Iliotibial tract syndrome
I have been fighting ITBS for a couple of months now. Was not to bad until I did a HIM 3 weeks ago. Before the HIM I was stretching, using the foam roller and nsaids. I also had a workup to include a mri which confirmed ITBS no joint problems. Since the race I can't run at all. Have not run for three weeks. I have been riding without any pain though. I tried to run today and could not even go a mile without getting sever pain at the attachment of the ITB to the fibula. Oh yea have also tried a steriod injection. Anyway I am seeing a sports med ortho doc. He wants to try Autologous Conditioned plasma injection (ACP). He says he has had good results in others with my condition. He is also a triathlete that was one reason I chose him. For those of you who either do this or have had this done to you what do you think? I have read up on it now and understand it really hasn't been proven in good controlled studies. Any thoughts would be appreciated. I would love to get back to running again as soon as possible.
Comments
hello:
sorry to hear about the ITB.
i'll get right to the point. steroid injection and plasma injection for ITB treatment is pretty extreme. if it is the same doc that is recommending these treatments, then i would suggest you try another. there is no scientific evidence to support the plasma treatment, no molecular mechanism that has been delineated, so you are correct to be suspicious.
i have found that even the most stubborn ITB cases can be resolved with focused flexibility training, rest and then gradual sports specific training that is monitored diligently (i.e. stop if you feel pain coming on, ice afterwards, rest as needed and don't force the issue and be patient). there is no big mystery as to the mechanism of the ITB pain. it is caused by the ITB rubbing on the bone. why one side and not the other? likely lack of flexibility, even by the smallest margin. NSAIDS at therapeutic doses, like 600mgs every 6 hours will mask the pain and you will irritate the area even more without knowing it. before you know it you have a pretty angry ITB.
have you ever tried yoga? it is very effective. for time efficiency, try a dvd and go straight to hips and lower body section (although it's always best to focus on whole body). don't forget hips because it is often at the hip that you find the cause of the problem below at the knee.
if you are patient and disciplined with this approach, the ITB pain will resolve and your running technique will benefit. not to mention increased hip flexibility will get you able to hold the aero position on the bike for longer.
i have seen stubborn ITB syndrome resolve over three months on average, but depends on the patient's ability to hold back and really focus on consistent flexibility training and gradual ramping up of sports specific workouts. a good sports med facility, where someone can assess your running style both at strongest and when you are fatigued, plus measure your progress flexibility-wise, would be great...if you can find one.
hope this helps!
GH, MD & Ph.D.c
Hi again Todd:
was this your first HIM? your first training leading up to the HIM? if so, i still recommend felibility training for balance, but a contributor to this episode could also be overtraining. when new to the sport or when finally reaching 'fast' levels, the weakest links show through. a not so strong core can eventually get your hips rocking too much and combined with a stiff ITB on one side BOOM rubbing on the fibula.
in summary then...
-no more injections;
-flexibility and core work;
-patience and focus;
o.k., my lab timer will sound soon and i need to get back to doing science!
Gh
Gilberto, thanks for all the good information. I will add a few more things here that you mentioned. I have been doing HIM's for three years now, and shorter distances for about 7 years, this time. I did triathlons back in the late 80's. Have never done a IM. I did increase my training distances in March. I was running faster than I have ever run before and was really feeling good about my run. As far as core work and stretching go, I do quite a bit of them both and have done so the last couple of years. I have not done yoga though. If I am understanding you correctly it will take about 3 months to heal. So no running for 3 months? What about cycling? It does not really bother me on the bike but I have read that cycling alone can cause ITBS. Does that mean no cycling also? I do really struggle with patience and often push to hard, hence my current difficulty.
Todd
Have you ever had anyone do a run/bike analysis on you?? chronic ITB without joint injury (hip or knee) is functional 90% of the time (meaning it's caused by muscle imbalances).
If it were me, I'd be looking at the following:
1) how my foot hands and absorbs the impact (does it flatten all the way or stay on edge only)
2) length of my stride (is it shortened in the back half and if so, does my leg rotate to make up for that?)
3) do I push off (full knee and hip extension with toe off) or pull through
my advice would be to get the immediate symptoms loosened up and healed and then focus on getting to the bottom of it all and find the cause. A good sports massage/ART person is a good start. Due to the long span of the symptoms, you might also want to look into finding a Graston practitioner (soft tissue massage that uses metal tools to really rake the muscle/tendon). www.grastontechnique.com will help you find someone. If you're really lucky, you could probably find someone who is both ART and Graston certified and go for the two-fer.
@todd:
no. no need to rest for three months. just giving you a general time line for overall recovery. the idea is to rest enough to allow the inflammation to cease. then gradually introduce running. however, the main focus during this time will be core strength and flexibility. run perfectly as tolerated. as others pointed out, adding in massage helps breakdown scar tissue and expedite the healing and recovery from swim, bike and runs that are done during this time.
so why ~3 months?
imagine your objective was to do the splits. you could not just start stretching and be able to do the splits in two weeks. it takes time for your muscles and tendons to adapt to the new demands. same goes for limbering up a stiff pelvic region or strengthening lower back and abs. your previous running likely has your quads and hams flexible, but you'd be surprised how stiff one's hips can be.
finally, i recommended yoga because it has a balanced approach built in already in the way one movement flows to the next. you don't have to think, just do. i recommended DVD vs. a class because a class instructor often focuses on different body parts vs. just hips and legs. however, it's up to you.
you can do this all yourself, but of course always easier to have a massage thearpist, trainer, etc.
you will get better with the recommendations that everyone has given you so far in this thread, so just stay disciplined and positive!
GH
Thanks Leigh and Gilberto for all the information. I will have to learn patience. The hardest thing for me right now is not running for three weeks and there has been no change at all. Even though cycling does not appear to bother me I am wondering if it is keeping the inflammation stirred up.
it will keep coming back unless you invest in the patient and permanent way described above...remember what yoda (from star wars) said about choosing the quick and easy path!
gh
A little update here. I haven't run now for 4.5 weeks, I may try running next week a little. I had been riding without any problems until this past sunday, my knee started hurting and I had to cut the workout short. That had not happened before so now I am not riding either. I have taken up yoga as Gilberto suggested and continue to do core workouts. The knee really doesn't bother me at all in my normal daily activities.
Lawson, I have heard a lot of good things about ART. No one locally here who does it. I live in a very small country community. Do you go to a PT or a chiropractor or who does that?
Anyway not riding or running is really a bummer but seeing Coach P's atitude about recovery has really helped me chill out on this thing. I have decided to do a 5k swim with my daughter which I would not have done if I was able to train normally. That will be cool since I have never done a IM or swim longer than 1.2miles. It will be a good open water experience. Thanks for all the advice.
Todd
http://www.champion-health.com/index.php/services/activereleasetechniques
Good Luck with your test run. I am sure you know this, but just in case, run slow, flat and not too far. Even if it feels good, take it easy. If it does bother you stop. I thiink I may try and run tomorrow.
I agree the core strengh and stretching is key! I used my trigger point ball religously until my dog found it. I hate to spend $25 on another, but in my case it's worth it.
P.S. Lawson is my husband, deployed to iraq. I'm hacking while he's gone.
Jessica
Walt Reynolds (exercise) http://www.sportsinjurybulletin.com/archive/0168-knee-injuries.htm
It's a little hard to figure out at first, I had to read the instructions several times. You may even be able to google it and find some pictures. Anyways, I am willing to give any new stretch a try to beat this IT band stuff. Just thought I would share it with you too.
Jessica
Musculoskeletal issues like you are experiencing may be secondary to another issue and now have developed a life of their own. I have corrected, using ART, ITB issues as: hamstring, adductor magnus, contralateral iliacus or gluteus medius....abnormal biomechanics often cause compensations in other stabilizers. Best of luck in resolving this. Internet diagnosis is challenging because athletes often layer compensation upon compensation over months and years of training. Endurance athletes are truly proverbial onions to treat it seems. Acute traumatic injuries are so much easier...less to figure out.
ART was developed by a Chiro but is taught to: chirps, PTs and CMTs. Experience is key.
Vince
Thanks
Jessica