ITB not improving, Therapy next?

Triathlon Forum
1

My IT Band flared up 1 mile in to a half a month ago. Instead of just walking back to the starting line, I hobble/walked through it… big mistake, I know. I gave it 28 days of rest, only swim (where I use little legs) and bike (twice). Foam rolled and stretched nightly, focused on Gluteus Medius exercises to help build up the source of the problem. I walk down stairs fine, and have felt little to no pain for over 2 weeks. I just went to test it out and 1/4 mile in it started to burn again, right below the outside of the knee cap… a pain I’m way too familiar with. My question is, has anyone else delt with something chronic like this? If so, does physical therapy do anything I’m not already doing?

Side note, just because there are some extremely detailed folks on here with 40 years experience: the pain always begin at the top of the outside of the calf (where it appears the ITB joins the calf?)… the typical outside knee pain sets in slightly later.

2

That sounds similar to what I have experienced before. I went in and got ART and also made sure to stretch my calves. I think tight calves was the root of the problem for me. Good luck and get healthy.

3

My ITB band problem effected the same area you describe, it wasn’t an overuse issue but caused by my running on sloped beaches. Never the less, rest didn’t do much and the foam rollers seemed to make it worse, until I realized not to apply pressure with the roller on the painful areas.

I did get some relief using an ITB strap I think it was made by Cho-Pat???

I used it above the knee if I remember correctly, which made the upper section of the band stretch a bit elongating it.

Best of luck, it’s worth a try.

Ron W.

4

I had same issue (6 years ago) and spent a few months in physical therapy strengthening all the flexor muscles around as well as stretches from hip to calf. Also, when I get a massage I still have them work that area pretty good.

5

I had similar issues as you describe. Did physical therapy, nightly stretching & rolling and did no running for almost three months. Focused my work outs on the bike and swimming as these activities did not bother it. I still stretch & roll everyday. The PT also looked at my running form and I tweaked a few things there as well. PT also suggested using a less supportive running shoe or insert. It has been almost six months and just now building mileage back up. PT also taped the area which seemed to help.

Good Luck - it sucks but don’t push it as it will take a lot longer to heal.

6

How many hip hikes can you do?
Report back and we’ll take it from there.

7

it sounds like you may have weaker areas other than the Glutes Med (Glutes Min, Piriforis, Hamstring etc etc etc etc etc etc) the list goes on. Any muscle group that is weak and allows you leg to track in putting pressure on the ITB will be a cause.

Get going on a bunch of exercises to build all of those and you will be good to go. A good physio should be able to work out what is weak.

Keep on top of it and it will go :slight_smile:

8

how many can i do without needing to stop? about 100

9

Based on my experience, I have to say that 1 month to heal with this type of injury is not that long. It took me about 6 months to fully get over my ITB issues, which involved limited to no running at all and a lot of stretching. The only thing that really helped me was taking some time off from running and daily stretching/exercises. Good luck!

10

Ok, 100 hip hikes is good.
What about your cadence?

11

I’m not sure on cadence. Are you referring to when running?

12

Yes, a cadence of 90 (or 180 steps) per minute is considered the “slowest” you should run to minimize impact stress and retain muscle/tendon “spring action”.
If you are down at 80 you are in the “prepare for impact” zone.
Also, do you heel strike?

13

Well since this is chronic and rest is not giving you the recovery you need my suggestion is you find someone is skilled in ART (Active Release Technique) or someone who practices The Graston Technique. You can find providers for Graston on their website, just google it.

I think seeing someone will help provide you the relief you are looking for and get you back to running, long term you need to figure out what your inefficeincy is and work on strengthing that area of your body so you overcome those imbalances that lead to ITB.

14

That’s a good question, I’ll have TI check on the cadence, I’m not sure. I can tell you that the pace becomes uncomfortably slow if it’s slower than 10:30, but I guess that does not answer that question. Regarding heel striking, I land mid foot, that’s something I spent a few weeks correcting back in June.

15

Thank you, I found a provider of both by my house. Which would you recommend between Graston and ART? They seem similar?

16

It sounds like you are trying a lot of good options. I suffered with this issue REALLY badly for about six months and still wrestle with the “twinges” now and again.

I would also STRONGLY suggest that you try a treatment called COLD LASER THERAPY. I get it from my local chiropractor. You will feel nothing during treatment and maybe a very mild soreness the next day of so. In a nutshell, I think it increases healing at the cellular level. Regardless of what it does or HOW it does it, this was one of the first treatments to get me back to running.

I will say this – different Lasers have different widths. The one my chiro uses is about the size of a hand-held shower head. I also had this tx done by a physical therapist early in the injury with a much smaller laser. At the P.T., one tx worked, the next didn’t. The thing with ITB is that the SIGHT of the pain is virtually never the CAUSE of the pain. The bigger laser, as he went up my leg, gave a better chance of hitting the actual root of the injury.

Prior to starting the cold laser therapy, I did the rest-stretching-strengthening-accupuncture-physical therapy for three months to no avail.

Hang in there and don’t give up!

Ray

17

Do you heelstrike? Heelstriking puts more pressure on the ITB than midfoot or forefoot striking.

18

I have been in sport 36 years so almost qualify as your 40 year expert.

IIiotibial Band Syndrome (ITB)
The iliotibial muscle (band) runs along the outside of the thigh and becomes a tendoninous.
This is pain & inflammation on the outside of the knee is caused by friction rubbing up against the thigh bone (femur) and along the knee joint.

Symptoms
Starts with a dull ache from 4-16 minutes into a run which continues. During a running race or high intensity effort the pain can suddenly increase. The pain stops when you stop exercising, continue training and the expect to experience a dull ache especially after twisting. Continue training and a sharp pain will occur especially walking down stairs or running down hills or on the camber. (Beaches on holiday – always running on a cambered road surface facing the traffic cause this problem etc), the problem will often occur when you go back to normal surfaces after the change in training terrain.

Tenderness to touch excruciating pain when being treated.
The area is inflamed.

Massage before you experience any problems can high light a tight ITB.

CAUSES
Feet rotate inward when the foot lands.
AVOID
Avoid the leg bending forwards.
If using a foam to strip failed to heal this type of injury (note you must have used it at least once a day for 2 weeks) the STOP AT ONCE doing this type of treatment.
Ignore a masseur who also want to strip it out it will make matters worse.
It will simply pull the knee more out of alignment.
I have known a few professional triathletes who have not been able to train after such treatment.
Worn out shoes or the arch dropping ever so slightly can bring on ITB problems.
Sudden increase in hill running up & down hills

Self treatment.
Stretch the muscle ONLY when warm. Deep warm baths can case more inflammation.
STOP RUNNING.

Rehabilitation back to fitness tips
NEVER run on cambered surfaces.
Avoid up and down hill running.
Contact your doctor pharmacist about taking anti-inflammatory drugs for up to 7 days.
(This information was given to me by a sports injury specialist and helped me a lot)
I.C.E, apply ice every 2 hours ice the knee for 5-10 minutes with an ice cube, once it melts you have iced it enough.
If safe to do so use anti-flammatory gel or arnica oil and lightly where the pain is.
Self massage the area with your finger tips pressure to avoid too much heavy friction.
Too much will just aggravate the area. Less is more with this type of injury.
CAUTION TOO MUCH FRICTION can easily make the problem worse.

NEVER
Don’t self massage & don’t get anyone else to massage the side of the knee that you feel most pain.
ITB (iliotibial band) muscle stretch
Stand with the left leg crossed over the back of the right leg. Stretch the right arm against either a chair pole or wall or non moving solid object.
Lean against the object while pushing your left hip in the opposite direction.
Make sure your left foot is firm on the ground but allow your right knee to bend & flex.

I am not shouting when I put words in upper case, been there had the injury and don’t want you or others to have to suffer if you get ITB problems.
If the ITB stretch is done correctly you should feel the stretch in the left hip ITB muscle & along the outside of the left thigh. Hold still the stretch for 20-30 seconds then relax slowly without suddenly releasing.

For every mile you ran on the pain full injury (usually a race expect it to take 3-10 days to recover) so no running.
What causes it to happen?
Everyone is different and has different running biomechanics.
Tight calf muscles can be the cause of the problem.
Strengthen the hip flexors.
Regular preventive massage has stopped it reoccurring again.
Swimming and cycle train as normal.
Stretch and improve flexibility remember a tight muscle is not as efficient and tightens up quicker during hard training and racing.
Yes & no for the cross trainer sometimes it helps sometimes it does not.
Over striding and a breaking heal strike makes the problem much worse.
Improve all the muscles so they work in harmony – Glutes, Hamstrings, & Piriformis,
Expect severe ITB to take 3-6 weeks to heal all depends how quickly you resume training and how long miles intensity (race) or miles in training.
If ignore sorry it can take 6 months, except it and work on core other sports, fitness cross over will help when you start running again.

ITB survivor
Ironmate Mark
www.ironmate.co.uk

19

My ITB’s were such a mess it was insane. They were stuck to my quads, tight and so bad it was causing knee cap tracking issues. However, the last piece of the puzzle was my tibialis. I bring this up b/c you feel it at the outside of the calf and THAT was where my massage gal said ‘oh damn we have it whipped now!’. She did this excruciating routine where I would dorsiflex my ankle back and forth while she used her thumbs to split the muscle bed apart. Tears. Ouch. After the 2nd time of that I stood up and knew I was on my way…hope that helps!

20

I have had ART done and it helped tremendously. Graston is similar though I haven’t had it done. What I understand though is that ART can often be a better choice as it doesn’t require tools and therefore can get into tighter spots a little easier. Either way you will know in a few treatments if it is working for you. And a good practitioner will likely lay out a schedule for you as well as give you some work to do at home.