Help with ITB healing

Triathlon Forum
1

I wanted to get your opinion on how I should proceed with healing the ITB issue I’ve been dealing with.

I got my ITB (low, pain right on lateral side of L knee) in July during some mile repeats and exacerbated it during a long run while training for IMFL this past week. During the whole training period my ITB would only hurt while running but not during biking. When it would get really bad, I would take a couple weeks off from running, and the ITB would improve but never go away. So 6 weeks ago, I got a cortisone shot so I could at least train. It worked great. It knocked the pain out and I was able to train and do 70.3 Augusta and IMFL this past weekend. It flared up again during IMFL.

My plan is to take off completely from running for 8 weeks. That I am sure about. I also want to strengthen my glutes and posterior chain in with some strength training. My questions are:

  1. How long to wait until starting strength training. I’m planning starting mid november (about 2 wks after IMFL). Is this too early?
  2. Should I bike while not running or just not do that either? (4 days out and I’m getting the itch to train already)
  3. How about walking a couple hours on the treadmill at 3% grade for some fat burn?

Thanks in advance.

2

I never got the shot but seriously considered it. It took me 2 months of therapy, strength training (pure body weight work), and being patient before it went away.

You should definitely see a sports therapist as the cortisone injection should have been a last resort.

Find someone who does active release therapy. It is painful as hell but it works!

Here is what I did:
-physio-active release and massage
-strength training:
HIP-ABDOMINAL STRENGTH PROGRAM

  1. Push-up position: feet on the swiss ball, upper body supported by elbows
    5x hold for 30sec eventually build up to 1min
    DO NOT SAG IN THE MIDDLE

  2. Push-up position: feet on the swiss ball, upper body supported by hands
    Raise one leg off at a time, 2x 10reps
    KEEP LEGS STRAIGHT, DO NOT SAG IN THE MIDDLE

  3. Start from push-up position (as in 2)
    bring both knees into chest whilst keeping feet on the ball, 2x10reps
    KEEP CONTROLLED AND SLOW

  4. Bridge position: ball between shoulders, feet flat on floor, knees at 90 deg
    5x hold for 1min
    DO NOT SAG IN THE MIDDLE

  5. Seated position on the ball, balance with feet off the ground
    5x hold for 1 min
    TRY TO MAINTAIN BALANCE, IF TOO EASY DO WITH EYES CLOSED

  6. Squats with ball between back and the wall, feet-shoulder width apart
    squat down till thighs are level with the ground, at upright position come up onto
    tip toes, 3x 20 reps DO SLOW AND CONTROLLED

I also used a tennis ball to do active release on my own. It helped a lot!! also consider getting a bike fit if you have not done so. There could be a huge bias with you quads as apposed to glutes/hamstrings etc.

good luck!!

3

also try sticking to swimming for a bit. Early in the off season (depending on your schedule)–fix the cause of the problem

4

This routine helped knock my issue out within a week or 2 when my flared up. I’d go ahead and do this or something similar now (or as soon as you feel up to it) and get things going back in the right direction.

I don’t think biking will impact you either way.

I’d do the strengthening for a week or two before walking/running again. That worked for me.

5

Thank you very much.
My quota on the swim is full though. I trained for 9 months for the swim and the swim got cancelled. I don’t think I look at the pool again for at least a month.

6

I got ITB after IMAZ in 2012. I remember the day (it was finally noticeable) distinctly…I came in from an 8 mile run and with about 0.5 to go I got a stabbing pain on the outside of my knee. I felt lucky to have completed IMAZ without even knowing. It took about 4 months to figure out what was causing it and address it.

I tried therapy 3x per week, rolling, compression, icing, cortisone shot, different shoes, etc. I couldn’t run at all but could cycle with no pain.

For me, the problem originated at my hips. When I started stretching and strengthening my hips I started getting better. Stretching and strengthening my hips is now part of my normal routine and the ITBS has not returned. I’m not sure “waiting it out” is going to address the issue if you have an underlying problem.

Good luck with your recovery…we all know how frustrating it is to be sidelined.

7

Cold laser therapy. Works wonders on soft tissue like tendons.

8

I have been battling ITBS now for 6 months.

First stage was denial - Im sure we have all been there, just run through the discomfort/pain. DONT.

Firstly rested it, iced it, anti-inflammatory’d it, stretched it, foam rollered it - all the usual things you would do for yourself when suffering from a soft tissue injury. Symptoms went away slightly but never got “better” and any long run would make it tres angry.

Secondly went to a physio. Did a “hip screening” which showed that my abductors and adductors were comparatively weak to other muscle groups, also my glutes were a bit weak - causing hip instability which in turn caused the ITB to become part of the stabilizer system - aggravating it. Was given a long routine of strengthening exercises coupled with core work. Predominately band work, clams, reverse bridging, etc. Did this religiously twice a day for 8 weeks. No improvement to pain.

Thirdly went to a specialist sports medicine Dr. Had x-ray. Had MRI. Ruled out everything else that could possibly be causing the pain. HAS to be ITBS. Was given a steroid injection, told to rest and then gently reintroduce running whilst keeping up with exercises. No change after 8 weeks. Was told to take 8 weeks solid break from any running.

During this time period, visited an Osteopath to see if there was anything more mechanically out of kilter, also treated myself to frequent massage to ensure my body wasnt tight anywhere. Felt great all over.

Have also hit the gym to do more strength work - particularly quads, hammy and glutes (squats, inclined leg press).

I have had no ban on cycling (and have increased my FTP by 40 watts in the last 14 weeks - yay!) but the ITB occasionally feels a little tight after a hard session. No associated knee pain.

Had my first run/walk session the weekend just gone. 5 minute active warm up, 30 sec VERY slow jog, 1 minute walk, on grass. Active cool down. Stretching, foam roller, ice. No pain!

Crossing my fingers and hoping like mad I will be ok this time… Geez its bloody frustrating!!! If it reoccurs now, my options are:

a) longer forced break
b) steroid injection and wait
c) surgery

(note: my swimming has improved dramatically… silver lining)

9

I feel your pain (literally). I struggled with ITB a little bit last season after a stupid marathon, and then this season after my HIM which was used as a training session 7 weeks before my Full IM in CdA. I went into panic mode, and really hit the weights to do some serious strength training for my lower body. I can tell you that for me, it was absolutely due to weakness in my hips and glutes. With amping up my mileage on the bike and run, I somewhat neglected my strength training, and it finally reared its ugly head when I pushed myself during my HIM.

I was able to recover enough to have a decent time at CdA, but I attribute it to some serious strength work. Rear Lunges (with weights), side leg raises, squats, flutter kicks, planks, and using that leg spread machine thingy that most guys wouldn’t get caught using but like to watch women using.

As far as training while dealing with ITB problems, I was able to swim and cycle pretty much uninhibited during recovery. Instead of running, I used a treadmill on steep incline (12-14%) whilst walking at 4 mph. This is a no joke workout that has minimal impact, and didn’t irritate my ITB. I slowly worked in run intervals on the treadmill as I improved. I also did my lower body strength training 3 times per week. Since I was desperate, I also bought one of those ITB bands that goes around your leg, and I used it with some success during the race when I felt pain coming on during the marathon. I wouldn’t use one of those unless it was an emergency, as the real problem is an imbalance/weakness somewhere else in the body.

To hopefully prevent this from ever happening again, I saw a running coach after I was healed from my full IM, and have been working on learning a running form that is more efficient and is easier on the body. I can see how this will really help for next season. Sorry for the rambling, but hopefully this will give you some help and comfort.

10

I got ITB after IMAZ in 2012. I remember the day (it was finally noticeable) distinctly…I came in from an 8 mile run and with about 0.5 to go I got a stabbing pain on the outside of my knee. I felt lucky to have completed IMAZ without even knowing. It took about 4 months to figure out what was causing it and address it.

I tried therapy 3x per week, rolling, compression, icing, cortisone shot, different shoes, etc. I couldn’t run at all but could cycle with no pain.

For me, the problem originated at my hips. When I started stretching and strengthening my hips I started getting better. Stretching and strengthening my hips is now part of my normal routine and the ITBS has not returned. I’m not sure “waiting it out” is going to address the issue if you have an underlying problem.

Good luck with your recovery…we all know how frustrating it is to be sidelined.

This^^^ Same story, except 1 week after IMWI. Guess running 12 miles with crappy form after my hamstrings started cramping, really stressed my hips. I’m doing strengthening including bands, yoga, stretching… on top of my normal strength training. Also trying some different shoes and one of those Compression bands (hell I’ slather pig sh** on my leg if I thought it would help).

11

Here is an article I put together on the topic http://irepathletics.com/Articles_and_Resources.html#band

Feel free to PM me or shoot me an email with any questions happy to help.

12

Find the cause.

End of story.

Well, actually it’s the start of your story but everything else should come off the back of that. You can do all the strength work you like but if it’s an issue with gait or you have stability shoes when you should be in neutral then you are just trying to strengthen to overcome the cause.

I struggled with it for a year or two, told to wear sterility (?? Stability - nice auto correct) shoes by several stores. I did relentless glute exercises. In the end I changed my stride length (reduced, foot more under the body) and was told by Physio to go to neutral shoes. Issues disappeared in a week. Saddle height on the bike can be another cause as can foot angle.

On the issue of glute exercises. Don’t hammer the crap out of them. Treat it like any other exercise, build slowly and let them recover so don’t do them every day AND all of your other swim, bike and run. The glute med and min and priformis are small by all accounts so give them a chance.

Find the cause and it won’t hang around for long. Good luck.

13

A great read with great insight, exercises, and treatments: http://www.runningwritings.com/2012/02/injury-series-biomechanical-solutions.html

Usually the cause is in the hip somewhere. You don’t have to stop running completely, in fact in my experience (both personal and while coaching) I would advise not doing that. Dial it back but don’t stop completely. Best of luck.

14

The only thing I will add to the other great suggestions is stretching. And, not just muscles above the knee.

I suffered through ITB pain this past summer, did a number of the things listed and saw a number of specialists, but only really found relief when I complained to a friend, a PT specializing in joint rehab and expert in ortho inserts for shoes, said the issue might be due to force transfer from the foot and that tight calf/soleus could be the issue. I added focused stretching of those muscle groups and the pain has eventually gone away, letting me get back up to long distance running. I still feel tightness there, but it’s not painful during and I don’t experience the hobbling effects for days after a long run that I was dealing with this past summer.

15

I dealt with ITB issues for several years. I even had an MRI done this summer to rule out knee damage such as a torn meniscus or ligament tears. A physician friend (runner) recommended a foam roller. He said to roll it out every night and take it easy on running for a few weeks. I did those things and took some naproxen sodium for two weeks. I haven’t had any issues since. I also have done less volume in running and more speed work. I cut out the garbage. As well, I am swimming a lot more, which is good training and injury prevention.

16

Don’t focus too much time on the ITB itself. You may need to look upstream to the TFL (Tensor Fascia Latae). It’s the small muscle at the front of the hip that controls tension in the ITB. Lie down on your left side. Get a lacrosse ball ( or tennis ball, or racquet ball) and place it at the point on the hip where your hand just slips into the pocket of your jeans. Roll around on that bad boy for a little while. If you have small impressionable kids, you may want to wait until they are not within earshot … this will not feel good. You have been warned.

Then hit this stretch. http://youtu.be/sS7cYp4Z2kk (wfs)

For strengthening the hips, if you don’t already know how to do them, find someone who can teach you to deadlift and squat and don’t be afraid to go HEAVY … that’s how you build real strength.

Not sure where you live, but if you are in a state that allows it, find a PT that does trigger point dry needling.

Good luck.

17

I hope you heal up. I’ve only had it for 3-4 months so nothing compared to you.

I wish you the best with it.

18

Sounds great. Thank you for the advice.

Btw, I do that hill walk workout too. It’s a beast of a workout.

19

Here is an article I put together on the topic http://irepathletics.com/Articles_and_Resources.html#band

Feel free to PM me or shoot me an email with any questions happy to help.

That’s a great article. I’ll make sure to do some of those exercises.

20

A great read with great insight, exercises, and treatments: http://www.runningwritings.com/2012/02/injury-series-biomechanical-solutions.html

Usually the cause is in the hip somewhere. You don’t have to stop running completely, in fact in my experience (both personal and while coaching) I would advise not doing that. Dial it back but don’t stop completely. Best of luck.

Also a very nice article. Thank you. I gotta work my hip.