prevent further
swelling of the knee or you can also
use a knee sleeve as support,
provided that the bandage does not
cause additional pain to the knee.
d. Elevation (Elevation): Put your
knees higher than your heart. In
conditions of therapy due to injury,
do this as often as possible.
e. Other treatments that can be done
also include relaxation, stretching,
massage, and using a foam roller in
areas of pain and inflammation,
exercise therapy may also be needed
to reduce inflammation and
strengthen the gluteus medius
muscle.
You can also use TENS, SWD, US,
or a therapeutic modality that is tailored
based on the patient's needs and the results
of the examination. A physiotherapy
program that aims to restore and improve
performance to an optimal level (Uswanas,
2021).
Massage Therapy
1. Definition
Massage comes from the Arabic
word mash which means "to press gently"
or the Greek word massien which means
"to massage" (Priyonoadi, 2011). Massage
is a soft tissue manual therapy performed
on clients or patients with the aim of
improving health (Kennedy et, al, 2016:
15) (Syahputra, 2020).
2. Types of Massage Therapy
According to Graha (2013: 1-2), The
development of massage in America is
very rapid and gave birth to various kinds
of massage, including:
a. Esalen Massage (developed at the
Esalen Institute) is used to create a
state of deeper relaxation and
general health. When compared to
the Swedish system, Esalen Massage
is slower and more rhythmic and
emphasizes the whole person (mind
and body). The combination of the
Swedish technique and the Esalen
technique is widely used by
therapists.
b. Rolfing massage (developed by Dr.
dr. Ida Rol) is a manipulation that
involves a form of deep tissue work
with the aim of releasing/loosening
adhesions or attachments in the
flexible tissue (fascia) that surrounds
the muscle. In general, this style
straightens the main body segments
through manipulation of the fascia.
c. Deep Tissue Massage using slow
strokes, direct pressure, and/or shifts.
Compared to the Swedish massage,
 this procedure uses greater pressure
and applies to deeper layers of
muscles.
d. Sports Massage is a massage used
for the purposes of athletes and
consists of two types: maintenance
(as part of the training rules) and
competition (before the race or after
the race). Sports massage is also
used to promote recovery from
fatigue and post-injury. Reflexology,
also known as zone therapy, is based
on the oriental idea that stimulation
using finger pressure from specific
points on the body has an effect on
other parts of the body.
e. Neuromuscular massage is a therapy
using finger pressure that focuses on
specific muscles. This massage can
break the cycle of muscle spasms
and pain and is used at pain trigger
points, which are knots of tension
from muscle tension that cause pain
in other parts of the body.
f. Trigger point massage and
myotherapy is a variation or part of
neuromuscular massage.
g. Bindegewebs massage or connective
tissue massage (developed by
Elizabeth Dicke) is a myofascial
release technique that deals with the
surface of the connective tissue
(fascia) that lies between the skin
and muscles. Followers of
Bindegewebs massage believe that
massage of the connective tissue will
affect vascular and visceral reflexes
associated with a number of
pathologies and disabilities.
(Syahputra, 2020).
3. Benefits of Massage Therapy
According to Westmann & Blaisdell
(2016: 36), the benefits of massage therapy
include:
a. Reduce stress levels
b. Control pain
c. As a means of body relaxation and
sleep
d. Reduce inflammation
Other benefits of massage based on
research by Ellis et al (2007) are decreases
in daily pain (VAS) and running pain
during a validated treadmill running test in
both groups. However, no significant
difference between groups. Less days to
become pain free whilst treadmill running
for intervention group compared to control
group. More subjects from intervention
group recovered from ITBFS in 10 days
compared to control group Decrease
(P<0.05) in overall pain experienced over
trial period. Decrease (P<0.05) in running
pain from day 0 to 3 in a validated
treadmill running test for (b) intervention
group. Increase (P<0.05) in running
distance in all groups from days 3 to 7, and
in (b) intervention group from days 0 to 7.
4. Physiological Effects of Massage
 According to Weerapong (2005: local circulation and improve venous
242-245), there are several effects that blood flow.
occur in someone who is given massage c. Friction
treatment, namely: Friction namely a grinding motion
a. Increased muscle and skin using the fingertips by grinding
temperature circularly like a spiral on certain
b. Promote blood circulation muscle parts which aims to help
c. Reduce stress levels destroy myloglosis, namely the
d. Stimulates the parasympathetic accumulation of energy-burning
nerves remnants (lactic acid) found in
5. Massage Technique muscles that causes muscle
According to Weerapong (2005: hardening and overcomes muscle
237), there are several massage techniques spasms and adhesions due to injury.
available, namely: long time (Arovah, 2009: 117).
a. Effleurage d. Tapotement
Effleurage namely the movement Tapotement namely the movement
carried out at the beginning and end of tapping the skin tissue with a
by gently rubbing the body while rhythmic motion that is fast enough
doing massage. The goal is to to stimulate innervation.
improve venous blood circulation e. Vibration
and stimulate the parasympathetic Vibration namely a vibrating
nerves. In addition, the effleurage movement using the palm of the
technique has also been shown to hand or the fingers resulting from
reduce feelings of anxiety, pain, isometric contraction of the muscles
reduce systolic pressure and heart of the forearm and upper arm. The
rate, which are indicators of stress goal is to reduce and calm excessive
(Gensic, 2017: 37). tension on the nerves and stimulate
b. Petrissage the nerves subtly and gently
Petrissage namely massaging (Arovah, 2009: 118) (Syahputra,
movements by lifting, squeezing, 2020).
rolling tissue, or mobilizing muscles 6. Massage Method on Iliotibial Band
following the flow of effleurage Syndrome
movement. The goal is to increase a. Relaxation of the iliotibial band
syndrome
 This is done by manual therapy
(massage) at the trigger point (pain
point).
b. Deep Transverse Friction Massage Figure 3. Four recommended

(DTFM) positions in the DTFM.

Hand position is important for
maximum strength and control. Four
recommended positions: A. index
finger crossed over middle finger, B.
middle finger crossed over index
Figure 2. Deep transverse friction finger, C. two fingers side by side,
Massage. and D. opposite finger and thumb.
Deep transverse friction applies Based on the research results of
friction and pressure to a certain Schwellnus et al. (1992), stated that
depth of the lesion that is thought to DTFM can reduce daily pain and running
be the cause of pain or functional pain and the addition of friction in
impairment to reduce abnormal massage does not change the therapeutic
fibrous adhesions (Doley et al., outcome of these conditions (Ellis et al.,
2013). Deep transverse friction 2007).
massage is carried out perpendicular
to the fibers to separate each fiber in Stretch
the trigger point area, thereby 1. Definition of Stretching Exercise
providing mechanical effects, local Stretching exercises is an
hyperemia, analgesia, and scarring administrative action to minimize the risk
on the structure of ligaments, of harm when carrying out physical
tendons, and muscles (Tanifia, activities. Stretching exercises are part of
2015). physiotherapy modalities, carried out
Deep transverse friction massage manually both actively and passively to
restores muscle mobility in the same increase mobility and prevent tissue
way that mobilization causes free contractures (Hasanah, 2017). Active
joints. stretching exercises are progressive in
nature involving active movements with
rhythmic repetitions intensively while
passive stretching exercises involve
external assistance which is emphasized on exercise. This is done for 5-10
restoring posture and body functions with minutes before starting the exercise
low-intensity, controlled movements and so that the muscles become more
given resistance at the end of the relaxed and comfortable (Yaqin,
movement. 2018).
Stretching exercise is one of the b. Reduce Pain
exercise therapies to accelerate healing In Akuba's research (2018), it was
from a certain disease which in its reported that stretching exercise is
implementation uses body movement one of the exercise therapies to help
exercises both actively and passively accelerate the healing of a certain
(Monayo, 2019). According to Khayyirah injury/disease, the implementation of
(2018), stretching exercises are usually which uses body movement
part of a warm-up and cool-down for exercises both passively and
people who exercise which can increase actively.
range of motion, flexibility, circulation, Joint pain is caused by
and the success of all exercises. calcification or other diseases
2. Benefits of Stretching Exercise (Rahmiati et al., 2017). Stretching
a. Increases Muscle Flexibility can lengthen or stretch soft tissue
Stretching exercises can cause structures such as pathologically
muscle tension to decrease, the body shortened muscles, tendons, fascia,
to become more relaxed, expand and ligaments in order to reduce pain
ROM, provide a sense of comfort, caused by spasm, muscle shortening,
and help prevent injury. Stretching or due to fibrosis. By stretching the
exercises can help increase the muscles will be trained to lengthen
flexibility of muscles that are tensed which affects the sarcomere and
and affect nerves (Rahmiati et al., fascia will reduce the degree of
2017). Stretching exercise is one of overlap between the muscle band
the best techniques to increase links that have trigger points
muscle flexibility (Ibrahim et al., (Ningrum, 2020).
2015). Stretching exercise is a c. Prevent Injury
physical exercise that helps stretch a Stretching exercises are useful for
set of muscles so that elastic and improving blood flow in the leg area
comfortable muscles are obtained and making the leg muscles more
which are usually done before flexible by doing it every day before
 starting work activities for 3-5
minutes (Monayo, 2019). The study
also reported that after doing
stretching exercises for 5-10 minutes
before activities, the body will feel
more relaxed and comfortable so that
it can avoid injury (Monayo, 2019).
(Dwinagara, 2021).
3. Implementation of Stretching
Exercises Figure 4. Stretching position in standing

Stretching exercises are a stretching (Source: Arumugam & Govindharaj,

procedure that can be done independently 2018).

by the patient according to the instructions 4. Stretching Method on Iliotibial

of the instructor with various positions that Band Syndrome

can be done such as sleeping, sleeping on a. Stretching iliotibial band syndrome

his side, prone, and standing (Arumugam Done to stretch the muscle that feels

& Govindharaj, 2018). stiff.

In the stretching iliotibial band (ITB)

the patient stands on the normal extremity,
with the tight extremity crossed behind the
back, keeping the patient's feet on the
floor, bending side away from the tight
side, shifting the pelvis to the tight side,
allowing the normal knee to bend slightly,
arms folded over the head and arms on the
same side of the legs stretched in the same
direction (Arumugam & Govindharaj,
2018) (Dwinagara, 2021).
Figure 5. Stretching Iliotibial Band
(Source: Hollenbeck et al., 2020)

b. Iliotibial band syndrome stretch

To increase muscle flexibility.
 Figure 7. Strength Isometric Quad/VMO
(Source: Hollenbeck et al., 2020)

Figure 6. Iliotibial band stretch

(Source: Hollenbeck et al., 2020)
Figure 8. Strength Hip Abduction (Source:
c. Iliotibial band syndrome stretch with
Hollenbeck et al., 2020)
arms extended overhead
The most effective stretching IV. CONCLUSION
movement to increase muscle Based on the explanation above, it
flexibility. can be concluded that the interest in
d. Iliotibial band syndrome stretch with running is high and the impact of the high
lateral trunk flexion incidence of iliotibial band syndrome is
To increase muscle flexibility. that optimal treatment is needed to
e. Foam roll exercise for iliotibial band overcome these events, namely massage
syndrome and stretching as one of the services in
To reduce pain levels and increase physiotherapy.
muscle flexibility.
f. Strengthening iliotibial band REFERENCES
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