I thought I’d tap into a collective of triathlon experience and ask about my injury.
I started as classic IT Band syndrome symptoms. Last July I was 3 miles into a long run when I experienced sharp left lateral knee pain. Stretched it out some, ran another half a mile and had to stop again. Eventually I had to walk home. I rested a couple of days after icing it to try it out, hoping it would work it’s way out. Nope. Went to physical therapy, they loosened up my sacrum and low back. No help, I was in pain 2 miles into a run. Went to a well known orthotist and got a pair of orthotics. I could run maybe 3 miles at first with some pain. I got an MRI which showed mild quad tendonosis, otherwise normal. Went to another physical therapist - well known for sports injuries. Got stretches and exercises, treated for a posterior fibular head, taped fibula. I could run maybe 4 miles but was so sore afterwards, I had to take days off. After 6 weeks she recommended I see a specialist. I went to a sport medicine physician who treated me with a prolotherapy injection. He also did an ultrasound of my knee and didn’t see anything too out of the ordinary. 6 weeks later, without running, tried again and got pain. I could run one mile without pain. Stopped running except to try it out every couple of weeks. Continued exercises. Took up Pilates to strengthen my core. After another six weeks went to an ortho who looked at the MRI and found maybe some mild tendonosis of the left IT band. He also mentioned I had the largest, widest IT Band he had ever seen. (Wish I had been at a urologist and gotten the same comment :>)) He gave me a cortisone shot and told me to wait it out. I started more frequent leg work-outs: squatting, lunging, and straight leg dead lifts as well as exercises specifically for gluteus medius. 8 weeks later I tried to run again and got 2 minutes before the pain started and 4 before I had to stop. The pain was less laterally than just lateral to my left patella. I was sore the rest of the day after the 4 minute run. BTW I stopped the orthotics about 3 months ago since they were throwing my neck out. Also am using the foam roller.
What’s next?
I recently posted a similar thread titled “Nagging IT band injury” many people suggested going to see a chiro who specialized in active release therapy??? well after my first visit yesterday i can already tell a huge difference. I can actually stand up for 5 min without pain! wow! may be worth a try when all else has failed… thats what im trying! I’ll let you know after i get the nerve to run again if it really worked.
I had pretty bad IT problems last year. I stopped running for about 3 months and rode the bike exclusivly. I was using the foam roller too but found it created more problems than it solved. I just stretched with a thera band my IT each side 30 seconds x 5 each morning and night. I also started stretching all of the muscles in my legs and lower back twice a day 2x30s each muscle. I have stopped running 5 times a week and only run 3 times a week now. Every once in a while I get a “twinge” in my IT band but nothing that makes me even close to stopping running.
Now that the IT band problem is under control I keep stretching once a day 2x15s each musle group in my legs and lower back and seem to be doing fine so far.
Sorry to hear about your issues - I know it is very frustrating. I was off 6 months last year with IT band issue. It would start at the hip and if taken too far would give me pain in the knee area. I couldn’t run for more than 10 minutes without knee pain, to the point where I was limping for 3 or 4 days after a 10 min. run.
I know everyone is different, so I’ll just let you know what worked for me. To be honest, I still don’t know what actually has worked; I just know I am running now.
Like you, I would take 4-6 weeks off completely from running and try a “test run” of 10min. and it would flare up. I eventually took the shot-gun approach with the following:
long stretching of the IT band (build up to 5min.) Strengthening the hip adductor muscles with a tera-band (I actually think this is what has cured me, but can’t say for sure) I do these 3-4 times week.
Lots of core work: front planks, side planks, back extensions etc - 3 to 4 days week squats with a ball against the wall - adding weights eventually - 3 times week massage every 2 weeks with a trusted RMT slowly building my long run up (when you get to this point)
I’ve been doing this stuff religiously and have not had any major set-backs, but I can still feel the issue sometimes. I know it’s still there if I stop the above.
I actually am up to running 6 days/wk for the first time ever, and ran 93km in a single week 2 weeks ago. When I stretch my IT band, it is always tight even in the best of times though…
What kind of IT band stretches do you do? You mentioned “long” stretches. I’m assuming that means time spent in the stretch.
I was working the abductors. Should I work the adductors too?
What kind of IT band stretches do you do? You mentioned “long” stretches. I’m assuming that means time spent in the stretch.
I was working the abductors. Should I work the adductors too?
Thanks!!!
Steven
Just the basic IT band stretches, where you put right leg behind your left leg and stick your right hip out to lengthen the IT band. The longer you hold this the better. You can do this in a variety of ways by bending at the hip, arching to the side, etc. Just as long as you can feel the stretch, you’re good.
I’m not very good at the anatomy of the hip area, so you may want to research it yourself. I strengthen the “closing the legs together hip muscles” and the “opening the legs apart hip muscles”. Like I said, I use a tera-band for this, and do leg lifts on the ground, lying on my side.
I really think you need to keep strengthening all the muscles around your hip area 3 to 4 days/wk. Just get in the habit and keep doing it.
I suffered like you for nearly a year before finding the answer. once I did I was fixed and back running in 4-6 weeks. First, stretch the IT band in the hip area, not at the knee even though that’s where the pain orginiates. Second and most importantly, stregthen the medial glutes. They are notoriously weak on triathletes and runners. There are many exercises for this. Laying on your side and doing side leg lifts to exhaustion is my favorite and most thorough. I promise this will fix you up. Don’t stretch too much while it’s still inflammed. Once it’s healed stretch religiously. I hope this fixes you up. It did me right away.
Look at this site: http://www.nismat.org/ptcor/itb_stretch The Ober stretch is what really helped me when I got this. Be careful with the weights until the inflammation is under control. Strengthening will help but too much load too soon will make the problem worse. Be careful with cycling under load, fins in the pool, stair climbing, even the elliptical can make it worse.
After having bone surgery to remove bone cancer in my left distal femur (6 years ago), with a bone graft, titanium plate and screws installed (directly under the muscle and where the IT Band runs in my leg) I have found that the foam roll has been the best and most effective way of treating ITBS. I basically have ITBS all the time with varying degrees of pain. To stay mostly pain free the key is to roll that sucker 2X per day (for 60 seconds of non-stop rolling) and especially before and after workouts. It hurts when you break down and massage that scar tissue with the foam roll - you’ll feel it and it will hurt. But over time you will get that tissue worked out and should be able to get closer to pain free. The foam roll I’m talking about is about 3 feet long and about 8 inches in diameter. Search the web for techniques on using it for rolling the ITB. You want to put a pretty good amount of pressure on it with the roller and go back and forth - all the way from the hip down to the knee. Like I said, it will hurt.
I’ve got chronic IT bad problems that I’ve been able to keep at bay the last few years due to a routine of stretching and adductor/abductor exercises with a bungee. Here’s my list of suggestions:
First off I think you need to let your IT band recover, which it sounds like you haven’t fully done. It sucks, but based on my experience you have to take at least a couple weeks off without running or cycling.
I’d also limit the amount of IT band specific stretches you do - in my case stretches seemed to compound the flare-up. Once things are feeling better, then start stretching again.
I’ve got a desk job and sitting at the desk all day doesn’t help things during a flare-up, try to get up and walk around periodically.
I’ve read that IT problems can be related to weak hip flexors. I do a set of adductor/abductor bungee exercises every day. This seems to be the key to keeping my problems away. Basically the exercise involves attaching a bungee to a fixed object and using it as resistance for standing hip adductor/abductor exercises. Don’t hold onto anything for stability while doing the exercises. I do 45 adductors (15 toes pointed left/15 toes straight/15 toes right), 45 abductors, and 45 in a forward motion. Do them in a slow controlled motion. By the time I get to the end of the first set, both legs are burning, especially the leg being used for stability.
All this may not work for you, but at least you’ll get lots of input from the forum here.
ITBS sucks and its tough to get rid of. Hope it gets better!
To reinforce what some of the others have said, you need to STRETCH YOUR IT band as much as possible. That doesn’t occur through abdominal exercises, back stretches, hamstring stretches, etc. Though these are very beneficial at preventing other injuries, to limit the ITB syndrome you need to fix the IT band. If it is very tight it is creating a really large load across the lateral knee. The above stated exercises will not change this. The only way to do that is to lengthen the IT band. This will also help eliminate bursa inflammation as well. Also, this doesn’t happen overnight Stick with it and the pain will go away.
edit: I noticed the above guy said the stretches increased flare up. This may be because when you are stretching you are increasing the tension in the IT band which will increase the load across the affected area. If this is the case you might want to take some time off and ice the area until it will be able to take the load from stretching and then begin stretching it religiously.
Thanks for all the advice. I am going to do double duty on the stretches and foam roller. It’s frustrating going from 10 milers and not a pain in the world to 0 milers over the span of a few seconds.
I suffered from some IT band issues last year and tried a number of things including ART, core strengthening, heat, ice, stretching, etc. A chiro that I was seeing for ART finally diagnosed my problem as weak glute/hip muscles. As I was running my hips were dropping which was putting an increased load on my IT band. Once I started doing some exercises to strengthen the affected muscles I saw a quick improvement. Now, if I could just get these shin splints under control, lol.
I would give serious consideration to the theory that it’s not your IT band. I have 3 clues that I base this on.
The injury onset during a run with severe pain. That’s not how ITB injuries present themselves. They are always painless during the offending run with pain onset afterwards.
You mentioned the pain being more on the outside of the kneecap most recently.
You indicate the pain being very sharp. I never classified my IT pain as ‘sharp’. Very painful yes, but not at all like a knife.
So what does that leave us with? SHARP pain, that moves, that comes on suddenly during activity and isn’t consistently present…I vote for loose knee cartilage. Do you know whether your MRI was viewed only in the region of the ITB (because of the tentative diagnosis) or did they view the entire knee? You might want to ask that the results be reviewed again by a radiologist specifically checking the knee cartilage.
The MRI was of the whole knee and was viewed by the radiologist, who did the report, the sports medicine guy, and the ortho. I also had an ultrasound that showed no problems with the meniscus or the cartilage. I also started to consider other possibilities like problems with patellar tracking etc.
The MRI was of the whole knee and was viewed by the radiologist, who did the report, the sports medicine guy, and the ortho. I also had an ultrasound that showed no problems with the meniscus or the cartilage. I also started to consider other possibilities like problems with patellar tracking etc.
That’s certainly possible, but just about every case of chondramalacia that I’ve had and heard of first-hand was relatively pain free during the run with pain before and afterwards.
What running shoes do you have? (be specific…model and model year) How many miles on them, when were they purchased?
How much do you weigh, when the injury began how many miles per week were you running?
I had the same symptoms of sharp pain that came suddenly during activity. I also thought it might have been loose cartlidge so had an MRI, came up negative and was ITBS. If only there weren’t a hundred things that caused knee pain it would be easier to solve.
I would disagree with your (1) and (2) below. An inflamed ITB can hurt whether you are sitting around, walking, or running. An ITB isn’t “always painless during the offending run” unless you have a mild case.
As far as the pain on the outside of the kneecap goes, a tight ITB pulls your kneecap out of alignment and can cause correspondent patellofemoral pain.
I would give serious consideration to the theory that it’s not your IT band. I have 3 clues that I base this on.
The injury onset during a run with severe pain. That’s not how ITB injuries present themselves. They are always painless during the offending run with pain onset afterwards.
You mentioned the pain being more on the outside of the kneecap most recently.
You indicate the pain being very sharp. I never classified my IT pain as ‘sharp’. Very painful yes, but not at all like a knife.
So what does that leave us with? SHARP pain, that moves, that comes on suddenly during activity and isn’t consistently present…I vote for loose knee cartilage. Do you know whether your MRI was viewed only in the region of the ITB (because of the tentative diagnosis) or did they view the entire knee? You might want to ask that the results be reviewed again by a radiologist specifically checking the knee cartilage.
I just finished yet another attempt to run. My symptoms first came on in early August. I tried to stay off of it, let it rest, take anti-inflammatory medication, foam roll, hip strengthening exercises, physical therapy, chiropractic services, etc. I have still yet to find a way to make the pain go away. I am writing you, because after reading your post, I am experiencing the EXACT same thing you did. About mile 2, I feel like I just got stabbed with a knife. I am contemplating an MRI, eventhough my doctor doesnt think I need one, because he, and everybody else is convinced it is ITBS. Did you ever find any relief or figure out what was wrong?
a good massage therapist can help. You will likely need to pair that with cold therapy and downtime. Stretch as well. fortunately the off season is here. Use the time to re-boot the server and move to swim focus while things heal. Orthotics and anti-inflam drugs I am not a fan of as they only mask. Only an opinion of mine.
Stick with it and the pain will go away.