Journey of an IT Band
Thought I would openly share my ongoing saga of IT Band injury. Even after an extensive background in running I didn't know what an IT Band was until I found Triathlon. A few weeks after IMFL I started to run again. (I ran a 4:04 marathon in Florida). I noticed that I was really tight, but didn't think anything serious of it and chalked it up to post IM tightness. 4 weeks after IM I was running 3-4 times a week no more than 6 miles at a time and more typically a 30 minute run. Started Jan OS. By end of January my knee felt sore after running and then finally I had a tight pulling sensation on the outside of my knee. By the first of Feb I declared myself injured and had my first appointment with a Chiropractor who specializes in Graston, ART, and Athletes. This Friday will mark my 6th appointment with the Chiro. I should say, that I am a frequent roller and stretcher. Even with this, I am still tight but the Chiro thinks that my Foam rolling saved me from having really big knots in my IT Band. instead I only have small knots.
-I was diagnosed with an IT band strain and pelvic misalignment. My pelvis was so out of sorts that one leg was nearly an inch shorter than the other. He cracked my pelvis and got me realigned. At the last appointment the adjustment was showing signs of sticking as my legs were nearly perfectly even. Progress. I have been stretching like crazy 2-3 times a day and doing all sorts of glute and hip exercises daily sometimes multiple times a day. My favorite so far are the lateral walks with a band around my feet. My second favorite are the one legged pelvic bridges while on my back. Those are killer. I have maintained 3-4 bike sessions/week the entire time. I have ran 2 times the last two weeks. 1 mile each time. I thought things were progressing nicely but after yesterdays 1 mile easy run my IT band feels bad today. I may skip any running for another week or two. The plus side of no running is my bike sessions are all going well. I have had the Graston and Art Treatment many times now. One of the interesting things is that most of the issue is actually on the opposite side of my body. Meaning my left hip is tighter than my right. It's my right side IT band that's injured.
It feels like it's been an eternity, when in fact it has only been 3-4 weeks since I declared myself injured...I'm feeling a bit frustrated but keeping my fingers crossed that I will soon be running normal again.
My knee still feels pain and at times I think I should go see a MD and have an MRI to see if anything else is going on. I have also recently read again the forum thread on "how I rebuilt my run from scratch", which seems to really highlight the importance for endurance athletes needing to do hip and glute exercises.
Looking for some encouragement. There are times when I feel like my season is slipping away from me.
Comments
Nate,
Having somewhat recently emerged out of a very long and painful battle with ITBS myself I can empathize with your journey. After 4 years of triathlon, I had never had any IT band issues before last season and didn't really even know what to look for in terms of the symptoms. When I developed persistent knee pain after Ironman last season, I did my usual of staying off it for a few days. When that didn't work, I stayed off of it for a week. When that didn't work, I stayed off of it for 2 weeks, a previously unheard of amount of rest for me, and was dismayed to find that the pain still persisted.
Unfortunately, I had 2 further races on the books for the season and did them both with pretty much no other running between them. On the second one (a half), my knee was messed up something fierce. When I reached the point where I was limping at work and could hardly make it up or down stairs I knew I was long overdue to see the doctor.
The bad news is that ITBS was by far the lengthiest running injury I have ever dealt with, it was 4 months from onset to when I was able to run pain free again for me. The good news, is that pretty much took only a month of actual targeted treatment (stretches, rolling and exercises) to finally knock it out of my system. If I had been more responsible about it from the start, the whole ordeal probably would have been over much sooner.
It can be a long journey, but just when I felt like it was never going to go away, one day it simply did and I've been pain free ever since. Now I'm a bit more proactive about it so I hope it will stay that way, and a few months later so far so good. Hang in there and maintain discipline in your treatment and you'll kick it too.
Stay the course, dude! You're doing EVERYTHING right. Getting quality treatment, following through with your home exercise program, keeping up with the bike work and (kinda) avoiding the running... There's no doubt in my mind that your glute and pelvic stability exercises will see you out the other side of this a stronger runner than you were. Your bike only stands to benefit from it as well! Look at this as your opportunity to rebuild, like a lot of us who chimed in on "How I Rebuilt My Run From Scratch" thread did. We were all in Run Jail, which is essentially where you are at the moment. If you're going to be in Run Jail, this is the time of year to do it!
I know how frustrating this is, and if there is any doubt in your mind, go get that MRI. If there's one thing I've learned in the past two years, it's that it's better to GO find out what's going on via any avenue necessary rather than sitting on something and waiting - that's valuable treatment time you could be wasting should there (heaven forbid) be something more serious going on.
Finally - and as a (former) medical professional, I'm almost embarrassed to admit I own this as I was TOTALLY skeptical when I first saw it online, but was also desperate - consider getting a home ultrasound: http://www.ezultrasound.com/ultracure-pro-portable-home-ultrasound-therapy-machine.aspx
John and I have both used it and have had great results with it. My IT band flared up right before my 5k run test in January (it does that when I haven't been running consistently and then start again, which I'd done the week or so before the 5k) - I used it 2x/day for 3 days before the race and have had zero pain since. I'm certainly not saying that it'd work that fast for you, but it's possible it could help speed things along!
GOOD LUCK!!!
So, trust me - I know sometimes it feels like you are losing lots of valuable time by not running, but ITB issues won't go away on their own. If you ignore them, it'll just get worse. If you don't correct the core problem (which it sounds like you are doing), it'll never go away. So keep on keeping on.. Worst case scenario is that you lose a portion of this years training, and you don't get the results you were hoping for - but if you learn how to avoid ITB issues in the future, then you'll be much better off in the long run for it.
The challenge with ITB issues is that the inflammation is on a tendon, which is ill-suited for inflammation removal because of the lack of blood flow. So while you may have made great strides in correcting the core problem (pelvic stability) - you still have to deal with scar tissue and inflammation on soft tissue that gets rid of that stuff very slowly.
If being conservative on the bike to set up a good run is proper micro execution for an IM, then taking time to heal and remedy an injury to set up solid future successive training seasons is good macro execution for training.
As far as preventive measures: I am a big proponent of dynamic stretching prior to a run (especially the tough ones!) This is a great video clip that takes you through the stretches I like to use: http://triathlon.competitor.com/2012/08/training/your-best-10-minute-run-warmup-2_46795
Lastly, I have found that my IT issues, as well as a host of other ones I've experienced, seem to stem from my hips. It sounds like you've already kind of figured that out. But for guys especially, it seems to be an area that we can all use some work on. The static stretching (done AFTER a run seems to help there). I use ones that focus on the IT, hips and glutes.
Bottom line is, I've run through some of before since I was told that I really couldn't damage anything (but that is in serious question). I even ran a half marathon when it was pretty bad and it was not a fun experience. When you begin to run again, start with short distances and build slowly. Funny, one day, it just seems to disappear! Good luck!
Just kidding brother. Get the recovery/therapy you need and heal up. Tons of time left to get on track with the running, especially for a fit guy like you.
***Full disclosure: I have a personal interest in you getting better. I need someone to ride with again once it gets warmer around here.
I developed ITBS (severe pain and almost couldn't walk) after participating in one of those 200 mile relay races 2 years ago (was in great cycling shape, but had not been running enough...had to run my legs for the team, so just had to suck it up and really got it inflamed...stupid move in retrospect). I'd never heard of it (wasn't a runner then), but a physical therapist was on our team and she diagnosed it and tried to roll it out. Quit running after that, and fortunately never have had pain with cycling.
Trained properly for the 200mile relay last year, and it didn't bother me much. As I then got into triathlon last summer, it flared up again (albeit not as bad as the original time). I'm a physician/surgeon, and have read pretty much all that I can get my hands on re ITBS. As you know, there are two main theories...tendon rubbing over bony prominence, irritating the "Pachinian corpuscles" or bursa underneath the tendon. This is supposedly due to the tendon being "too tight". Tendons aren't supposed to stretch, but the muscle attached more cranially can be sort of stretched. Theory two is the contralateral hip stabilizers are too weak.
Not sure which one I believe. Like most things, probably a little of both? So, I did those same strengthening exercises you mentioned (the lateral creep with band around ankles and the clam shell thing on your side with resistance band). I also found a great stretch that really seemed to do the trick for me. Put your lower leg on a counter top, outside of ankle and knee on the counter, about waist high. Bend over at waist bringing chest to countertop. You'll feel the stretch in the lateral glute/hip area. After I did this regularly, esp before and after runs, it finally went away. I was also rolling over one of those large foam rollers (holy crap that hurts) after runs. Not sure if the strengthening stuff helped, but the combination (about 6-8 weeks of all of that) worked. I've been running the past 4-6 weeks with absolutely no pain...not even that twinge that starts before it really feels like an ice pick has been inserted into your knee!
I empathize with you...stick with the stuff you're doing and hopefully you'll have similar results. Hang in there. Lots of folks also report relief with steroid injection. May have to be repeated, but not always.
I did get a steroid injection last year in a desperate move before IMSG in the Spring. It worked wonderfully for about 3 months, I ran pain free through the training for IMSG and through most of my training for IMCA. However, about a month before IMCA, it started to flare and the month leading up to that race were incredibly painful. I will never do a steroid injection again, however, because I had some delayed side effects. When the pain started again, I noticed a draining wound at the site of the injection (three months prior!) and began to have atrophy of the area around where the injection was placed. The surgeon thinks that I had some fat necrosis in the area and atrophy of some of the muscles. This then took away some of the support of the ITB in the area where in attaches to the lower leg. So, I am back to pain and discomfort with longer runs.
I do ART therapy two times per week and physical therapy weekly. I roll the ITB after every run and most every bike ride. I'm trying to do all that I can, and am keeping it "in check" at this time. You are doing all the right stuff. Don't worry about standing down from the running. The fitness will still be there and you will get back.
@jess, I'm really considering buying one of those ultrasound machines even though I'm not convinced it does anyting. But at this point I would stand on my head if you told me it might help.
@Jeff, that's my undrstnding of the cause and I also undertand that you aren't neccessarily stretching the ITB but the mucschles around it. seems like poor body design if you ask me.
@Brad, thanks for the video.
@Roy, trust me, it goes against all instinct to stand down especailly when it doesn't hurt "that" bad....good news is it doesn't hurt while biking...
Note, I haven't missed any workouts in the Jan OS to date due to the hip. Just sore.
-This injury is ultimately going to make me a better athlete
-8 weeks of solid stretching and I'm a lot more flexible, but still not very flexible. My wife and I have developed a nice routine of stretching as part of our getting ready for bed routine. You know, brush your teeth, foam roll, and stretch..(that's normal right?). After two weeks her flexibility in her hamstrigs was like a 50% improvement as mine is only slightly better but no where close to her level.
-I didn't realize how big an imbalance I had with my glutes and hips until I started strengthening those muscles. I have been doing hip and glute exercises probably 4-5 days a week sometimes 2x day.Now that I have some strength in those muscles I can really feel the difference when I run.
-I have learned that I am pulling a bit on my ITB while I bike. My knee had a tendancy to come up and slightly over the top tube probably in an attempt to stay more Aero. At least I remember reading that and it had always stuck with me. I now try and pedal keeping my knee more in line or over my foot.
-NOT running or doing running at an Easy pace is a sure fire way to not get burned out during the OS and makes for some great Gains on the bike.
-Last week was a big milestone for me in terms of coming back from this injury. I ran 3 times as 3 miles, 4 miles, 5 miles all at Easy Pace. Tues I Ran followed by a bike session.
-Have been doing the ultrasound machine 1-2 times a day. I can't tell exactly what its doing but feels like its warming things up.
-Icing once a day.
-Doing self Graston with a smooth edge a few times a week.
Although I'm still not 100% most of the pain is gone. Still some stiffness at times at the point of injury but I can squat down and my ITB doesn't pull or feel sore. I have learned that doing hip or glute exercises right after I work out will tighten up the muscles/ITB in a bad way. I try and break this up now.
I have all my fingers and toes crossed that after another two weeks of easy pace running I can slowly begin turning up the speed on my runs. Would like to get my easy paced long run sessions up to 7-8 miles with no ITB symptoms felt during or after before I speed things up.
I've been seeing a chiro 3x week. He stretches me, does stim, and now started A.R.T. - which really hurt this AM. We haven't done any ultrasound yet but daily heat treatments definitely makes everything feel better.
My left hip is about 1/2 as flexible as my right (and probably weaker). And I too have a funky little move at top of pedal stroke on my left side - where leg goes out before going over top?!? More noticeable on tri-bike. But it clearly has been this way for a long time - well before I started triathlon.
I haven't run in a week and my body wants to - so that part is tough - especially since this was probably my best OS for running to date. One thing I found that helps is working on this one elliptical type machine at gym where I can set it so that your doing a very high knee stretch at whatever easy/hard resistance you want. This really helps loosen things without the pounding of running on the hip.
I have no issues biking - so long as I don't make cockpit adjustments that close the hip angle (which is what caused my problem in the first place). So, like you said, looking for a new higher FTP in a few weeks. I even notice my left hip when swimming, but not my right ..
A couple of things I noticed after about 12 sessions w/chiro - mainly to work out the scare tissue built up in my left hip to get it more range of motion - at least equal to my right hip.
1. I've been running slowly for 2 weeks now and its feels like a whole new running gait (although I'm sure its not even noticable). More balanced, left hip doesn't feel like its playing catch up with the right. Back has been sore in places it was never sore before - I am assuming due to small change in gait and new pressure points.
2. Just last nite I noticed that I may no longer need the extra shimmy in my bike cleat for my left leg.
3. My left pedal stroke has less of a "outward bend" to it at the top then it used to - and it "feels" more inline with the pedal - like my right.
So I am assuming this is all moving in the right direction. Signed up for more chiro sessions. Probably need to sign up for yoga seesions too.....for the rest of my life!.
and it goes without saying, you have to do your hip, glute, and core work.