ITB Issues, What Worked for You?

[bourbonisgood]

I hate to say it but it sure sounds like a back issue. I never had any pain in my back either (well, rarely) but it turns out that I had a congenital fracture in my lowest vertebra that screwed up the mechanics of my entire spine. My low back seemed like it moved great, but all the motion was occurring at the damaged vertebra plus T12-L1. Also, my thoracic spine was super stiff, but that's true for a lot of people with no pain. I went to PT school with this screwed up back, got examined by my professors (all us students did) and not one single person noticed anything odd except that my low back couldn't be manipulated (presumably because of my 'extra motion' at the damaged vertebra).

I guess what I'm saying is that despite all the fancy lingo (which I try to avoid unless amongst medical professionals) and the hundreds of billions of $ spent on backs every year, nobody understands them all that well. If you're being treated by someone who claims to have all the answers then run as fast as possible for the exit.

I'm not affiliated with them, but as I mentioned earlier the PT's certified as McKenzie Practitioners are probably better than average at detecting subtle spinal lesions. If you're in a major metro area then its worth it to go to a McKenzie Diplomat. Yeah, stupid name but they have the most training. And the vast majority of folks do really well with conservative treatment of back injuries. A big part of treatment is simply being aware of the motions/positions that aggravate the injury. And plenty of people get one cortisone shot and then never have symptoms ever again.

I'm still kind of with you jma on the possibility of a lumbosacral issue. JTrue, if you have a PT that you trust and is willing to experiment a little: have him/her MMT your left glut med, then mobilize or manip the lower lumbar spine and SIJ on your left side, then repeat MMT for glut med. If the score improves, rule in a back problem, if the score changes, rule it out. At least this would shorten the list of possible causes...

[chewymix]

had your hips looked into? I have heard the odd occasion where people describe ITB type problems that end up being hip related

[kingdom-tele]

That's the problem I feel like I've been pretty persistent at examining most avenues presented for working on LPHC dysfunction, except maybe focusing a ton of attention on my ankles and back/upper body. Obviously things like RDLs hit the lower back along with the other areas I've been targeting. I've tried some of the McKenzie protocol exercises just to see if it did anything for me, haven't noticed anything. When these issues first started occurring I had weird muscle spasms and twitches in most of the muscles surrounding the hip down my quad, it didn't seem normal, even when taking all the muscle imbalances into account. They slowly went away over time. I'm still wondering if I have some sort of back issue that manifests itself tightening up a group of muscles surrounding the hip and down the left side of my body. I should retract my statement when I said I haven't ever had back pain, I have in my mid back. But it wasn't anything that was debilitating, just a slight pinch here and there, it went away and I didn't even think of having a doc check it out. My PT states every time he looks at my back that it looks awesome during movement. And there are definitely other aspects that don't point to a back issue, but I can't help but not be curious. I agree that the experiment is a failure so far and I need to go down other paths. This started off as a bilateral issue and now it's mostly one side.

The differences I notice between left(affected) and right(unafected) are a slight weakness in the glute med along with having a harder time contracting it. Tightness and knots in the vastus lateralis and rectus femoris on the affected side. Get cramps in both gastrocs and adductors. Working on the gastrocs, just mobilizing my ankle, but not sure what to do about the adductors. They are definitely much weaker than my abductors. Just as a test I got on the adductor/abduction machine and can do the full amount of plates with abductors for more than one rep, can't come close to one rep with adductors.

Try to step away from the reductionism a bit. The problem with looking for one muscle as the fix is the fact that it can be used for a variety of purposes by your brain. Think movement, what does you unaffected leg have access to? By that I mean when you move the hip how does the ankle respond, ho does the pelvis respond, the ribs, the whole of you. There will be subtle differences that may help making what feels like weakness dissipate. One leg has access to a different body than the other leg. The elevated muscle tone burns out the neuromuscular junction, you will get mm jumps and cramps because it can't tell the muscle to turn on or shut off. Its a back issue, but only in the sense that the spinal interneurons for those muscles are poorly regulated. If you were your thigh bone or lower leg bone, how does the tissue around you move, compare legs, which bones have tighter pants around them? How easily can the bones move inside their tissue pants? Hope that makes sense. You in Utah?

[powtario]

One of my buddies has had back stuff for 10+ years, and mogul skiing at a natl level didn't help, and he still gets spasms occasionally.

What worked for him was stretching, but not in a typical way. For ex cross R leg over L, and try and keep your shin vertical (if that makes sense). He would do that, not to the point that it hurt or anything, very gently, but he would do it for a half hour each leg per day on the bus. He found the very gentle, very prolonged stuff worked for him. If you're at a desk, gives you some time to experiment.

[JTrue]

Added some bodyweight back extensions last night to my routine. Did the same other exercises I've been doing for long time, that was really the only change. Now my right vmo is contracting and releasing, it started in the middle of night and is still going this morning. Its like the the beating of a drum, doesn't hurt, but a noticeable set of contractions then release. Kind of like an estim/tens machine is how I would describe it. Thanks for the replies I'll read through them and respond when I have some more time.

[jma233]

Added some bodyweight back extensions last night to my routine. Did the same other exercises I've been doing for long time, that was really the only change. Now my right vmo is contracting and releasing, it started in the middle of night and is still going this morning. Its like the the beating of a drum, doesn't hurt, but a noticeable set of contractions then release. Kind of like an estim/tens machine is how I would describe it. Thanks for the replies I'll read through them and respond when I have some more time.

If you're getting leg spasms/weakness in both legs after some stress to your spine then that's not good. Problems with one leg is pretty normal with a typical low back lesion. Problems with both legs will cause most medical practitioners to start investigating further right away. Hopefully bourbon will weigh in here.

[JTrue]

If you're getting leg spasms/weakness in both legs after some stress to your spine then that's not good. Problems with one leg is pretty normal with a typical low back lesion. Problems with both legs will cause most medical practitioners to start investigating further right away. Hopefully bourbon will weigh in here.

I wouldn't say I'm getting noticeable weakness down both legs, only my glutes seem to be affected. On my affected side, that is usually tight, I just feel like when I try to contract my glutes it's harder to fully contract that side, whereas my other side I can get a hard contraction without trying as hard. When I say spasm, maybe I should have used the word contraction, from my understanding a spasm is something that causes the muscle to tense up and not release. Whereas with the muscle contraction I'm feeling contracts then releases just like a tens unit would do at a a lower setting. I've been doing one legged RDLs and have done higher weight RDLs before without these symptoms, so I'm not sure what the back extension is affecting that deadlifts would not..

[JTrue]

Try to step away from the reductionism a bit. The problem with looking for one muscle as the fix is the fact that it can be used for a variety of purposes by your brain. Think movement, what does you unaffected leg have access to? By that I mean when you move the hip how does the ankle respond, ho does the pelvis respond, the ribs, the whole of you. There will be subtle differences that may help making what feels like weakness dissipate. One leg has access to a different body than the other leg. The elevated muscle tone burns out the neuromuscular junction, you will get mm jumps and cramps because it can't tell the muscle to turn on or shut off. Its a back issue, but only in the sense that the spinal interneurons for those muscles are poorly regulated. If you were your thigh bone or lower leg bone, how does the tissue around you move, compare legs, which bones have tighter pants around them? How easily can the bones move inside their tissue pants? Hope that makes sense. You in Utah?

Yeah, obviously my approach of going through every system isn't working. What you're saying does make sense and I've been really trying to pay attention to subtleties between both sides. Just haven't been able to really figure out how some of these asymmetries affect the whole system and how my body is compensating because of them. I try to do exercises in front of the mirror, close my eyes and see how standing on one leg vs the other feels. Try to notice how I walk, how my foot strikes on either side and what's different. Like I said my glute med doesn't seem to contract as well on footstrike on my affected side, my heel strike seems a little different on the affected side

I am in Utah, I think I'm going to make an appt with Esther Smith, a PT that runs http://www.grassrootsphysicaltherapy.com/. She is McKenzie certified and specializes in biomechanics, and how they affect sports performance. She also backcountry skis, so might understand the biomechanics aspect better than the other PTs I've seen.

[jma233]

Yeah, doesnt sound very concerning when you put it that way. Btw, one legged dl's mostly unload the spine since you're on one leg.

[JTrue]

Another day, went through most of the day and the right vmo kept contracting and relaxing until about 2pm. Went to the gym after work around 4:30, did some mobility work on the quads and hip flexors prior to any lifting. Then did one leged rdls with 50lbs in opposite hand of stance leg, 3 sets on affected side, 1 set on good side. Hamstring curls, 3 sets on affected side, 1 set on good side. Stir the pot, Stuart McGill core exercise, combined some isometric holds in plank on the exercise ball along with making circular motions for one minute at a time, 4 sets. I really feel my core being worked, after the third set it's harder to support myself with my core and I start feeling my lower back start to take the load, I stop once I feel this starting to occur. Then did 4 sets of bodyweight back extensions, keeping it very controlled and making sure not to hyperextend at the top, just hitting neutral. Did a little more mobility work with a lacrosse ball on the quads and glutes after lifting. So far tonight, no weird muscle spasms, and very limited lateral knee tightness/pain.

Scheduled an appt with Esther on Monday to check me out.

[bourbonisgood]

Scheduled an appt with Esther on Monday to check me out.

Keep us updated, it'd be interesting to hear what a McKenzie practitioner finds.

[BraddA]

had your hips looked into? I have heard the odd occasion where people describe ITB type problems that end up being hip related

In my limited experience, extricating the two is nearly impossible. Hips may not have been the cause, but if ITB issues exist, the hips are necessarily part of the rehab/recovery equation.

[JTrue]

Went to see the McKenzie certified PT today. It's a private cash only practice, but I paid less out of pocket then the out of network PT I was seeing. Funny how insurance works.

Anyways, no smoking gun. Through all the tests there wasn't one thing that stuck out to her. No reg flags while she put pressure on my lumbar spine. We went through my history, what I've been dealing with. What flares up my condition, what helps, etc. She said she deals with mostly athletes and that with a lot of them it's hard to flush out the issue right away since most of them are strong and can compensate a number of different ways for any dysfunction. She mentioned if my quads were affected it could be an issue higher in the lumbar region which are sometimes harder to illicit a response from during a short period of time. Every sport I'm interested in is an endurance sport so I tend to be in the same position doing the same movement for long periods of time.

After talking with her about my lifestyle we did come to a conclusion, I appear to live in a way where I try to keep my back in extension as much as possible. I don't sit unless I really have to, because I tend to slouch when I sit and this seems to tighten up my quads and IT Band. I have a standing desk at work and at home. When I watch tv or read I always try to lay on my stomach on my elbows, laying against a wall with a pillow behind me and my back in flexion seems to make my symptoms worse. I also sleep with a pillow under my pelvis/lumbar area which also seems to create less tension on the lateral side of my knee.

As a follow up we decided to tape my back to limit and remind me not to go into flexion, along with only doing McKenzie exercises over the next couple days. Nothing else that makes me feel better, like one legged rdls, etc. Just to see what happens. Since we couldn't illicit any change in symptoms during a one hour visit I'm hoping we can flesh out some of the things that contribute to my pain/tightness over a couple days. If it makes no difference we can go from there, but it's one avenue I haven't gone done before, so it's worth a shot.

[JTrue]

Went to see the McKenzie certified PT today. It's a private cash only practice, but I paid less out of pocket then the out of network PT I was seeing. Funny how insurance works.

Anyways, no smoking gun. Through all the tests there wasn't one thing that stuck out to her. No reg flags while she put pressure on my lumbar spine. We went through my history, what I've been dealing with. What flares up my condition, what helps, etc. She said she deals with mostly athletes and that with a lot of them it's hard to flush out the issue right away since most of them are strong and can compensate a number of different ways for any dysfunction. She mentioned if my quads were affected it could be an issue higher in the lumbar region which are sometimes harder to illicit a response from during a short period of time. Every sport I'm interested in is an endurance sport so I tend to be in the same position doing the same movement for long periods of time.

After talking with her about my lifestyle we did come to a conclusion, I appear to live in a way where I try to keep my back in extension as much as possible. I don't sit unless I really have to, because I tend to slouch when I sit and this seems to tighten up my quads and IT Band. I have a standing desk at work and at home. When I watch tv or read I always try to lay on my stomach on my elbows, laying against a wall with a pillow behind me and my back in flexion seems to make my symptoms worse. I also sleep with a pillow under my pelvis/lumbar area which also seems to create less tension on the lateral side of my knee.

As a follow up we decided to tape my back to limit and remind me not to go into flexion, along with only doing McKenzie exercises over the next couple days. Nothing else that makes me feel better, like one legged rdls, etc. Just to see what happens. Since we couldn't illicit any change in symptoms during a one hour visit I'm hoping we can flesh out some of the things that contribute to my pain/tightness over a couple days. If it makes no difference we can go from there, but it's one avenue I haven't gone done before, so it's worth a shot.

Just wanted to report back, wore the tape since Wednesday, it definitely served to remind me when I was slouching. Did the McKenzie exercises daily and slept with a pillow under my lumbar spine. The tightness and irritation are basically non-existent when I really pay attention to posture. My IT band on the affected leg seems much looser than it's been in quite sometime. It feels un-natural how straight I have to stand up to stop the tightness and pain from coming back. I notice that when I'm standing my shoulders want to slouch forward if I don't pay extremely close attention, this results in a slight rounding of my back. If I notice the tightness coming back I immediately go into standing back extension and it seems to help.

I haven't ridden my bike or gone touring while trying to ride or skin with improved posture, but that's the next step. I've been told my posture on the bike needs improvement by one of the first bike fitters I went to, it's very easy to get lazy and let your back round on the road or mountain bike when you get tired. I'm sure the same thing happens while I'm touring, leaning over slogging up a steep long slope allowing my back to round. Same thing with after I'm done with a long ride or tour, I am usually exhausted and my posture probably suffers for it. Have my next appointment on Wednesday, so I'll be interested in what conclusions we come up with after this test. It appears that any exercise or posture that keeps me more upright and keeps the posterior chain tight helps my issue. Trick is going to be staying on top of myself and figuring out how to make some lasting changes.

[JTrue]

Went to go see the new PT again today, she thinks it's an issue with discs near l1/l2. The press-ups are definitely helping, if I feel tightness in my lateral knee I go do a pressup or standing back extension and am good to go for a bit. My IT Band is the loosest it's been in a long while when I palpate it. She gave me some additional things to work on, including some movements to target right between the thoracic and lumbar spine. Next step is to continue the pressups and other movements she gave me. Trying to continue to stay out of flexion and the movements that are keeping my symptomatic. She said if I can stay symptom free for a week we can start working on additional strengthening for my upper and lower back. I never target the upper back when I go to the gym. But exercises that have targeted the lower back have seemed to help in the past. She also had me practice keeping my transversus abdominis tight while doing bird dogs, which I don't think I've done before. She taped my back again to remind me about posture.

[bourbonisgood]

JTrue- glad you are finding the root of all this. I am not a certified McKenzie person, but I really like what they do. It's rare they I've ever found someone with ITB problems isolated from dysfunction in the spine (but I'm sure it does happen). Hopefully you'll be back to your previous level in no time - without pain!

[JTrue]

JTrue- glad you are finding the root of all this. I am not a certified McKenzie person, but I really like what they do. It's rare they I've ever found someone with ITB problems isolated from dysfunction in the spine (but I'm sure it does happen). Hopefully you'll be back to your previous level in no time - without pain!

The nice thing about the McKenzie approach is that they really listen to what's been going on and try to put everything together. Yeah I had some other legitimate issues that I think have been contributing factors, specifically weak glutes and hamstrings. However, the chronic nature of this issue after working on strength for a long time seems to point to my back and some movement patterns I need to change, especially since these extensions seem to drastically decrease tightness in the lateral quad/it band complex. I only once had the stabbing lateral IT band pain people talk about. My main complaint was the feeling of the lateral edge of my knee cap irritating the soft tissue underneath and constant tightness in the vastus lateralis, restus femoris, tfl, resulting in my it band feeling tight all the time, resulting in the lateral pull on my knee cap. I'll also be seeing a feldenkrais practictioner to assess me.