Until 5 weeks ago, I was on track for a great performance at HIMNOLA. I had reached a point where I was no longer really building volume, I was up to 8 hours per week on bike, 3 hours per week swim, and 30 miles per week running.
One day on a hard run, I got pain in the fibular head, I would call it a burning pain. It happens during the liftoff phase of the stride.
Since then I have not been able to run more than a mile before it returns. I never have run through the pain.
I have continued cycling hard, continued swimming hard, but only running up to pain and then stopping. I have also done the Ice, NSAID, etc.
I have visited a sports chiro, who diagnosed ITBS; I now think this is not right, because the pain is too low (fiibular head) and because I did not respond to 3 weeks of his treatment protocol at all (zero improvement).
I have an appointment with Ortho MD next week, but I am grasping at straws and am losing patience (and run fitness) quickly.
Is it possible that what I am doing on the bike is causing this (even though I have no pain on the bike at all)?
At this point (5 weeks of no real running) either something in there is pretty wrong, or something I am doing (cycling/swimming) is exacerbating the issue and not allowing it to heal (while not causing the pain either).
pain at the head of the fibula without traumatic insult is almost always insertional IT band syndrome, but … The common peroneal nerve does course direct over this and can cause a burning sensation if entrapped/injured, but you don’t appear to have any reason for this (i.e. recent trauma, surgery to the area, cast impingement, etc.).
The lateral hamstrings (biceps femoris) insert on the fibular head and can be a source of tendonitis. Very frustrating in runners. rroof is correct about the peroneal nerve but symptoms of entrapment are usually downstream (and rare). The usual stretching, strengthening and relative rest can be effective (but never fast enough). Physical therapy, massage/manipulation techniques, eccentric strengthening, modalities (iontophoresis, e-stim, ice massage) would be the more aggressive route. I would avoid cortisone injection. Of course, an examination, X-rays, and potentially MRI may point to a different diagnosis, but the differential list is short for that location. Good luck!
pain at the head of the fibula without traumatic insult is almost always insertional IT band syndrome,
Maybe I am misunderstanding the anatomy (very possible) but I thought that the IT did not actually connect to the head of fibula.
You are correct, it does not (being vague about lateral knee pain, but Gerdy’s tubercle to the lateral femoral condyle vs. head of the fibula isn’t very clear to most athletes). But in general in a runner or cyclist, lateral knee pain in itself is ITB syndrome until proven otherwise. If you are sure it is the head of the fibula only, that would be more unusual with your description (pain off weightbearing, burning, etc.) since the tendinous insertions there should hurt with use instead as was mentioned.
I had/have something very similar. Stepped in a rut and hyperextended my knee. Was sore that day but the following morning I couldn’t get down the stairs. The pain is below the joint and on the far outside. Interestingly enough it really flairs up after time. I can run fine, but the next day I pay.
FWIW, My diagnosis is seral nerve entrapment. The best luck I’ve had is nerve flossing exercises and foam rolling the outer part of my lower leg below the knee. The pt also did some work to manually get the fibula moving again. It was really tight.
Still acts up, but I manage through it. The problem is I think this has led to other injuries… To be continued.
Thanks guys, I guess I will continue my stretching and strengthening routine (can’t hurt) until I see the doc and hopefully get some solid answers. I am pulling for some imagery.
I am pretty sure that my pain comes at the fibular head, it feels like it burns around the head (both posterior and anterior) almost like it is inside the leg.
I am also sure that the pain is its worse when I am pulling the foot off the ground and starting to draw the leg forward. After I start walking, it hurts for a few steps (while the leg is extended) and then goes away completely (unless I start running again).
Frustrating, so much hard work, if I have to walk that HIM I am going to be so pissed off!
It very well could be a symptom from the IT band, but that is still where the pain ended up, not necessarily where the problem started from. Try to determine other areas of weakness, even if it is on the other side of your body and try to restore strength and rom in those areas as well as just treating th area where you hurt.
Last May I injured my hamstring running a long, steep downhill during the last leg of a trail relay. After a few days rest, my hamstring felt okay, but my fibular head had a constant ache with some burning pain, and I felt a lot of numbness and tingling down the length of my calf into my foot. It actually felt okay while running, but a few hours after a run, I’d be in serious discomfort. Over the next 9 months I saw a variety of doctors, a physical therapist, and two chiropractors. Possible diagnoses included 1) fibular stress fracture, 2) ITBS, 3) compartment syndrome, and finally, and correctly 4) subluxation of the fibular head. Basicially, my fibula easily moves very slightly out of position and sits directly on the peroneal nerve. With ART, taping, nerve flossing and hamstring strengthening exercises, I’m finally pretty much back to “normal” pain wise.
Could definitely be subluxation of fibular head. The common peroneal nerve bifurcates just behind the head and the superficial branch runs down the lateral aspect of the fibula and deep branch crosses underneath the head of the bone to the muscle in the from of the leg. Even slight displacement of the joint can set these nerves off. Go see a good manual therapist and if it is the case, relief, although at first temporary, should come fairly quick. Additionally, go down the soft tissue root (ITB, HS…) Likely a combination of the 2.
Seen this is many people over the years; lots of possibilities for mechanism; overuse, ankling on bike (especially on upstroke), bike fit, lateral hamstrings (biceps femoris), varus stress at knee joint (LCL), running mechanics or foot wear, run route cambers, first hard run in flats or minimalist shoes… Get a good differential dx and you should get to the root cause. ITBFS clincal testing is fairly definitive, how were you diagnosed?
The diagnosis came from the chiro and is one of the reasons that I have lost confidence in him. It did not appear scientific or systematic, It seemed like this :“you are a runner with lat knee pain, you have itbs.”
I say “really, the pain seems a little misplaced for that”
he says “nope” and on we went with soft tissue treatment that showed no improvement for several weeks (I was open to it taking time, but improvement should have been gradual in my mind.)
Met with Ortho yesterday, preliminary evaluation shows nothing, xrays show nothing, MRI scheduled for today, meet with doc again on Monday with MRI in hand.
Frustration is building further, another weekend without a run, and the weather is so great!
MRI results are in and it is . . . .ITBS. I don’t understand it, but the guy was positive.
He has prescribed PT and topical antinflamatory.
I am hopeful that the PT is going to look at my gait and get me into orthotics or at least find something wrong because I have been doing the strengthening and stretching and don’t feel any tightness at all in the ITB (I roll on quadballer and foam roller with no issue at all).
I am one month out from HIM NOLA I need to get back on the run!!!
Any hints before I get to the PT, I am guessing that I won’t see him for at least a week.
Thanks for the update! Hate to say “I told you so” … Could still be “something else”, but again, lower/lateral knee pain in an otherwise healthy runner is ITBS until proven otherwise almost every time. Now, why you have said pathology is what you need to find out (besides just simple overtraining issue of course. Best of luck.
Thanks for the update! Hate to say “I told you so” … Could still be “something else”, but again, lower/lateral knee pain in an otherwise healthy runner is ITBS until proven otherwise almost every time. Now, why you have said pathology is what you need to find out (besides just simple overtraining issue of course. Best of luck.
As far as cause goes, your guess is as good as mine. I am hoping that the PT has some good insight.
how’d the bursa near the knee look? is that inflamed at all?
Keep us updated.
Me reading that MRI is like . . .me reading tea leaves, the radiologist sent it to the ortho with a note that the ITB was the issue. The Ortho looked at it, showed me the white area where I guess it should have been less white. He showed me some healthy ligaments and mentioned that the bursae looked good (over there). I said what about the bursa by the ITB and he said it was all inflamed.
This confuses the crap out of me, because I do not have any pain 99% of the time, only when running. How can this thing still be inflamed?
He said it still looks like the acute phase (6 weeks from injury date now).
Everything you have described is EXACTLY what I have been experiencing for the last 11 months. For the first 5 months every PT and Chiro indicated that my pain was associated to ITBS. I went with it for awhile but when I pin point the location of discomfort (ONLY WHEN RUNNING and at exactly 1.5 miles) it was behind my knee. After a series of negative X-rays, MRI and EMG tests, I was sent to see a sports specialist that is known for figuring out the “unknown” injuries in athletes - she is quite good. She focused on the fib/tib joint. After a few adjustments of the tib/fib joint I felt great but it only lasted for about 2 runs. Then it started all over again and this time in the fibular head location. I went to see a PT who took his time and examined almost every square inch of muscle/joint/stability/strength/range of motion… literally we tested everything and he said this doesn’t make sense; IT band is not tight, hips are super strong (hence the prior 7 months of PT), stability is spot on but the second I would get to 1.5 miles on my runs, my lower knee feels like shrink wrap is being wrapped around it and then the rubbing sensation of bone on bone is so intense I won’t be able to walk for a few days. Then, I’ll wake up and waalaaaa- pain free, until the next run that is.
One evening during a late night PT session the therapist asked me to do a round of plea squats and i told him that i pulled my groin muscle when I was 17 while playing soccer and it just hasn’t felt the same since, every time I add weight to any type of squat, i feel as if the groin will snap. Suddenly, a light bulb went off and he tested my hip and surprisingly enough i have very little mobility in my right hip (same leg as my Fibular head issue). He made an adjustment to my hip to open up the joint and then I got on the treadmill and ran 2 miles pain free, (yes, i know that’s not much- but that was a big victory for me after 11 months of no running). We reported back to my sports doctor and she said she thought maybe my body was guarding an old groin injury, which was putting pressure on the fibular head. The third MRI test revealed I have a torn labrum and the diagnostic test proved that the labral tear was causing my fibular head to dislocate. I am scheduled to have hip surgery next month and all fingers are crossed that this will take the pressure off the fibular head joint and I can race again. Ironically, the surgeon is not buying that this hip surgery will help my fibular head issue but the sports doctor is confident this will work.
This is EXACTLY the pain I’ve been experiencing over the last 3 months. I’m horrified at the prospects of being “out” for the rest of the year…
Right at the 1 mile mark in a run, I experience the same burning in the fibular head and just behind/inside that area…I tried to run through it once or twice and it just became debilitating, causing me to limp back home and limp around for the rest of the day.
No running = no pain, but I can’t live with that diagnosis.
Thinking ITBS, I completed 4 weeks of rest/cross-training. Zero improvement
Went to sports chiropractor for some A.R.T., shockwave, microelectric, accupuncture, etc… for 6 weeks. Zero improvement.
Last week saw an orthopaedist - he couldn’t find anything wrong with my knee/leg - then I said “There it is!” Pain when he pushed on the fibular head. He went back to look at the x-ray and said “right there may indicate some healing of a stress fracture.” Let’s MRI it to be sure it’s nothing else or to see if we can see anything else.
So the MRI of the knee/fibular head area is forthcoming.
I ran 60-70 miles a month 1/09-9/10, and then 90ish/month Oct-Dec. '10. Guess I ramped it up too quickly. This first hit me on 12/24/10, and I haven’t run since, other than 3 or 4 times I hobbled to a stop at the 1 mile mark. After running, the fibial head swells up visibly, and even now after not running for weeks it feels like it protrudes a little different than the left side.
I am bow-legged and my right hip (same side as these issues) always pops when I stretch, but isn’t painful. Wonder if the hip issues contribute.
I’m glad to finally find someone with this same issue - I’ve searched the web for months with no success. I’m sick of doctors telling me my pain and lack of rehabilitation is highly unusual - ready to get better.