Here I go again.... Wall sits. Lots and lots of them through out the day. Oh and the reverse hyperextension....

Without any more information, I'd be against having surgery. I had ITB issues for a while, pretty bad, like hurt to do anything (walk, swim, bike). I can't point to one thing that fixed the issues but improving my form is probably what helped for the long term along with some strength work/stretching to clear it up initially.

I've been fighting IT band issues for around 5 years and had pretty much given up running until I impulsively signed up for IM Tulsa (after taking 3 years off). I've tried just about everything with no luck (orthotics, multiple physical therapists, sports chiro, massage, countless pieces of "recovery" equipment, dry needling, cupping, and pretty much anything else you can think of). The last time I saw the doctor was a couple of years back and he recommended surgery, but I've heard from people who regretted the surgery (anecdotally) so I held off b/c I don't really like running anyways. It seems like everyone has a magic cure... "oh, you just need to do this thing and it will go away". Unfortunately I'm in the minority and none of it seemed to help.

If you're doing this for fitness and not necessarily for racing you might want to look into racewalking. I know, it looks goofy as hell, but after trying it a few times my butt was kicked... literally. It uses very different muscles and I could feel my hips and glutes the next day. I'm hoping it will help to strengthen that area and am using it in addition to some of my running. I'm a middle of the pack athlete on a good day so it's not like I'm running 8' miles finishing up an IM. If I can walk 12' miles and toss in some running I should be able to finish middle of the pack.

Definitely curious to hear what other people say about the surgery

Sounds like it's been frustrating for you. Especially having thrown a ton of treatment at it....hoping one will stick.

Patello-femoral pain, ie any pain around the patella....TYPICALLY isn't a surgical case. Lateral release surgery has very mixed outcomes and really aren't performed much anymore. A general knee scope isn't any better than conservative management.

Often with these cases, it's about load management and a painfully boring/tedious progression with your running as your tissues adapt/get stronger. You mention doing some hip strength stuff as that is often prescribed for PF pain and there is good evidence to support this in clinical studies....but there's often more to the puzzle. Pain science tells us that a long "persistent" bout of pain (decades for you) is more about sensitive nerves vs tissue damage at this stage (another reason to avoid surgical intervention)

Often with patello-femoral pain in runners, improving dynamic quadriceps strength in that 0-45 degree range of knee flexion is key. Maybe you did some of this prior, but it does take consistent work before you can load up running miles. Sometimes it does take some research finding the right clinician (one who sees a ton of runners and knows running mechanics). Obviously, it's tough to know exactly how you present. Hope this gives you some help

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CB
Physical Therapist/Endurance Coach
http://www.cadencept.net

As a doctor, but not a sports medicine specialist, I would have to say have anyone questioned the diagnosis of what is causing your knee pain? Bias is common in medicine and there are many things that can potentially appear similar to ITB etc. I don't think any surgeon would even go near you at the moment without imaging (MRI in particular, and have it read by proper musculoskeletal radiologists) and other conservative options. Surgery is only useful if it is fixing a known underlying issue (OK, have you read the studies where they did sham knee scopes and showed no difference in outcomes versus those who had been scoped)....not saying it should not be an option, but it needs to be the right option for the right diagnosis.

Thanks PTinAZ. It has been frustrating! Frustrating for the physios I've seen as well but, after a while, they kind of run out of ideas.

I don't have classic patello-femoral pain. My knee can ache in general, but the pain is most definitely localized to the lateral side of my knee, sometimes around the fibular head. I know clinical studies have been mixed for hip strength improving ITBS. I haven't done as much quadriceps work as glute work though, so I will start adding that in more.

My understanding that ITB surgery is different to a lateral release surgery. They now either make a small 2cm incision to the ITB or there are arthroscopic procedures to remove the synovial recess from under the ITB, both of which are day surgery and seem to have high (85-95%) success rate.



I do believe there could be something else causing it. I went to an orthopedic surgeon and had an MRI because of a 'dynamic snapping biceps femoris', where my biceps femoris (long head?) flicks across my fibular head when I squat past 90 degrees. When I found this out, and saw that there are a handful of clinical case studies showing that people who have it present with lateral knee pain, I thought I had found the silver bullet of my knee pain. My MRI only showed inflammation under the ITB and no other pathologies, and the surgeon was quite adamant that my snapping BF was not the reason for my knee pain because it didn't cause me pain in itself. I still question whether that is the case -- surely, over many miles, small idiosyncratic movements of the BF could cause irritation? The snapping BF does improve with deep glute stretches, and incidentally that is what improves my lateral knee pain when running the most.

I would concur that seeing someone that has a good understanding of running biomechanics is key. You will see many rehab strategies thrown about but there is literally no one size fits all protocol for ITB tendinitis. To be honest in my practice the biggest factor has been in how a person returns to running after pain has subsided, way too many people are content just to pick up where they left off and that is why it seems like it never resolves.

I should have mentioned that all the physios I have seen have been specialists in running. I even saw one person with a PhD in running biomechanics!

The last time I got injured, I returned to running by starting at 10 mpw building slowly to 20 mpw. I then hung out at 20mpw for 2-3 weeks, then 25 mpw for 2-3 weeks, then 27-30 mpw for 3 weeks, followed by a down week, then a couple of weeks at 30-33 mpw. Then I got injured.

Lateral knee pain doesn’t equal ITB issues. An MRI showing “inflammation” doesn’t confirm anything. If you’ve exhausted treatment for ITB issues without progress then chances are you don’t have an ITB problem. Surgery for an unconfirmed diagnosis can only lead to a poor outcome. Try backing up and start with having your spine examined closely with a good clinical mechanical examination. Stay away from diagnostic imaging; as you’ve already found out it’s inconclusive. The spine refers pain in many variable patterns. This needs to be ruled out before looking elsewhere. Good luck.

I would get your glutes checked out first. Make sure 1 they are firing properly and 2 they are strong enough to support everything they need to be supporting and stabilizing.

Hopefully I am not telling you something you've already tried, but I had persistent ITB in my left leg until I strengthened the adductors of the inner thigh... this kept my knee from sagging inwards upon contact with the ground which results in the ITB "pull"

https://www.youtube.com/watch?v=8lRqe1fnFpk

Don't go for surgery.
You need a superviolent physio, who is strong and ruthless enough to really sort it.
The only other thing which once helped me was 2 weeks of hopping on the bad leg (because I had ripped the ankle ligament on the other one). Bit extreme but I guess it must have done some kind of strengthening??