ITBS - Steroid Injection

talonraid

Barefooters
Feb 11, 2011
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I didn't find anything on this topic using the search function, so if it's been addressed here, feel free to point me to that thread.

I'm curious to get the Docs' opinion(s) on using a steriod injection to help in the treatement of IT Band Syndrome. Some of you may or may not have been following the various discussions about ITBS treatments in the other forums. I have been incorporating rest from running, stretching, strength training, ice, motrin, foam roller, etc. into my attempt at recovery, but I still have flare ups (now on runs of less than a mile).

Well, I guess I won't muddy the waters with any more commentary. So, what do ya'll think about using a steroid to help ITBS?

Thanks.
 
I'll toss a couple of cents

I'll toss a couple of cents at it. From what I have learned, an injury can turn a corner and become degenerative. I would think if things have gotten to this point in your case, while the steroids will reduce inflamation, it may not restore full normal working of the system. My worry, as a layman, would be that after the injection you may feel good enough to think everything is okay to return to activity only to realize later on that the problem was not addressed, and your leg could become worse than it is now. There is a definite issue that caused the problem to begin with. My last thought would be yes, do the injection, but find and fix the problem as well. :)

Speedy recovery! I am not a doctor, but I stayed at a Holiday Inn Express last night.

John T.
 
I agree with dunetraveller

I agree with dunetraveller 100%.

I know you're desperate and don't want to bag the hottest half but remember that this is not the last race, there will be another race next year.

You're are going to get over this bump on the road on due time...trust me.

It is better to fix the problem than to mask it. Continue to do what you're are doing and be pacient(sp?).

Don't be a sissy, put your big girls pants and deal with it the right way.
 
Dama!What the heck are you

Dama!

What the heck are you doing here? I think you're here to torture me some more.

First, I can't wear big girl pants with a kilt...it's ridiculous looking.

Second, this could be my last race. I might be killed by the jealous husband of some lady I help with her groceries next week. Besides, you know I'm kind of type A when it comes to running.

Third, I have no third, but it wouldn't do to cut this list short.

Fourth, I did go to the doctor today. A civilian this time and not the military sawbones. He assured me I didn't have ITBS beacause according to him the pain would be in the front of my leg on top of my quads....I didn't argue with him, I just said "thanks for your time." He did give me a referral for 3 weeks of PT and said maybe an MRI if it didn't improve.

For the record, I have continued with the icing, stretching, resistance training, foam roller, etc. I rode the stationary bike for an hour this morning and then did about 10 forty yard sprints afterwards. Sprints feel good on the leg for some reason.
 
I keep hearing that.  What is

I keep hearing that. What is up with sprinting making stuff feel better? I wonder what they science is there.
 
TJ,I have no idea why

TJ,

I have no idea why sprinting doesn't hurt, but Abide is the one who pointed it out to me. Since he mentioned it, I've seen it in a few of the hundreds of articles I've read. My pea sized brain would think sprinting would hurt more...but not so. If only I could sprint for 13.1 miles...
 
I've sent an email to the

I've sent an email to the docs for you, so one of them will be by shortly to answer your questions.
 
Great, thanks TJ.

Great, thanks TJ.
 
talonraid wrote:Dama!What

talonraid said:
Dama!

What the heck are you doing here? I think you're here to torture me some more.

Hahahaha, I am your worst nightmare I'll tell you that.

On another note, I don't know about you but for me biking makes my ITB worst but if you think is helping you then by all means continue. Do you have access to a rowing machine? that's another good alternative to keep you buff and all that.
 
Do you have any recommendation


Do you have any recommendations for how long the R in RICE should last? I've given breaks of up to 2 weeks and then tested the leg only to have the pain come roaring back. Most of my past injuries i.e. blisters, Achilles Tendonitis, muscle pulls only required a week or less time off. This answer to getting rid of ITBS is a bit of a conundrum to me.
 
Finding the biomechanical cause


Finding the biomechanical cause is the key.



I come back to this a lot as you can do the self assessment. ITBS tends to be caused by runners going lateral in midstance or excessive internal rotation at the knee.. So injecting and rolling ITB of little use to fix the cause. I’ve seen runners literally pull the lower ITB off the fibular head with aggressive rolling.



These injuries are degenerative too as mentioned above.



Really tough as always to see what you are doing and your issues of joint stability,mobility, and alignment.



http://naturalrunningcenter.com/2011/07/09/ask-the-experts-how-much-time-do-i-need-to-transition-to-minimalist-footwear/



if you cannot balance and stabilize in midstance running will be difficult and injury will occur.



The knee does what the hip and foot direct it to do….so to fix ITB you need to fix above and below. Weak Glut Medius can play in here. Need someone to really assess your kinetic chain.



Mark
 
talonraid wrote:I have no

talonraid said:
I have no idea why sprinting doesn't hurt, but Abide is the one who pointed it out to me. Since he mentioned it, I've seen it in a few of the hundreds of articles I've read. My pea sized brain would think sprinting would hurt more...but not so. If only I could sprint for 13.1 miles...
Funny you should mention that. I suffer from the ITB stuff as well and all I do is high intensity interval sprint training. I haven't had any issues with flare ups at all while training, but I just completed two big races (a tri and a 10.5 mi. steep canyon run) and both times my IT band gave me grief. That must be why my trainer has me doing only Tabatas and sprints rather than LSD runs. I'll be running a half marathon in a month and I'm seriously hoping to get all this worked out with mobility and rolling work.





I wonder if it has to do with the fact that you turn over much faster in sprinting so there's less impact with the ground?
 
Ive seen runners

I’ve seen runners literally pull the lower ITB off the fibular head with aggressive rolling.

Geez, Dr. Mark! That can't be good. It's important to note that we can overroll, so be careful out there, all.
 
The only thing I can think of

The only thing I can think of that might be helpful is to ask what kind of strength training you are doing. If the underlying problem is a muscle imbalance, and you're targeting already-strong muscles instead of the weaker ones, you could be undermining your recovery. I'm guessing that both the military doc & the civilian doc would have checked your muscle strength for imbalance, though. If they didn't, than your PT-ist will. Don't be afraid to push for the MRI if PT doesn't resolve it - unsolved chronic injury is worth any effort to fix.
 
Well, here's my attempt to

Well, here's my attempt to answer/address some of the questions above.

What am I doing to target strengthening: walking lunges, side lunges, dead lift, squats, lighter weight squats on a BOSU ball, leg press, leg extension machine, leg curl machine, abductor and adductor exercises, the exercises in a recent Running Times article http://runningtimes.com/Article.aspx?ArticleID=18359&PageNum=1 that Barefoot Gentile sent me. I'm also swimming 3-4 times per week doing both a flutter kick and a frog kick.

I'm also doing variuos stretches (which I don't know the names for) that target the glutes, hammies, quads, piriformis, etc.

I've never had any problems with my knees or hips when running in the past (shod or barefoot) and this entire episode sort of popped up with no warning at a time when I finally felt like my barefoot running was becoming very comfortable and effortless. No huge mileage increases. I was making gradual increases of about 1 total mile per week...not each run...total. The only thing I can think of is that I had done a run that involved a lot of hills, which I had not trained for, the day prior to my "flare up" and perhaps I irritated something on that run.

As far as the actual physical exam by the military vs. civilian doc. The military doc didn't touch me other than to shake my hand, but this is not uncommon with many military physicians. The civilian guy did a couple of things to test my knee stability and actually stated I had very strong and stable knees in his opinion for my age and history. Of course, he's the same guy that ruled out IT Band Syndrome because I didn't have pain on the front (top) of my thigh along the quads. I'm holding out hope that the PT will help.

I'm definitely trying to address the underlying problems and not just ignore them and look for a silver bullet. What prompted my original question is the video on the link below from Elite Runner's World. Maybe I should have posted this along with my original question. The doc in the video was very non-chalant about using a cortisone injection to get runners past a race. His statement is that it's into the bursa and not into the joint, so it really wasn't a big deal (I paraphrase of course). Again, I'm not trying to bypass any correction of muscle weakness or form issues, I was just curious if this might be appropriate to use in order to allow me to do an upcoming race, I suppose.

http://eliterunnersworld.com/itbandsyndrome





Edited: 9:16 Central, 2 August to correct reference from Runner's World to Running Times and add link to article.
 
Mark--Great article!! I have

Mark--Great article!! I have ITBS too. I did the tests on myself, and my flexibility seems to be fine, and I can do the toe-lift...but my balance leaves something to be desired. So I'll be doing the balance exercise a lot.

I'm embarrassed that of all the exercises my PT told me to do last year, that very exercise--balancing on one foot--is the one I have NOT done. :) I'll do it now!
 
Talonraid-A couple of

Talonraid-

A couple of thoughts on ITBS. I have been through it myself and it was no picnic. Was about 2 weeks away from having surgery on it and I am thankful to God it got better before having surgery. There are a few things that you might try other than steroids. I had a steroid shot. Helped for a while, but pain came back. Work on your gluteus medius muscle-hard. I don't know if you have already been doing it, but work on it religiously. Foam rollers are good, stretching is good, but ultimately the glut medius needs help most probably. As far as interventions go, PRP (platelet rich plasma) injections might be beneficial. It has shown promise with a host of chronic injuries. The physician spins down your own blood then injects the platelet rich plasma into the affected area. It has a host of healing factors in it and I think is WORLDS better than injecting steroids into anything. Ultrasound might be a helpful adjunt and you can pick up a personal ultrasound unit for fairly cheaply. See MendMeShop. Also, medical grade devices can be picked up used for a few hundred dollars if that happens to be burning a hole in your pocket, which in this economy is probably not likely. Prolotherapy is another out of the mainstream treatment that may have some role. I had that done to (in my friend's basement as a guinea pig...don't call the authorities. He is a licensed sports med physician). Takes a few weeks to work, but the idea is to actually incite some degree of inflammation because the inflammatory cascade brings with it factors that stimulate blood flow and the reason a lot of the chronic soft tissue injuries are hard to heal is because ligaments and tendons don't have as robust of a blood flow as other parts of the body. Ultimately, surgery can be helpful as a last resort. Just a few ideas that you may have already tried. Take it for what it is worth.



Jon