Friday, March 30, 2012

ITB Woes

If you run at all then you have had or know someone who has had trouble with their IT Bands. If you have no idea what an IT Band is then check this out HERE. If the link bores you or (you don't want to click it and get side-tracked from this riveting post) just know that the ITB (that's what us cool sports medicine professionals call it for short) is an impliable band of fascial tissue that runs from it's muscular junction at the hip to the outside of the knee. People who suffer from Iliotibial Band Friction Syndrome have a sharp, stabbing pain at the lateral knee, mostly with running, although you can have symptoms with walking or stair climbing.

Why am I bringing this up and going all super nerd on you? Because for some unknown reason my ITB has decided to turn on me and has declared war. It is mad at me and lets me know every time I run more than 2.5 miles. It started last weekend when I tried to go for a nice easy run. I think it's pissed because after my half (not even two weeks ago and that I had NO injuries with) I didn't really do anything for 5 or 6 days. Maybe it feels neglected, but I was busy. I had a to-do list a mile long, and I wasn't motivated to get on the bike and recover properly and now I am paying for it.

Yesterday, I went for a 5 mile run, I got 2.5 miles out and it decided to act up on me again. I had to run/hobble/walk 2.5 miles back to my clinic. Fun. Not only did it take for ever,  I looked like a giant dork hobbling along the road.
I felt like this was being stabbed into my knee with every step!

So I thought I would take this opportunity for a little PSA about what ITB Friction Syndrome is and how to treat it successfully.

I know NERD ALERT...but I feel it is my duty to inform you!

ITB Friction syndrome has traditionally been thought of the result of :

  • An inflammation of the Iliotibial Band
  • A result of a tight ITB, so stretching to elongate the ITB is called for.
  • Friction when the ITB rubs forward and backward over the lateral epicondyle of the femur.

All good thoughts and many rehab professionals have used this for years to build treatment plans. But what we now think is that the inflammation and pain isn’t coming from the ITB it’s coming from the inflammation that occurs in a “highly innervated pad of adipose (fatty) tissue that rests under the ITB“. When the hips and core are weak it allows for the knees to drop in towards the midline of the body putting tension on the ITB and “anatomical studies have shown that in fact the ITB doesn’t move backward and forward appreciably across over the lateral epicondyle (of the femur) but under higher tension tends to pull outward from the leg at the lateral epicondyle. However, it is attached by ligaments to the femur itself in the region of the lateral epicondyle, so as tension is released, it is drawn back in toward the bone, so as you run, that highly innervated adipose pad experiences repeated compression and decompression that may be the cause of it becoming inflamed."

To correct this,  hip and core strength must be addressed to stop the unnecessary and repetitive compression/decompression.

So back to what I plan to do about it. The same thing I do for my patients (and I am actually going to listen to myself for once).

  1. First modify my activity....which means pain free running if I can run at all :(
  2. I would take and NSAID if I could, but I am allergic and my face swells...good times!
  3. Lots of core strengthening, which will focus on the hip extensors and hip external rotators.
  4. Stretching...ok, if you read the article you know I am contradicting current research, but I still think that tight hip muscles will attribute to biomechanical problems. So foam roller, ITB and piriformis stretching will be part of the plan (it can't hurt and can help with acute symptoms).
  5. I am also doing Graston. This is a form of soft tissue mobilization I am trained in. Again, kind of goes against what Mr. Myth Buster Article Writer wrote, but I have used it on many an ITB patients, including myself in the past, and the results don't lie. It works when added to a comprehensive plan.
  6. And of course ICE.
  7. If that doesn't work I am off to see the Orthopedic and am hoping for a nice does of steroid injected into that fat pad.

That's the plan and it's already been put in motion. I am going to give it two weeks before I give in and see call the doctor. Wish me luck. But now I am off to ice (again today) and I hope to go for a birthday run tomorrow. I will be 37 and hope to run at 3.7 miles to celebrate! 

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