Major knee problem.. 6 weeks

Triathlon Forum
1

My wife is struggling with a knee issue. She has not been able to run at all for the past 6 weeks now. The problem started 6 weeks ago while she was training for a hilly trail marathon.

She has pain on the outside of the knee that got the various doctors thinking of an ITB problem or stress fracture. She started off with complete rest from running for 2 weeks and a bone scan that was negative on the stress fracture. In parallel she started deep tissue massages 3 times a week. 1 hour of ITB stretching per day as well as specific muscle exercise. After 2 weeks she tried running again and had to stop after 3 minutes.

Continued massages and tried the TP ball as well. Went to an ART doctor recommended on this board last week, had some more deep tissue and ART session there. She tried running again a week ago (5 weeks after first problem started) and could run no more than 3 minutes.

Both the ART guy and the sport doctor suggested a cortisone shot. Was done 4 days ago. Tried running today and had to stop after 10 minutes.

Going for an MRI next week.

Could an ITB issue be that severe and not improve after all of the above ?

She is now pretty depressed as well. Any other idea ?

Thanks.

2

Please keep me posted. I have what sounds as the same thing. After pain 4 weeks ago,I stopped running. 2 weeks ago forced my way through a 5k,mistake. 2 more weeks of not running(but deep water running and eliptical work) and still have pain(only when I try to run). Mine is on the impact,not push off. P.T.thinks it is an overuse injury from biking on my lateral quad attachment,so I feel it on my strike. I still have been biking 150 miles a week with no pain. If does not clear up soon I will stop all for a week. I am getting concerned,have IM CDA on June 25.

3

Sounds like exactly what my wife had last year. We never figured out exactly what it was. Tried electro-therpy, ultrasound, stretching, new orthotics, massage, ice, heat and nothing seemed to be working in the first month or so. Finally she went for a dozen accupunture treatments wth a Chinese Dr. in our area. That cured it about 50%. We kept up the other treatments but progress was slow. Time was the healer and it eventually got better but she didn’t run for 5-6 months but could swim and could ride the bike after a few months. It was brutal and depressing because my wife is serious about her running. I hope it progresses better for your wife.

4

I had an ITBand injury in a number of years ago that lasted as long as what your wife is going through. Too much running a couple days after a marathon aggravated it. I took a couple weeks off and used the bike with no pain for about 4 months. During this time, my weekly or biweekly attempts at running would get about 400 yards before I would feel pain. Finally, after 4 months of this, I decided to try to “run through” the pain as it was getting close to track season. The first few days did hurt, but after a week the pain subsided and it never came back. I don’t necessarily recommend that method and I expect that the time off really did help. That was my experience with ITBand. It has been 20 years since and I have not experienced any more trouble. I hope hers subsides a bit quicker than mine did.

5

Did any of these specialists ever figure out the cause of this pain? If it is truly ITBS did they suggest a weakness of the TFL or Glute Medius, which is usually the case?

I do not treat athletes but many of my new clients come to me with an existing injury, most common is ITBS. The stabilization program I normally set them up on has a variety of exercises that would help strengthen the area that is normally weak and leads to ITBS. I even add a supplemental exercise to most programs just to target this area. See the crab walk exercise in http://www.slowtwitch.com/mainheadings/coachcorn/strength.html

Most athletes that have ITBS and do these exercises and the stretches from their PT are cured within 2 weeks. There is even a study noted in the above artcle that suggests this is more common than from just the clients I have seen. Most recently this happened to a runner who had not signed up for Boston. She came to me, saw the PT I recommended and did the strength routine. Was back to her long runs (Then 18mi, now 4 weeks later she did 22 with no pain) within 2 weeks. She felt better after 1 week. Bottom line, not only do you have to treat the pain but you have to resolve the problem, whatever caused it. Sterngthening exercises do 2 things. Makes the muscle (in this case TFL & glute med) and connecting tissue stronger so it is not prone to overuse (and inflames the connecting tissue which is the ITB) and provides a better blood flow to the area for healing qualities.

Good luck and tell her not to lose her spirit. If she needs to, I can get her in contact with the lady I mentioned above. She had also gone to various doctors and PTs to resolve her issue before seeing us.

maylene

6

“using tubing?”

where do I buy or find “tubing” for your exercise.

Re: the crabwalk. I take it, the exercise is “done in place,” you are extending your legs just to the sides and not going forward.

Also, let me ask you this. Isn’t this working the same area (glutes) that a nautilus machine does which makes you spread your legs. I don’t know the name of the machine. But you sit down on it, and try to move two sides out, by spreading your legs out.

7

where do I buy or find “tubing” for your exercise

Tubing as in what I am using in the picture, very common at gyms or seen on this link http://performbetter.com/SearchResult.aspx_Q_CategoryID_E_360

and i really like lateral resistor bands but they are a bit harder to find at gyms but can be seen here http://www.performbetter.com/SearchResult.aspx_Q_CategoryID_E_327 watch out for the rubber bands around the ankles. They can be uncomfortable and tug on hair if you have it so use them over socks.

We have had many requests for the equipment we use so there will be a link to Perform Better on our website later this week. We buy all our equipment from them and have never had a problem, they are awesome.

Re: the crabwalk. I take it, the exercise is “done in place,” you are extending your legs just to the sides and not going forward.

Actually, you move to the side, like a crab. You take a step to the side then bring your feet closer together (do not completely lose resistance) then step again in the same direction, 12 total then return 12 steps back. Do not walk like a sumo wrestler by bringing your foot up, keep it down about an inch from the ground, do not drag, and bend the knees, keep level, just like a crab. I know, it’s hard to understand, even with still pics, hence the dvd. It’s out, by the way, and shows this exercise. http://atp4athletes.com/dvd.html

Isn’t this working the same area (glutes) that a nautilus machine does which makes you spread your legs.

Yes, it’s very similar to the Abductor machine (I call it the butterfly) at the gym but if you read the article you will understand why the crab walk is a better choice as it is a closed-chain exercise. Remember, we are not only trying to target the actual muscle but everything that your body uses in conjunction with that muscle group for that movement. And remember the glute med helps with traction of the femur. If your femur is tracking correctly it can illeviate many problems such as patellar movement, over pronation, ankle sprains and… ITBS.

Great questions - thanks and good luck!

maylene

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Maylene, have you ever had a client injure themselves using the abductor? I have had several using the machine with out supervision of a trainer come to me and complain of hip difficulty after using it.

9

Get an MRI and see a physician.

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As with any exercise, if not done correctly, you can injure yourself. It is especially prevalent with use of machines. I have noticed with the ABductor machine that people tend to hyperextend their backs to help with a heavy load. With the ADductor machine they do the opposite and lean over as in a crunch. Unfortunately, many trainers in clubs are not properly trained and can not, or will not, address people when doing an exercise wrong. When asking for advice or hiring a trainer make sure you check their credentials. For athletes, I always recommend NSCA CSCS, NASM PES and sometimes ACSM. Most certifications will teach exercises and safety, however they usually do not understand why and when to do them. Many of their continuing ed will only introduce new moves or what is “sexy”, rarely the science or periodization methods.

I like to use the case of the trainer that decides you need to do plyometrics and yet you have troubles doing a one legged squat. Why should you jump when you can’t even land correctly?

Again, great question. Thanks and take care, maylene

11

Hi,

She is doing quite a few strenghtening exercises. Not precisely the one your are describing though. At this point she will probably wait to see the MRI result as no progress in 6 weeks off running does not sound too good.

12

One more note on the crab walk. Make sure your feet are parallel to each other. As I stated in another post, our bodies tend to take the path of least resistance, so in the case of an athlete with ITBS, the ITB is least stretched when your toes are pointing out. Always check your form!

13

This is an update on this. After negative MRI and XRays my wife decided to TAKE 4 MONTHS OFF running. Not even one run.

Yesterday she went out and after 15 minutes had to stop.

Doctors have no idea. She went for extensive physical thrapy sessions and ART sessions here in the Bay Area. Nobody has a clue… She also did something like 1.5 hours of stretching strenghtening exercises for the IT band per day for 2 months.

One of the doctor is suggesting to “go in” arthroscopically. This sounds a bit extreme.

Any feeback would be appreciated on potential next steps.

PS : Cycling is fine. Hiking is fine (5 hours in the Tahoe Sierras last week with no problem)

14

I was just looking through this thread after reading a suggestion from Maylene from the patellar tracking thread. I can sympathize with your wife, obviously her injury sucks. I’m fairly surprised to hear that hiking for 5 hours (presumably on mountainous terrain) is problem free. I’m no sports medicine guy, but what are the biomechanical differences between hiking steep hills and running? Seems to me one of the big differences is strike impact (more impact running, relatively less hiking). Is it possible her knee problem is a reflection of a foot/shoe problem? Has this been evaluated at all? Seems like an easy place to look, but you don’t mention it in the previous posts. Man, I hope things work out for her- 4 months off with no improvement must be really hard to take.

Ken

15

I had a bad case of ITBS that would not go away, after stretching, icing, ART therapy, and strenthening it did go away. Then I got it in the other leg, I think I ramped my running miles up too quickly, I still have it about 4 months after the fact. I am getting accupunture currently and doing Mayleens exercises also. I found that when I run I roll my foot out of supinate, so I need a shoe with no support. I also saw a foot Dr. that thinks alot of these problems are from modern shoes, and his advice was to run in a racing flat only, or a shoe where the back padding is not higher than the front.

16

Hiking was on the mountains, two days in a row for 5 hours each time… Even my knees were hurting… Not a pb for her.

Regarding the foot, she went to a podiatrist, running expert. He analysed her gait, everything seems normal. She runs in Asics 2080/2090, which the guy told her that they are the right shoe for her.

In fact I had her try pose for only one run (I run that way), same issue.

I read in some book that some very severe case of ITBS (if it is that which I am not sure anymore) can be helped with surgery. I am a bit sceptic on that one.

17

Is it true that rollerblading is a good alternative for athletes with an IT band injury? I was told that the side-to-side motion relives some of the muscles and IT band of all of the up-and-down motion (flexion/extension) associated with swimming, cycling, and running?

I’m interested in hearing your take on rollerblading with an IT band injury.

Dave from VA

18

So much for my career in sports medicine. I’ll restate the obvious, only because I think it would direct my thinking regarding the next step- what is her diagnosis? It sounds like nobody is sure, and given that I’d be very reluctant to elect for surgery without knowing what problem is to be corrected. Here’s some advice I haven’t yet followed myself for my own relatively minor problem- keep looking until you get a diagnosis (that makes sense). If your sports medicine/ortho person is honestly trying and hasn’t hit on the answer, he/she shouldn’t have any shame in suggesting someone else to consult with. Best of luck.

Edit- if a diagnostic arthroscopy is what’s being proposed, that might make a little more sense, but only after knowing what the probablilties are regarding making a diagnosis as a result.

Ken

19

Absolutely. If you think about it, the crab walk is the same motion, just done slower and with more tension. The thing is with swimming, cycling and running the motion of the legs are always forward and those muscles and other soft tissues, although mainly being used for stability purposes, are being stressed - sometimes to an “overused” state.

Now rollerblading can also be overdone but it is cross training for tri and will help to strengthen those muscles that help in femur, and thus patellar, tracking.

But try to keep a strength session(s) in as well - this will provide the overload the tissues need to get stronger. Once you have been roller blading for awhile, as with any other activity, your strength gains will plateau.

good questions!

maylene wise, cscs

20

lionel

hang in there! i had similar circumstances last year, but w/a different type of knee injury. I did exactly what your wife has done, tons of PT, cortisone, time off, etc. and after 8 months I still couldn’t bike or run. In my case the doctors said the same thing, we had run out of options and they needed to go in with the scope to see what was going on. I was very hesitant as i had never had surgery but I decided to give it a shot. Needless to say 2 weeks later I was back on the bike pain free and within 4 weeks was riding full on. The surgery ended up being the best decision I could have made and with perfect hindsight I wish I had done it sooner! Now i’m not advocating surgery but I think sometimes it can be a fantastic solution. Good luck!!

jay ladieu