Knee pain, not sure if it's ITB... debilitating! Please help!

Jason--Might be ITBS. I

Jason--Might be ITBS. I started a thread on mine a few weeks ago. It's a LONG thread but has a lot of useful info in it. Click here to read it.

My IT band has been doing great (including on my 11.9 mile run Saturday, which was my longest ever.) I did have to go to an awesome physical therapist though. With all my at-home treatment I just couldn't get rid of it. The physical therapist did ART (Active Release Technique) on it 6 times over the course of 2 weeks. At his office I also learned more effective rolling techniques; they are BIG on trigger point therapy at that office. And he gave me specific strengthening exercises because my glutes/pelvis/hips have been too weak. I've also focused on my form. (See the Chi Running articles I linked to in my first post on that other thread.)

It's taken a lot of commitment on my part. Rolling twice a day, doing strengthening exercises 6 days a week. Plus the cost of all the appointments, which was substantial!! But so worth it. I'm all about treating myself at home when I can, but my ITBS came and went over a period of 9 months. I knew it was time to get a pro to help, and thankfully I was able to go to someone very experienced in treating runners.

Jason, I consider myself

Jason, I consider myself completely recovered from ITBS that I got after my last marathon in June. You most certainly have ITBS. Here's what worked for me.

First, what worked best for me was to continue to run...but to cut my mileage to less than 1/4 of what I was doing. Running loosened up my IT band, and helped take the pain away. The key there is that the exact second I felt pain, I stopped and walked. DO NOT run through the injury. The more you run through the pain, the worse it will get. I did this, and I ended up going from max long run of 20 miles...to 14 miles...to 6 miles...to 3 miles. You will end up not being able to run at all if you push it.

I think it's a good idea to go to see a professional like C.Beth did. I did this as well, and learned that my ITBS was caused by overstriding in my VFFs, coupled with a weak glute muscle on my left side (which is where my ITBS was). The overstriding I cured by staying away from my VFFs and only doing barefoot runs. I also did several strengthening exercises, which didn't improve my symptoms, but have prevented any pain from coming back.

Finally, in my opinion stretches are worthless. In the beginning they did help my take some of the pain from IT band stiffness away because my IT band was REALLY tight. But actually what worked for me more was to NOT stretch the IT band at all. The reason, at least for me, is that all IT band stretches put your knee in a locked or hyperflexed position. This ends up aggravating my IT band right around my knee, and thus makes my IT band stiffer.

On the other hand, a foam roller is a great investment. You need to break up the scar tissue around your IT and help loosen that muscle up...because it's too tight right now.



Hope this helps! We've been there man. You're going to get through this!

I've been hesitant to admit

I've been hesitant to admit this, but since saypay already did...

I don't generally do static stretches anymore. I'd heard and read about the body of research, which is at best contradictory, and at worst supports the idea that static stretching hurts more than it helps. I have been focusing on rolling, which my PT considers a form of dynamic stretching. (He supported me totally when I hesitantly told him I don't do static stretches anymore.)

Could future studies end up giving overwhelming evidence that static stretching is good? Sure, they might. But they also might give overwhelming evidence that static stretching is useless or harmful. Who knows? I just know that rolling works wonders for me, and static stretching hasn't had the same effect!

Let me take a minute to give you more details on what my PT teaches. I'd been using my foam roller at home before seeing him, but his techniques have been more effective for me than what I'd been doing.

For the quads/IT band:

• You'll start facedown with the roller just above your knee on the front of one leg. Other leg can be bent, off to the side.
• Roll up until you find a tender/tight spot. (At first they may ALL be tender/tight spots!)
• When you find that spot, stop. Make sure your upper body is low to the ground, and hips low too. "Pulse" your leg 2-3 times by bending it at the knee, bringing your foot toward your butt. This "pulsing" action is what seems to really help dig in there and loosen things up.
• Move on, and find another tight spot, and pulse again. Keep repeating, up to the top of your leg.
• Now repeat all that working down your leg, in between the front part of the quad, and the IT band. (If your leg was a clock, you'd start on 12, then moving over maybe halfway between 1 and 2.)
• Once that second portion of the quad is worked, you can work the IT band. You'll be on your side for this one, with your top leg stabilizing you on the ground if needed. Work up from the knee toward the hip (but don't go all the way to the hip bone!) The process is the same--when you find a tight spot, pulse that leg 2-3 times, and move on.

I'll warn you, when I very first started foam rolling, the pain was so bad that I was reminded of natural childbirth. (Not joking here!) I was really, really tight. It does get much better, very quickly!

I think my most recent bouts with ITBS were caused a lot by tightness in my piriformis & glutes too. It's hard to work that effectively with a foam roller; instead they had me use a tennis ball or massage ball.

They originally taught me to work the piriformis (which is about where your pants pocket is) by sitting against a wall, both knees bent, with the ball under my butt, finding a tight spot, and then stretching out my leg, pulling it back up, and then moving my bent knee sideways 3 times toward the ground. Don't "roll" to find another tight spot; lift your butt and reposition the ball. Unfortunately my butt's little and bony and I couldn't work it well that way; the ball wouldn't stay in place! So I work my piriformis in the same way they taught me to work my gluteus medius, which is...

• Lay down, on your back, knees bent, feet flat on the floor.
• Put the ball under one side of your butt.
• Find a tight spot in the gluteus medius (which is about where the TOP of the pocket of your pants is.) Pulse that knee sideways towards the floor 3 times. You'll feel the ball digging into that tight spot, loosening it up.
• Move on to another spot, and repeat.

I hope this all makes sense. My PT had to stress to me--DON'T spend a long time rolling. It can hurt you if you're hanging out for a long time on one area! Each tight spot should really only be worked for a few seconds. (One book I have says 15-20 but they taught me to be even faster than that at the clinic). You can roll as many times a day as you want, but each rolling session should be short. My PT suggests when rolling the quads/IT band not to spend more than 3 minutes on each leg. And when you're dealing with issues, make sure you're rolling at least 2 times a day. He suggested I do 3 times a day on my long run days. Always roll before a run. You can roll after a run if you want, but my PT suggested that I cool down first. And roll before bed.

I'm glad it helped, Jason....

I'm glad it helped, Jason.... Be sure to report back on how you're doing!

Bummer, Jason--maybe over the

Bummer, Jason--maybe over the holiday break you can get in some walks? Also I've started doing the run/walk thing...right now I'm doing 5 minutes run/1 minute walk. I'm actually faster overall (since I can push speed on my runs) and it also gives my IT band & surrounding muscles a chance to loosen up every time I have a walk break. I think I'll be doing most of my runs in this manner now...not because I NEED to walk but because the walk breaks seem to be making me a better runner.

Hey Jason, I don't know much

Hey Jason, I don't know much about your history but if you are just starting to do burpees, proper squat form is crucial and tends to get neglected in these. Read up about it and make sure you don't get lazy because the burpees are kicking your ass. I notice if I let my form get away from me my knees start hurting, which they rarely ever do otherwise.

Interesting.. I have had ITBS

Interesting.. I have had ITBS for a while and never really understood what it was until eight months ago, when I started running and researching it. But I also have general "knee pain" for five years.

Years back I would simply go for a hike, and on the way down I would get ITBS pain in the left side, over the next day or two it was gone. This was when I was a little overweight and wasn't that active so it didn't bother me. When I turned 30, I started getting knee pain on the right knee. I then started working out more and more, lost about 40 lbs, pain was still there.

After MRI's, a cortisone shot and Doctors telling me there was nothing wrong in my right knee, I finally got VFF's after dealing with the pain for about 5 years. A few months into having VFF's, now biking a lot more and starting to run, the pain was way less!! Yeah!! I also learned about "Movie-Goer's Knee", which is when you cross your legs, I apparently suffer from this. I cross my legs when I sleep, sit on the couch, work, etc, and after a while the knee pain kicks in... I learned this basically on my own (I started listening to my body and putting 2 and 2 together).

Then, I started getting more serious about my health, and went out on a 52 mile bike ride one Sunday morning; ITBS kicked in and I could barely walk for a week. My previous rides were maybe 25 miles... Increased mileage too soon... Learned about this later on.

Running... I started from 1 mile, and added 10% a week... then after getting 4 miles in I said "Ehh, I'll go to 5.5 miles.." WRONG. At mile five I got ITBS, ran through the pain, didn't know what it was... Stupid me. Did this a few times, mileage seemed to be getting worse and worse.

Learned about foam rolling, stretching, icing, Rolfing (you think foam rolling hurts?? HA!), bromelain pills (comes from the stems of pineapples and helps with inflammation), the IT Band strap, and finally KT Tape. Nothing was helping, except for the strap and the tape. I did a 13.1 mile trail run and around mile 9 I stopped running from all of the pain, and power-walked the rest. But keep in mind without the tape and strap, I could barely get a quarter-mile in without pain.

Here's the interesting part.. I took about a month and a half off from running, biking, spinning, leg workouts, etc, because I felt like all of that was keeping the ITBS alive. I did lots of stretching, some yoga, and kept researching. Seems like (for me) that the GLUTES and the TFL are huge contributors with ITBS. And..... with the month off, my right knee pain was slowly coming back (Jason, you mentioned something about this and that's what triggered my reply).

Now, I have been taking "Dr Miller's Joint Repair" (MSM, Chondroitin, Glucosamine, Shark-Cartilage, etc) and I think its helping... but I think working out with proper form and not overdoing it or increasing mileage too fast is key. For me at least... Also have been getting ultrasound from my Chiropractor, along with corrections, a couple times a week. We also learned about the glutes and TFL because when pressure is applied in those spots, the pain in my ITBS kicks in BIG TIME. Using a 6 lb medicine ball and sitting on that is key for my glutes; use it like a foam-roller.

When I am not working out, the general knee "aches" come back. When I think I am Ironman, I get ITBS. Need to take it easy, little by little, learn to listen to your body (I didn't!)...

When I get home I will link up a few hip/glute workouts that I have encorporated into my routines and hopefully it will help. Also, wearing the IT Band strap daily (this past week) has shown to be a huge help in keeping the ITBS away. At work I walk around to user's PC's, and I get a few miles a day in of walking... Wearing the strap has helped. Now I am just running about 0.3 miles and working my way up SLOWLY, with the strap, completely barefoot. And this is why I just joined this site....

Bad running form is a major

Bad running form is a major contributor as well. Are you keeping your legs bent while running and never moving from the same bent position?

After 18 years I finally learned to run the right way (and it wasn't from running barefoot). You should literally be 5 inches short than you are standing while you run, that's how much knee bend you want. And you keep this knee bend through the entire rotation never once straightening your leg.



I had IT issues, and it was all due to weak hips and bad running form.

Adam, are you leaning forward

Adam, are you leaning forward at all? I am trying to picture what you are describing.... I do think my legs straighten out while I run, maybe I need to crouch a little to bend the knees more.

 I lean very slightly, or

I lean very slightly, or sometimes I don't lean at all. I will lean a bit when I run faster than my normal pace, for example, when I do a tempo run.

If I do lean, I will try to lean with my ankles, not the hips. Picture you have a rope tied around your hips and someone is pulling you, really try to keep you hips forward as you run.

I really have been trying to adjust my form within the last two months. I have read from a few sources that a nice continual knee been relieves alot of stress from the IT band. It does feel strange at first but the more you do it, the more comfortable it gets. A nice bend also decreases the impact of the calves as well.

Yes crouching is exactly what you need to do. Just stand up straight bend at the knees, keep you the back and hips straight, then just starting running, trying to maintain the crouch and the knee bend. I know the POSE Method really enforces a knee band, there are a couple of drill video's out there to better describe this.

I think you are onto

I think you are onto something, Adam... I just went on the Arc-Trainer and if I stood tall, I felt like there was tension in my IT Band. I then lowered myself (at the knees) and my legs felt great...

This got me thinking about my mountain bike... when the seat was so low that everyone said it was too low, my IT band was fine. Heck, I even went out for a jog and had ITBS BAD, and then hopped on my mountain bike (with seat super low) and the ITBS went away. But, after a "bike fit" and getting the seat jacked up to where it "should" be, ITBS kicks right in - now that my leg is fully extended. And maybe that is why my road bike has always given me grief, since the seat was raised up since day one.

I did a quick barefoot jog yesterday, trying your "lowered" stance method, my ITBS felt fine but I certainly felt weird crouched down like that. Definitely something that needs to be practiced and gotten used to, I guess.

More good IT info.  This

More good IT info. This worked for me, and Running Times (unlike Runner's World) is more about running and less about selling stuff.



http://runningtimes.com/Article.aspx?ArticleID=3528



http://runningtimes.com/Article.aspx?ArticleID=6099&PageNum=&CategoryID=

What I am finding is that

What I am finding is that I have to stay SO vigilant on keeping everything loose, or it tightens right back up. It's like it's in the habit of being tight and I haven't yet "trained" it to stay loose. I didn't do much rolling for about a week while on vacation...and SUFFERED for 3 runs because of it! Thankfully, since my physical therapy a couple of months ago, and what they taught me about rolling, when it does get tight again it's usually worked out pretty easily. (Last Saturday I had to keep walking during a 5K due to my ITBS; today I did 13+ miles with just some occasional stretches during the run. So this week's rolling worked!)

I'm learning that I can't let up on the rolling just because it's feeling better. I need to keep rolling frequently for quite awhile, until those muscles are used to staying loose.

P.S. Great articles, Ken! My

P.S. Great articles, Ken! My PT has me doing strengthening for my glutes, as the first article says. It's good to know I'm on the right path there. Also, the 2nd article is very helpful; I found it when I first had ITBS many months ago. Stretch #2 is the one I LOVE and I have lately been doing it during my walk breaks when I feel tight. It helped a ton.

I recently had a sub fill-in

I recently had a sub fill-in for my chiropractor while he was on vacation, and she brought some "Tools" with her on my 2nd visit after we talked... it was called Graston, and I honestly think that has helped the most.

I also found this site with a ton of videos on ITBS:

http://gabrielbur.info/index.php?key=Iliotibial

That is great! let us know

That is great! let us know how your run goes and lets keep our fingers crossed...or shall we say toes?