Thread: IT band problems = 5 months of training down the drain?

I've been training since November for a 100-miler on April 27. Running 4-5x/week and weightlifting 2-3x/week, recent weekly mileages had been about 50-60/week. Training had been going great so far and I had easily done several 25-30 mile training runs. Two weeks ago (3/10) my right IT band started to hurt a little 4.5 hours into a training run, and by the time I got to the truck 30 minutes later it was hurting bad enough that I could not run faster than "fat man shuffle" pace and not downhill at all. I had never had IT band or any other knee issues running ever, so this was concerning. I did a bunch of easy spinning, foam rolling and stretching and backed the mileage way off for the next two weeks. I was planning on reducing mileage quite a bit for those two weeks anyway as a mini-taper for a 50-miler last saturday, so that wasn't a big deal. 2.5 hours into the 50 I started to feel my IT band again, and within an hour I was reduced to walking about 2 mph and had to drop at mile 20. The pain was worse than two weeks ago and it lingered much longer (almost two days vs. a couple hours previously).

So to recap: IT band pain @ 4.5 hours + 2 weeks rest/rehab = worse pain @ 2.5 hours. Given that, I don't see any way that I can reasonably expect to finish even half of a 100 miler in five weeks and I should just cut my losses and move on. Am I wrong?

That is a tough situation for sure. Your best bet is rehab. Go to your doc have them rx. Iontophoresis with dexamethasone. Take that to your local body shop and get the treatments done. While there have them give you the once over for strength and flexibility issues. Specifically look at glute and hip abductor strength and hamstring length. Foot and ankle alignement/ shoe issues may also come into play as could alignment issues from your spine or SI joint.

Maintain fitness in the pool with deep water running and on the bike as IT band pain allows.

Good luck.

Thanks Vin. I'm pretty well screwed then. The specialist access in my insurance network sucks. 1.5 years ago I inquired about getting a bone scan to check out what I suspected was a stress fracture in my fibula and it was a 5-week wait. I will be shocked if iontophorihadtgoogleit treatments are any better, but I will call TOSH and see what they can do.

this is one situation where the elliptical can be helpful (no hands of course). similar to deep water running, it allows you to "run" and not beat up your IT. (not better than water running, just different)

can you get a LMT, or better a PT, to work on it 2x or 3x/wk?
sometimes, regular massage, or even ASTYM or ART, can help

good luck, IT issues suck!

Managed to get an appt. with a PT on monday. Will report back then.

Really, really sorry to hear this.
In short, yes, I think your race is out the window. You've had some great advice so far, and I know you've got a good handle things generally.
I'm 18 months into an IT nightmare and if I can't pull out of it this season I'll go the surgery route. My story is similar to yours, except that I'm an idiot, and ran a 50 with an IT that blew up @ 9. I wouldn't wish the last year and a half on anyone.
My advice: rest. Rest harder and longer than you think you need to. I've had multiple serious injuries, but never one that came creeping back as soon as I get serious about training again. Over and over again.
The bike seems to be a less harmful outlet, but its not without its dangers. Obviously it too creates imbalances and fosters general tightness and fatigue. I've had great luck with the pool, specifically doing interval eggbeater stuff to improve my hip's range of motion. While they probably weren't at fault initially, my mobility issues have really come to light in the past six months.
Live on the foam for a while, go buy a lacrosse ball to really get in that socket. Good luck.

I should just cut my losses and move on. Am I wrong?

Fuck no. "Nightmare" is a great way to describe this syndrome. I have very similar results as BraddA. As soon as you think things are starting to get better, you want to start progressing again but no, it comes back and lasts exponentially longer if you even so much as feel the slightest twinge. As soon as you start feeling any kind of I T band pain all bets are off I have learned. If you can feel anything in that spot, don't aggravate it for anything in the world cause it's just going to take ten times longer to go away. I have had it now for over three months and have tried EVERYTHING except this, please explain: (Iontophoresis with dexamethasone) with no relief. I don't know what is fucking it up and what isn't at this point, there is just no change for the better no matter what I do. Foam rolling is a joke, as are hip abductor excercizes in my experience. A true stretch for the I T band doesn't even exsist in my opinion. Maybe it's just my body, I don't know, but I try all the different I T band stretches and have great flexibility and don't feel shit stretching. Sat around doing that shit all day for three months. Awesome.

Hate to be a debbie downer, but as BraddA says, I wouldn't wish this misery on my worst enemy. The only thing I can do is walk and my leg looks like a complete atrophied piece of shit now. All this thanks to the miracles of modern medicine. Pretty cool that my doc thinks its nothing. If I had known this could happen, I NEVER would have gotten acl surgery. I had far more functionality before, fuck at least I could climb up and down stairs without looking like a 90 year old invalid.

Sorry for the highjack, hopefully things work out better for you now that you caught it early. You didn't have a dumbass doctor tell you it's fine and you can't possibly be damaging anything by skiing on it. If anyone has ever actually gotten over I T band pain, I would love to hear about it. Any kind of anecdotal evidence that this nightmare ever ends would give me a glimmer of hope.

Fuck me.

BraddA - Have you had to give up lifting for the time being? I am starting to think maybe now would be a good time to work on getting a full lever or some other gymnastics circus trick.

Tone - Have you gotten back on your bike yet? By Monday I had no noticeable pain or twinges during everyday activities, including accidentally running about 50 yards from my truck to the grocery store yesterday. I am going to be in St. George this weekend and was going to bring my bike, but now I am questioning if even that is a good idea.

Originally Posted by tone capone

please explain: (Iontophoresis with dexamethasone)

Vin can probably explain in more detail, but there's a decent wiki page describing iontophoresis. It's a localized drug delivery method that uses a charge gradient to pull drugs into deep tissues instead of injection with a needle. Dexamethasone is a powerful corticosteroid.

I think you've gotten some good advice so far. I've been dealing with my own overuse issues for over a year now. It is a nightmare and seems like it will never end, but I think if you stay on it you will persevere. Like everyone above I would recommenced not to push it, I did and it really set me back.

Start at the hips, since I've been focusing on my hips I've had the best progress. I'm not sure how you're built, but I know my quads are way more developed than my hamstrings. I've been working on stretching/strengthening my hamstrings as well. I've found my hip flexors/piriformis are pretty tight. I stretch, foam roll, and use a home made "the stick", lately I've been able to ride a bit as long as I stay on top of the maintenance.

I've also found that sitting at my desk probably contributes to all the tightness I'm feeling. I'm not sure what you do for work, but if you're sitting all day try to change it up a bit.

DTM, the short answer is yes, I did lay off the weights for about ten weeks. Herein lies the bitch with the IT: it'll probably feel pretty good after another couple days of rest. Maybe a little tight, but far from the crippling pain you're now familiar with. Anyway, you'll likely get to the point (rather quickly) where running may be the only activity that causes pain/immobility. I think this is pretty common. Furthermore, it may be a given workout/distance, or level of stress/fatigue that needs to be reached in order to reactivate the issue, like Tone said. For me, this meant that as I reengaged my leg in the weight room or on the bike it felt pretty good. As I began running short distances 2 or 3 times a week it felt really good. As my confidence grew my willingness to increase my workload followed suit, and I've discovered that there is a relatively concrete barrier of +25-30 miles per week that I just can't break through. Riding the bike has been fine. Everyday? Not a problem. 30 miles in a day? Cool. Shuttling downhill for 2-3 days at a time? Great. Same goes for the gym, pool, etc. Its really just the running that gets me. You ask yourself pretty quickly how badly you want to run, or at least run any kind of distance and be competitive, even if its only with yourself. Good luck with PT, hopefully you find someone well-versed in this issue.

Oh, where is the pain currently? Knee or hip? Mine started with the knee. As I've begun working out my issues the knee pain has ceased and the pain has crept up into my hip. I'm told this is good. It seems that I've a bursitis chicken or egg issue, which either begat or was caused by the IT. My experience has differed from Tone's in that the roller+active/resistance stretching+a "mobility project" type approach has been really helpful in regaining what I need to make the IT a non-issue unless I'm running.

Summary: only run away from Bigfoot, and towards ice cream trucks.

Originally Posted by BraddA

it'll probably feel pretty good after another couple days of rest

Already does. Yesterday I was in a rush to grab some meat at the store after work and reflexively jogged the 50 yards from my parking spot to the door. Zero pain, but as I walked in the door I thought, “Shit, that was probably not a good idea.”

Originally Posted by BraddA

You ask yourself pretty quickly how badly you want to run

Badly. Running taps into some primeval part of my brain and nothing else really scratches the itch. Plus running gets you places that a bike just can’t (stuff in wilderness areas mostly).

Originally Posted by BraddA

where is the pain currently?

Knee, right at the attachment point at the top of the tibia.

my n=1

i am not an ultra runner; i do nowhere near the mileage you do...just up to half mary, no more

my recovery process was 6mos
it was a progressive exercise regimen based on causing zero pain and building back to previous fitness
that was 4 yrs ago - no relapse so far

my bike fit has been good and never caused problems for the knee, just running was a problem. i did not ski that winter

First I want to sincerely apologize for my negativity and overall thread highjack last night. I feel really bad about it today. It's just that I feel like this about skiing,:

Running taps into some primeval part of my brain and nothing else really scratches the itch.

and this is my second year in a row of sacrifice and it has really worn me down and stressed me out.



On the other hand, I just want to emphasize that I have REALLY been tripped up and fooled by the pain -mostly- going away, thinking I could get back to the meat and potatoes of p.t. and athletic activity. I can't tell you how wrong I was, more than once. I'll say again, I have had it come back full force just by triggering it slightly for a second. I'll really know about it 24 hours later, and that is what is so scary, It's hard to know when you're over doing it.

Like this:

Already does. Yesterday I was in a rush to grab some meat at the store after work and reflexively jogged the 50 yards from my parking spot to the door. Zero pain, but as I walked in the door I thought, “Shit, that was probably not a good idea.”

At this point, I am a firm believer in this:

my recovery process was 6mos
it was a progressive exercise regimen based on causing ZERO PAIN and building back to previous fitness

So far, spinning a 90 cadence on the bike, and not standing to pedal at all, is about the best I can do, for limited amounts of time. I am trying to stay positive I can build up from that like after surgery. I just hope that I didn't screw up on this too many times to recover. Obviously you are a highly tuned athlete, and maybe you will be able to progress more aggressively, but as for a mortal like me a year out of acl surgery, I probably have more biomechanical imperfections that may be more limiting for a while.

Best wishes, I sincerely hope you have the quickest and best outcome humanly possible. Apologies again for not controlling my frustration better. I'm on the one day at a time program at this point.

I suffered from severe IT band and hamstring tightness several years back. Got over it by massaging and rolling my IT bands to break up the myofacial adhesions that had built up after a summer of cross-country running followed by some hard early-season telemark skiing. I've kept IT tightness at bay by slowly rolling my IT bands every night with a Rumble Roller.

I also do light stretches because I found that hard stretching only causes "hardening" (for lack of a better term) of muscles.

here's an interesting take on IT band problems and an explanation of treatment using pandiculation rather than stretches.

good luck!

Had my appointment with the PT this morning. About 25% of his patients are runners with IT band issues so he has a lot of experience in this area. Given my current pain level (none), his overall prognosis was good and I am starting from a better position from most thanks to shutting things down quickly and not trying to push through the pain.

We ran through a bunch of strength and flexibility tests. The strength tests all checked out pretty OK. I am a bit quad dominant but not bad. My calves are somewhat tight (foot flexion test was only 4 degrees past vertical, should be more like 10 degrees), but the biggie was my quads. He said my quad flexibility is in the bottom 10%, maybe even bottom 5% of his patients. After he did the quad test he said there probably wasn't a single person in the room with tighter quads than mine (large PT room with 20+ people). Ouch. He thinks the quad flexibility issue is the primary culprit and says it's a fairly straightforward fix.

He gave me a number of stretches and exercises to work on and I'll be back in 3 weeks. He greenlighted me to lift, bike and run short distances if there is no pain. I think I will take a break from any lifting or running for a few weeks anyway though. I did some biking this weekend and felt no pain or twinges. They were short rides (3 rides of ~1 hour each), but on desert trails with lots of little ledge-ups, short power moves and chattery descents.

Good to hear. What are the quad flexibility exercises? I'm terrible in that area too.

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Glad you can continue to maintain your fitness. I too would like to know about what kind of quad stretches they have you doing. I think a big part of my problem is a tight lateral quad which is difficult to stretch. When I do a big traditional quad stretch, I have less crepitus under my kneecap for a few minutes. If I do contractions as in straight leg raises, the crepitus gets awful right away. These stretches are the only thing that makes any noticeable difference in how my knee behaves, but they also do nothing for the I T band pain.

I got an mri last week and I get results from that tommorow. I just want to know what the collateral damage is at this point.

First quad stretch is one where you lie on your stomach and pull your foot to your butt with your hand or a band. Ideally you should be able to touch your heel to your butt easily. I can only get within about 6 inches right now.

The second is a little hard to describe. While standing, raise your foot onto a shelf behind you that is about crotch level and bend your front leg to stretch the quad. Think sort of a standing lunge or couch stretch position. You can pull the trailing knee in laterally to stretch the lateral quad and IT band more directly.

Hold each for 60 seconds 3x per day. He stressed the importance of frequency if you really want to make progress.

Interested as to the kind of strength and mobility training you did leading up to this. There's a guy at my gym that competes in Ironman's regularly, does really well for his age group. Typical type A, very successful financially in career, turned ultra athlete. Was a good athlete in college too.

Started going to MBSC after having IT band issues. The following is based only on what I have viewed, I never asked any detailed questions, but he is there most mornings and have watched him over months.

They had / have him doing a lot of soft tissue and mobility work in the beginning with some "weird" strength and power training. Lots of single leg strengthening, power, and balance exercises. Stuff like lateral med ball tosses on one foot.

He backed way off the running and replaced it with alternatives like airdyne biking, sled pushes, etc. Basically only runs occasionally to keep his form and keep it in the muscle memory.

I know he also regularly sees the physical therapist / sports massage guy there (I think he's a DPT and has whatever certificate you get for massage). He always jokes that he is going to go pay $70 to get tortured. When the PT / SM guy goes to work, it some times sounds like there's S&M or something going on with all the grunts, yells and grimacing that comes out of the room.

This guys is probably spending $1,000 a month between the coaching, massage and PT though

I got MRI results the other day. Much to my amazement, they say there is nothing damaged yet in the patellofemoral joint despite the sometimes loud and painful cracking under my kneecap. Shows a small lateral meniscus tear but they didn't think it was worth operating on. I think it's the clunk I feel in the lateral joint space upon quad contraction/leg extension. Definetly not the same place as the IT. band pain which is 95% of the problem. Maybe they are related? I don't know.

If not, I can live with the clunk for awhile but this fucking IT. band pain is something else. Walking and easy spinning on the mountain bike and mellow trails seem o.k. for now (amazing, no pain) and I feel lucky for that. It's just that it's a long ways away from most every other worthwhile activity. No way I can hike, run, or ski in the future like this. I'm going to get two physical therapist opinons this week, I need a full evaluation like Dan spoke of. So, taking the next step. Sorry again for the hijack, but between all of us, IT band syndrome is goin down. Kick that shits ass.

from my perspective there are 2 ways to look at IT band issues.

1. addressing the localized symptoms, which include all the direct IT work already mentioned, managing the acute inflammation from the mechanical stresses, and modifying their routines. This is where people usually stop because it is good enough or fails and they simply drop the irritating movements from their life. If your expecting sidelying leg lifts to have some major impact on your pelvic and hip stability in a weight bearing/dynamic function i don't see how its possible. Not implying they aren't important, but they are a precursory exs.

2. addressing the underlying cause of chronic TFL tightness. This is the murky part, its not sufficient to normalize hip and lower leg mechanics, how you carry your trunk on your pelvis, how your pelvis is moving under you in dynamic motion is critical especially if the IT issues are not responding to step 1. You can roll and rolf and dig at your IT tissue till the cows come home, but if you don't know how your relying on the TFL, or more importantly how to stop relying on it, the process perpetuates.

We/our bodies/brains are incredible, it is a surviving machine, it makes corrections without wasting time for us to be conscious of those shifts, especially when it comes to injury, or repetitive trauma, your pain is telling you something but it is critical to look across the whole system for its cause, we can select from an assortment of variable body positions, but knowing which ones are beneficial and which ones can be detrimental is unique to each if us.

It's important to have this conversation with the people doing your body work, if they don't have the ability to incorporate that perspective, keep looking. Not to disparage their work, step 1 is an important part of our health, but its only a piece of the puzzle

good luck

ETA: To try and balance the cryptic nature of my response I thought a couple of anatomical/biomechanical points might help, from "The Thinking Body", Mabel Ellsworth Todd

"... equilibrium is brought about by the tipping and tilting of the pelvis... as it rotates on the femoral head. Consider the body weight as constantly moving through the pelvic joints from spine to thigh..."

"... the light tread, the bouyant walk... is transferred from spine to legs through the rolling pelvis. This in turn is aided by keeping the hip joints close up toward the center, so that the heads of the femora are not swung outward..."

'... control of the weight is accomplished by the deep lower and inner pelvic muscles, which reach well up into the thorax and down into the legs. The leg thus swings from the largest and strongest portions of the spine and the deepest muscles of the trunk..."

balance your pelvis/body to take stress from your lower body joints

^^It's real nice to read posts that are exactly what I'm thinking, but put into much better words.

Originally Posted by kingdom-tele

2. addressing the underlying cause of chronic TFL tightness. This is the murky part, its not sufficient to normalize hip and lower leg mechanics, how you carry your trunk on your pelvis, how your pelvis is moving under you in dynamic motion is critical especially if the IT issues are not responding to step 1. You can roll and rolf and dig at your IT tissue till the cows come home, but if you don't know how your relying on the TFL, or more importantly how to stop relying on it, the process perpetuates.

I don't know about IT problems, as I have (knock the shit out of some wood) haven't had any yet. But I do have a bum hip with an amazingly tight TFL. Turns out, I was compensating by using TFL to control internal rotation (both open and closed chain). To combat this, my PT has me strengthening glut med and adductor. Just some thoughts, maybe they won't work for you. But I have gained SO much hip stability since November, it's crazy to me I was even functioning to begin with.

The best thing is obviously to find a PT who knows what he/she is doing (I can give some good recommendations in the Seattle-area), but let me know if anyone wants details on the exercises that work for me.

That is all very interesting and informative, gentlemen. I do have some funky clunking going on in my hips and lower back ever since surgery over a year ago. No pain, just clunking.