Iliotibial Band Thingy

Hello,

I managed to finish the GNR, (wasn't that a well organised, great day out!), but now feel I have really done my knee some damage. My knee 'went' at the 2 mile marker and I managed to walk/jog the next 11.1 miles. This was after resting it for 3 months before the event.

Is it possible to get over this problem, once and for all?

Please help, I enjoyed the GNR so much I want to enter more races.

Regards,

Zandra

Zandra,
Yes it is. Knee problems (and there can be many different types) often arises from lack of core stability and muscle imbalances (one muscle of a pair that stronger than the other).
If you ITB was tightening up badly (did it hurt on the outside of your hip or slightly lower down?) it is because your ITB has to take over because the other stability muscles are not doing their job properly.
I had similar problems but have now completely overcome them. I don't get any knee pain at all.
I suggest you seek advice from a physiotherapist. But be patient as the remedy may take weeks or months to make to clear of the problem.
What I had to do was to strengthen my vastus medialis (the muscle on the inside just above the knee). That stability muscle was weak and my vastus lateralis (the muscle that runs along the outside of the thigh) was too strong and it was pulling my knee cap against the femur, hence the pain. Its a bit like a pulley system - you pull one side more than the other and the patela gets pulls out of the groove in which it is suppose to move. What I had to do was lots of knee bends to strenthen my vastus medialis and improve my core stability - try Pilates!

That is just my experience. A physio can see what your problem is.

Best of luck - hope all goes well.

Hi Zandra.
Listen to Mark! Except insert 'or years' after "as the remedy may take weeks or months....."
You did well to rest it, but not so well to run through the pain. Easier said than done, of course.

I think it's essentially a gait mechanics thing (coupled with increasing mileage too fast), and you need to sort the problem rather than the symptoms or you're lumbered with it.

In my (very iffy) opinion, the best tips are:
1) DON'T run with pain (or walk). Not an issue of discomfort (if we were bothered about discomfort, we wouldn't run!) but of damage (more inflammation equals more scarring equals easier recurrence). Find something pain-free to do while you sort the problem, and DON'T be tempted to run. For me the strider/elliptical thingy at my gym was ideal, as it's a respectable cardio-vascular workout.
2) Strengthen the adductor/abductor muscle groups (I guess Mark's vastus whatsit's one of them) - these are the muscle groups which move the legs together and apart respectively (side-to-side, not back and forth).
3) Come back gradually. The golden rule of not increasing mileage by more than 10% per week is obligatory, and try for less if you have the patience.

I'm starting to build up my mileage after big problems earlier last year. I'm encountering some slight tenderness in my knee, which worries me, but the encouraging thing is that this time last year it would have flared up into pain immediately - I believe I'm doing less to irritate the ITB and/or it's much stronger.

Sorry - I can never avoid a good ramble on this subject - hope it's helpful.

Oh, and I should have emphasised Mark's physio point (though I haven't done so myself). A proper one, not your GP, cos they'll know nowt. And also, it's important to know whether it actually IS ITBS before doing anything. Check the web for diagnostic advice (or see that physio!).

Has anyone got an idea about what I might have done? I ran my 3rd marathon (second road marathon) on 20/10/02 having put the training in. I had clocked up at least 4x 20 milers before the event and had done some serious milage before hand. All was going well until about 17 miles, the outside of my left knee began to throb and got simply worse - a kind of really deep seated ache followed by some really nasty stabbing pains. At 23 miles, my left hip joined in and that was that - not the time I was hoping for but one which was 30 minutes slower.

I ran in good shoes, had put the training in and was physically prepared so what went wrong?

Next question, obviously, what can I do to get over the problem? 2 days later it still hurts to walk or lie on the left side but there isn't a pinpoint to the pain, just a vague area maximum discomfort on the outside of my knee and the outside of my hip?

I'd be grateful for any ideas, remedies and suggestions. I ran a XC marathon in July and suffered no problems whatsoever.

Hi Adele,
Sounds like your preparation was very thorough. Not sure what went wrong but I have few thoughts and questions.

In the road marathon you have just done did you run in the middle of the road or towards the sides? It may be camber of the road. If you ran several miles on the left hand side, your left leg has further fall than your right, making each impact greater. Your ITB may try to compensate and tighten up to reduce the shock.

Now your ITB attaches through a tendon to the outside of your knee, so you may feel the pain there. At your hip, the ITB becomes the TFL (tensor fascia latae), a muscle which attaches to the pelvis. You don't feel the pain in the ITB because there are very little nerve endings - its just connective tissue. But you would feel the pain in the TFL.

Now the stabbing pain may be from a nerve being pinched as a result of a tightening. Its like a trunk cable running all the way down the leg and it passes the outside of the knee.

When I get time later today, I'll did out an old copy of Sport Injury Bulletin, the sister publication of Peak Performance. Owen Anderson has some good exercises to help cure ITB problems.

If it the ITB, of course. Trying to diagnose injury problems over the internet isn't easy. I'm not a physio but I've had plenty of it.

You really need to see a physio, but I'll find that article for you.

Adele,
I have found the following exercise helpful for my ITB. It comes from Sports Injury Bulletin, March 2001, by Owen Anderson.

"Stand on a step [4-6 inches high] with your involved leg (the one with the ITB problem). Your legs should be fairly straight as you do this.
"Now, with both knees locked, lower the opposite, non-involved foot and hip towards the floor. As you do so, your involved hip will move upward somewhat, so that it is actually higher than the non-involved hip. Your involved hip should also move a bit in a lateral direction (towards the outside).
"Next, attempt to shift most of your body weight to the inside part of the foot of the involved leg. This simulates the natural pronation of the foot which occurs during the stance phase of runnings, and it also enges and puts tension on your tensor fascia lata and iliotibial band, exactly as it would when you run.
"Bend your weight-supporting involved knee slightly (about 10-20 degrees), but keep the non-involved foot off the ground or floor. Now, move the involved hip forward about 4-6, while keeping the involved heel in contact with the step and your weight on the inside of your involved foot. As you do this, all of the action should be at the hip! Your knee angle should stay about the same thorough the exercise... As your involved hip moves forward, your upper body should move backward. Very key points: as your involved hip moves forward, make sure that it stays in the same lateral position, and also be certain that your involved hip is higher than your non-involved one.
"After you've moved your hip forward, move it straight backward - making sure it goes back 4-6 inches beyond the straight-up, starting position. As your hip moves backward, your upper body will tend to bend forward."

Owen's acticle goes into much more detail, but that is the basic movement. This exercise works because it mimics the running the movement and will strengthen your ITB. Do 10-15 reps every other day.

Let me know if it works for you.

Regards
Mark

Thanks to all those who took the time to help.

Glad to hear that it may not be a permanent thing!

Regards,

Zandra

Mark - many thanks for the advice. I've seen a physio and she echoes what you've said. I've now got to be patient and try the stretches and the exercises and try to strenthen the bits that have been letting me down.

Cheers and thanks for the advice and time.