Thursday, March 30, 2006

Dealing with IT band syndrome


Whenever I push it, my knees complain one way or the other. I saw a physical therapist way back when to get diagnosed. Turns out, I'm slightly knock-kneed and have weak hip abductors. This time around, my left knee is showing all the signs and symptoms of IT band syndrome.

"What is the iliotibial band?
Iliotibial band syndrome is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins at the hip and extends to the outer side of the shin bone (tibia) just below the knee joint. The band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint. "
"What is iliotibial band syndrome?
Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion.
However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. "

"What Are the Symptoms of Iliotibial Band Syndrome and How Is It Diagnosed? A person with this syndrome feels an ache or burning sensation at the side of the knee during activity. Pain may be localized at the side of the knee or radiate up the side of the thigh. A person may also feel a snap when the knee is bent and then straightened. Swelling is usually absent and knee motion is normal."

"Causes: Anything that causes the leg to bend inwards, stretching the ITB against the femur overpronation (feet rotate too far inward on impact) tightness of the ITB muscle lack of stretching of the ITB incorrect or worn shoes excessive hill running (especially downhills) and running on cambered surfaces overtraining." from http://www.time-to-run.com/injuries/thebig5/itb.htm

Keys:

  • IT band runs from hip to knee joint along outer thigh.
  • Pain often occurs on outside of knee. It can also occur in the outer hip. Guess what? This is exactly what's happening with me! In addition, pain can be sharp (um, me), and is worse going downhill (me again).
  • Causes--think biomechanics here. Wide hips or narrow knees (common in women) are often the cause. Weak quads, tight hamstrings, or weak abductors (outer hip muscles) vs. strong adductors (inner thighs) are also contributers.

And the big question? How to fix it!

  • After controlling the initial injury (RICE--rest, ice, compression, and elevation...as well as good ole' Advil), I am trying to get the injury to heal and prevent it from coming back.
  • Rest--Unfortunately, it takes time to heal. After a serious strain, it can a minimum of 6 weeks for the tissue to heal. It's important not to push through the pain. Every time I do, I reinjure the tissue and have to start all over. Right now, I'm laying off the running, which is the cause of the pain.
  • Test the waters...after the first week, I felt well enough to try and run on the treadmill every so often (2x/week) to reassess. The treadmill offers cushioning the outside road cannot. I can also control the incline and the speed. The second it begins to hurt, I can stop, and I don't have to walk all the way home. Plus, it allows me to see how I'm doing. For instance, last week I couldn't run 5 minutes without it hurting. This week, I can go about 15-20 minutes.
  • Cross-train. Perfect for us triathletes. While letting it heal, use it as an opportunity to train your limiters. We never have enough time to train. I'm using this opportunity to log more miles on the trainer and spend more time on swimming. These things don't hurt so I'm cleared for these activities.
  • Make sure you have the right running shoe. See a running specialist, physical therapist, orthopedist, or all of the above. Do you pronate? Need orthotics? In my case, I caused the injury by running on concrete in the wrong shoes. Plus, I went too far, too fast. Sigh.
  • Find the root of the problem. I saw a great physical therapist who specialized in running injuries back in St. Louis over a year ago when I first encountered my "knee" problem. Now, I know my biomechanics (weak abductors and tight hamstrings).
  • Train accordingly. Watch your form when you run and try to engage your glutes and abductors more. Hit the weight room. Well, I'll have to wait and heal first. I really need to strengthen my quads and outer hips. However, I can't do lunges, squats, or leg extensions right now b/c it puts excessive strain on my knee. However, my outer hips and glutes have no excuse. In addition, b/c my hamstrings are tight, and my adductors are dominant, I never, never do strengthening exercises for these muscles.
  • Stretch. Focus on IT band and hamstring stretches especially.
  • See a massage therapist for a deep tissue massage. Ouch in a good way.
  • When it heals, increase training slowly and back off when it begins to hurt, before injuring it.

Unfortunately, I'll always have to watch my knees and hips. However, it's a good indicator. If I'm pushing it too hard, my knees are the first to let me know I need to back off. Plus, I can use the down-time to catch up on other things with life and train in other areas that need it (e.g. swimming!).


9 comments:

Mon said...

OUCH! Sounds painful!

Cliff said...

Rachel,

Glad to see u have find the problem. That's the great about being a tri. If u can't run, swim. That's what i have been doing when I had my lower back. I just hit the pool.

IMmike said...

I had serious ITB issues. I've found that the best preventative measure for me is to incorporate strength training into my routine. But, I think the best thing to do is to take a break from the running and let the inflammation go down. Ice and ibuprofen helped a ton for me. Then try to address the problem.

Rita said...

Oh my gosh! take it easy, Rachel. :[ You don't want to shred your knees like Mr. Tougher and Tougher!

Glad to hear your sister came for a visit!

Rachel said...

hee hee. tougher and tougher!

Anonymous said...

Unfortunately six days is too long to wait let alone six months. I don't have the option of complete de-conditioning by sitting around six months.

Daniella said...

My right itb has been giving me problems and I don't know what to do because I am running a marathon next month. I've been going to a physical therapist for 3 weeks now and it has been helping a little not a lot though. I haven't been running for 2 weeks now and I just don't know what to do because whenever I do try to run it hurts and I have to stop.
What do I do??? :(

Unknown said...

Thanks for the advice on treadmill running. I just hurt my IT band for the first time yesterday on mile 10 of a 15 mile trail run. 5 mile walk of shame back to the car. Didn't know what the heck I hurt until I looked online. Tried to swim today and the IT band didn't care for that so much. Daniella, I get your anxiety, I have a half-iron in 2 months and like you, cannot afford to rest. Good luck and remember that losing entry fee and going to cheer friends is better than DNFing surgery--now if only I could follow that same advice!

Unknown said...

How long did it take you to recover?I have ironman Lousiville end of august and I came down with ITBS 3 weeks ago..I have a weak butt (gluteus medius) i foam roll and stetch RICE etc..Its killing me i cant train that well.I just came off of ironman st george and was hoping to build off of this but now this..