At the end of my rope with ITBS...

Hey guys,

I know every man and his dog has posted a thread about this issue but nothing I've tried has worked and I'd like to try here before I end up punching a hole through the wall.

Bit of backstory...
I've only competed once before - in the Nottingham half marathon, which went very well throughout. No issues arose during the training or the event itself and I finished in a pretty healthy 1:45.
I decided that I had so much fun running the half that i'd very much like to compete in a full marathon and signed up for Paris. Unfortunately for me the ITBS flared up during my very first training session in November.
I think the problem is overuse since I hadn't done any running since the half marathon and went straight onto a 5 mile fast run, probably not the brightest idea... plus I was on a treadmill, which I hadn't used to train on before that point.

So fast forward to now... I've rested, tried foam rolling, physio, gait analysis, TWO pairs of new shoes for my over-pronation, stretching and glute exercises. The furthest I've managed during the entire training is 8 miles before the pain kicks in, usually I make it to about three but sometimes I don't even make it a mile and a half.

Do you guys have any advice? I feel I could benefit most from those of you that have overcome this issue or people that deal with this problem in others, but I will of course happily eat up any advice anyone has for me! (though I don't want to resort to cortosteroid injections, I don't feel that's a good idea)

I'm considering acupuncture as the next option, good plan?

where do you feel the pain exactly?

It's on the outside of my left knee, specifically around the middle of that area. Do you think it could be something other than ITBS?

I havent got a definitive answer I am afraid but some suggestions!

There a few other things you could consider, if you have exhausted all the ITBS treatment (all of which i am sure someone will tell me is wrong, so take them with a pinch of salt! - i am not an expert!)

the first thing is, it could be your thigh muscle itself, not the ITB - check out this webpage on trigger points
http://www.triggerpoints.net/triggerpoints/vastus-lasterallis.htm

another thing is, it could be you are hitting the ground hard, consider if you heel strike or forefoot strike, you might like to consider a change to a more forefoot strike as in a barefoot running technique (i only mention this as I overpronate on my left leg and find barefoot shoes and accompanying technique very good) 

the next thing to consider is that it is simply that your left leg is weaker, you are running 'off centre', or it is something that cannot simply be fixed by doing all the accepted cures (eg, stress from expecting the leg to hurt is causing you to tense up and making it worse? - my husband gets a bad back when he gets stressed!), also have you been to a doctor about it, there could be a different sort of problem internally?

of course it could be something else you are doing that is not helping - eg I myself have had intermittent problems with the inside of my left knee, which at first i put down to overpronation, then unruly thigh muscles, then when I thought about it  i realised it was worse whenever i increased my strength training which includes doing squats. I am considering that it may be just due to being 48 and having a knee what is getting old and crunchy so i am in the process of leaving out the squats and trying other quad strengthening exercises instead (whatch this space!) so are you doing something else your leg does not 'like'

sorry for the waffle but the point i am trying to make is that it is not always as simple as putting a label on it and picking the 'correct' solution (which i am sure you have realised!) Take a holistic view and consider other forces that could be involved?

I feel your pain Tom...almost literally! I was in the same position in 2009 with serious ITBS problems pre FLM.

I tried everything, physio, foam rollers reducing distances and every orthotic and gait analysis I could . I even resorted to cortisone injections...none of it worked!

I'm sorry to say the only solution I found was to defer and have a really long look at what was going wrong. I found weakness and poor flexibility in my hip, hamstrings and glutes was the the probable cause and I started running in more minimalist footwear to try to sort the biomechanics rather than mask the problem.

It's taken a couple of years...yes that long...but with lots of strengthening and still using a roller I'm back to training for the VLM...18 miles tomorrow which will really show up any problems! So far though I've been injury free for over a year.

Take it slow, I'm not sure there are any quick fixes but one thing that really did help quickly was to avoid running on roads and pavements as the continuous camber really stressed out my ITB! Really good luck and I hope you find a solution but remember nothing is worth exacerbating an injury and making it more permanent.

Pete

Tom, good advice from Max's mum particularly the consideration as to 'running off centre'.

My suggestion is to get some treatment from a Bowen therapist - they will do some work around your pelvis, knees and also ankles - a lot of what goes on further up can actually be an ankle issue (perhaps due to old injury). Conversely, it may be also be coming from further up, ie right shoulder. It's very much look holistically at you and your body.

good point Pete about the running off road, some if my problems i think were not helped by the winter evenings mostly running on pavements!

Bruce Tulloh says that the majority of your training should be off road! thank god the evenings are getting lighter!

Wouldnt be too concerned about the diagnosis - you need to find out what's causing it, and why.....You sound more functionalyl dodgy than structurally duff - but the functional stuff will eventually lead to true structural change.

Things that mimic ITBFS are transverse tears in the lateral meniscus, or cystic change, or lateral ligament thingies or dodgy heads of fibula. Don't worry about any of this, get to the cause.

"functionally dodgy"

Cheers for the input guys, you've all been really helpful

I agree witht he imbalances, When I visited by dad's GP friend (who's done a few marathons himself!) he told me that my glutes are weak and need strengthening.
Do you guys have any exercises that you think could be useful?

Hi Tom,

Although I don't have IT syndrome now (I've had it in the past) but I've had a knee injury for a year now and as part of my rehab I've been trying to strengthen my lazy glutes!

 The execises I have been given from my physio are:

 - Clams - lying on side, bent legs, feet together, raise upper leg up and down. You can add in a resitance band to make your glutes work harder. You can also do this lying on your side with your legs straight, just raise your upper leg up and down until the muscle tires.  I do about 3 sets of 20. http://www.youtube.com/watch?v=vc-8G9SZvuc&feature=relmfu

 - Glute raises - lie on back, feet hip width apart, raise hips up. You can either hold here for a minute, you can balance on a bosu to make it more challenging, but what I actually do is raise one leg so I'm balancing just one one leg, and pulse up and down. Initially I feel this in my hamstrings, but after about 10 reps it tires and I begin to feel it in my glutes. So I do about 15-20 of those, 3 sets. I think this is a really good exercise. http://www.youtube.com/watch?v=zR4K8MeioCU&feature=related (sorry about the golf chat)

 - Squats with (or without) barbell are good for glutes - http://www.youtube.com/watch?v=j14GXiPMp7E If you really push through your heels you can feel it in your glutes. My hip movement is poor so I place small discs under my heels to stop me feeling like I might tip back, but if you can do without then all the better. I use about 20kg and do 3x15 reps.

 - Single leg deadlifts - http://www.youtube.com/watch?v=mG-Stc3c7N0. Make sure you keep your back straight, I do it without weights. You could also just do normal deadlifts for starters. This also works your hamstrings. I do about 3x15 reps.

 - I also use the pulley machine at the gym and use the ankle attachment to work my glutes. So I buckle it round my ankle and just raise up and down, also behind as well. http://www.youtube.com/watch?v=VFm7qfr9viE&feature=results_main&playnext=1&list=PL34D646243F614A1A

I'm not an expert but I do think they are fairly standard glute exercises. Really hope you manage to get over you IT problems and get running again! Let me know if you need more!

 Jen

Exercises are the answer.  Jennifer R's post is excellent, the most important exercise being the "clams".  Lay against a wall to ensure your body is straight and raise top leg no higher than 30 degrees.  Lead with the heel, keeping big toe pointing down slightly.  Do the exercise very slowly.  After 3 sets of 20 you should feel something happening!  You probably won't be able to do 3 sets to start with.

Recovery from ITBS is a long term process - it may take a couple of months - but persevere and it is unlkely to re-occur. The ITB connects the outside of the knee to the outside of the hip, so it may be worthwhile stretching this area out regularly.

Wow, thanks Jen, this is exactly what I was after! I'll try these out during my workout at the gym tonight - I'm thinking of replacing running with cycling for now to keep my cardiovascular level at a good point and perhaps it will help build up the quads in the process.
Speaking of quads, that's another area that I am anxious to build since they also seem to have an effect on how the itb behaves. Is there anything else that would be useful to do in addition to cycling in order to strengthen these muscles that won't irritate my knee? I've read that squats are good but shouldn't be done when suffering from this annoying issue! I don't know how true that is but I'm hoping that one of you guys might know

Thanks T Rex, I've accumulated a few good stretches over the past few months, I'll be sure to integrate them into my new and improved strengthening routine!

Hi Tom,

I too have been trying to strengthen my quads and it's proving more difficult than you would think! I am different though because I am trying to target my vmo (inner quad, teardrop muscle that keeps knee in alignment), but this is very hard to localise. I was using the leg extension machine in the gym but it seems to have made my knee flare up so I would be very wary of this machine. Cycling is definitely the best for stengthening the quads, have you tried spin? It's a great workout and will keep you sane when you can't run. Very good for the quads. I would give the squats a go and see how the pain is. You could also place the gym/swiss ball on your lower back behind you and squat up and down, progressing to singled legged eventually. You could try knee lifts/drives on the step at the gym, so sort of a step up, you can hold dumbells to make this harder. Also an exercise called a ski sit which is great for the quads, basically you just sit against a wall, as though there is a chair below you but there isn't! Keeps legs parallel, there should be about a right angle between your quads and lower legs. Hold this for as long as you can. It's important to stretch out the quads once they have been strengthened and I have been trying a progressive quad stretch which is like a normal quad stretch (lie face down, pull one leg up behind you) but placing a rolled up towel underneath your thigh which makes the stretch a bit deeper.

Good luck, you can do it!
Jen

Thanks again Jen, this is once all really helpful also. Thank you for going into so much detail too!
Ok, this month is going to be HARDCORE. I've decided that if I can run a week before the marathon then I'll still race but take it super-easy, walking for a couple of minutes every 6 or 7 miles for example. If, however, my knee is still a shambles then I won't bother at all.

On a side note, I came across this ITBS video just now and thought I'd share: http://www.youtube.com/watch?v=RHDpLK8COlQ&feature=endscreen&NR=1
It says NOT to stretch and ice? I know it's supposed to be really hard to know if you're stretching the ITB because it has no 'stretch receptors' but I always thought it could only be beneficial? A lot of treatments this guy suggests are the same as many others I've read about, but the no stretching or icing bit doesn't seem right to me...

Hmm...how are you going to get rid of you ITBS without stretching and icing?! Weird. I think the foam roller is definitely the best for your IT, there's one called trigger point or something that's harder than the normal foam rollers. You probably already know this. The stretch I do for my IT is the one where you sit upright, cross one leg over the other, and turn the opposite way, pulling your knee in towards your chest. The other option I guess would be deep tissue massage. Ive had acupuncture before but it didnt do much for me. Have you worked on your hips? My whole outside of my legs are tight, so hips, IT. I have been trying to stretch out my hips/groin/pelvis to see if it makes a difference. I have to say though, when I did have ITBS before, the only thing that helped was time and rest...sorry!

Go to Paris anyway and enjoy some desperados instead there's always next year, plenty time. I feel your pain though!

Jen