H
i Doug,
I stumbled upon your blog. Sitting here with a bag of frozen
broccoli on an angry ITB. Ha. After a two year hiatus from running I
have returned SLOWLY to walking, swimming and some running. My ITB
flared up in the past and lay dormant all this time- waiting to reclaim
its hold on any plans of race day glory. Im 37 years old and feel like
the clock is ticking too fast.
I consider myself an expert on the vast blogs and internet
approaches to treating ITB. I have done every "ITB...marathon
training..physical therapy... running" web search. I have read it
alllll. You are one of the FEW people I have read that touts the
impracticality of stretching a brick. Your argument made alot of sense.
I found your take very interesting. Im 37, fit and interested
in a conservative approach to learning HOW to address the ITB problem.
I am overly flexible, and probably lack strength. I have had some
success with PT- but everyone says stretch it, stretch it stretch it. I
wound up with a nasty hip bursitis (which began my running hiatus).
My question is- I have read your entire blog looking for
specifics on what path to take. I have correct shoes, run on soft
paths, avoid hills. Beyond Rest, Ice and taking time off...do you
advocate a foam roller or specific hip excercises? I live in Durham NC
and cannot come see you in practice. Do you have any tips on HOW to
treat ITB generally speaking. (I know you cannot treat people over
internet). I just mean...do you suggest massage, roller or specific hip
strengthening-all things equal.
Sorry if I rambled. I am a frustrated wanna be athlete.
Thank you, in advance, for any info you might share. I have to go the broccoli is starting to get mushy.
Sincerely,
J
A few years ago, I felt compelled to come up with answers that people could execute on their own and, as a result, created a great deal of internal conflict for my self and loss of sleep and who knows how effective the advice was. I understand this problem, ITB Syndrome, but I use certain tests to help clarify the nature of the it and certain tools to fix it. You, the reader, may or may not know how to do the tests or have access to the tools. I understand that might be frustrating to you but I'm trying to be as helpful as I can. I hope the information that follows helps you.
Treatment of ITB Syndrome: Fundamentals ( and this is the kind of topic I'll be covering in my new blog - I'll post this once it's up).
There are three main components: biomechanics, tissue injury, and attitude. What the reader has bumped into is that most approaches for this problem come at it from one of the components, usually biomechanical (orthotics, stretching, etc), and leave out the other two. So, if you actually have tissue damage in the ITB, which is entirely possible, and you correct the biomechanics, the tissue is still weak. So, when you resume loading it, as in running, symptoms return.
- Make sure you really have ITB Syndrome and not degenerative joint disease / chondromalacia. Fluid from inside the joint can find its way under the the ITB which then increases the pressure between the ITB and the bursa. Other signs and symptoms of a joint problem include aching, stiffness, a sense of fullness in the knee or pain. You should also have a positive Noble's Test (pressure applied to the lateral condyle of your femur while flexing and extending it through 30 degrees of motion).
- Now for biomechanics...and why I cannot tell you precisely what to do but can give you guidelines.
- People with ITB Syndrome tend to have a high medial arch of the foot and impaired control of the rear foot. Your orthotics should correct for that, if you have it, and not for the more common "flat foot" found in the general population.
- Make sure you have adequate dorsiflexion of the ankle as inflexibility is associated with ITB Syndrome. If you lack motion, find out if it's from tightness or structural limitations (you'll need a therapist to help you).
- Check your hip strength since weakness of the gluteus medius is common in ITB Syndrome. Stand on a step with one leg off the step allowing the hip to drop. Hike your hip up without rotating the pelvis right or left. You should be able to bring the top of the pelvis well above the horizonatal and be able to do this at least 10 times. Check both sides. Usually, the side with symptoms will fatigue sooner and / or you will not be able to keep the pelvis from rotating. I also use a digital muscle tester to test your hip strength using other motions which provides an exact measurement of your strength and I can compare this to both your other side as well as to a ratio of strength to body weight. Either case, your hip muscles are too weak and if so, you're not ready to run.
- Check your single leg squat strength. Stand in front of a chair on one leg with the back of your leg just in front of the chair. Hold your other leg off the ground in front of you. Squat down until your knee reaches a 70 degree angle and then stand up. I use an adjustable table that limits the range of motion. Watch the pattern of motion of your leg. Your knee, as you look down on it, should travel in a reasonably straight line. If not, if it tends to wobble in and out, and you are unable to control it using your muscles, your hip muscles and leg muscles are weak. You should not run until you can squat up and down at least 30 times.
- Now to address the tissue injury (assuming there is one which in most cases is not an inflammatory disorder (as in tendonitis) but a tendonosis (and if you actually have a joint disorder, that's another story).
- What to do here depends on how "irritable" your tissue is; how quickly you hurt. The treatment of tendonosis always involves discomfort. The exercise needs to stress the tissue. I usually use squats - single leg - at a load level that produces some discomfort in the leg between 20-30 repetitions and aim for 30 repetitions. I often use squats in supine (lying on your back) and in a sidelying position on a Total Gym since almost everyone I've seen with ITB Syndrome fails the hip and leg strength tests and has to exercise with less than full body weight. Perform 3 sets resting about 1 minute between the sets. This yields 180 repetitions of load and depending on your body weight, could be between 6000 and 10,000 lbs of load.
- People often get anxious about pain during the exercise. Tendosois pain generally won't hang around long after the drill and the degree of pain should be mild to moderate.
- As your leg gains strength, I usually add hopping on the Total Gym until you pass the hip and leg strength tests and then begin some limited hopping full body weight. The hoppin g prepares your leg for running.
- I use sidelying hip abduction drills (some call these hip or leg lifts). While on your side with the bottom hip and knee bent, align the uppe leg such that it forms a straight line with your trunk. Lift the leg up and down like a pump handle keeping it straight. As you fatigue, your leg will want to drift forward. If you cannot keep the leg in the proper position, stop. This exercise will fatigue the hip muscles considerably.
- I also use standing hip abduction drills. Standing on the symptomatic side, I attach a pulley to just above the ankle of the other leg. Now, bend the weight bearing knee about 20 degrees. This activates the hip muscles. Move the oppostie leg away from the body and then back. Repeat this 30 times, 3 sets with a minute of rest in between.
- Now to address inflexibility and pain...
- I use a foam roller under the involved side. Lying on top of it, just roll your leg back and forth, up and down. It doesn't matter which pattern you use. It will likely hurt. If a tennis ball feels better, use it. This procedure often reduces pain and improves flexibility through reflexive relaxation of the hip muscles.
- I use Capsaicin as a topical agent over the region of pain to reduce symptoms.
- As for attitude....
- This is reflected in how well you pay attention to your symptoms and the choices you make. A very difficult thing to do, for just about everyone, is to accept your current state of abilities and work from that level. If you find your self refusing to give up running, for example, despite symptoms that force you to stop or cause you to modify your running for, you have an attitude problem. No amount of physical treatment will work in the presence of an attitude that runs on denial.
I hope this is helpful. I realize it's a lot of stuff (and it's not everything, that's a book). But, you asked :-)
DK**
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