IT Band issues

[Michael Gartman]

Two trips into my 2014 backpacking season, and I am having IT Band Syndrome in my left outer knee. Starts after I get going on a downhill, and then gradually worsens. Within minutes of quitting for the day, the pain goes away (which I am very thankful for). While it's happening, every time I lift my left foot off the ground while pushing off, it feels like knife being stabbed into the side of my knee. Not when stepping down, when lifting up.

After googling and finding out with a fair bit of certainty that it is my IT Band, I know I need to do several things: exercise my legs to strengthen all muscle groups down there to bring them into balance, do some foam roller and stretching exercises, and rest up the knee for a while…luckily I have 2 weeks to rest before my next trip.

One thing I don't find addressed much in my web search is the role of shoes/boots/etc in this process. I am wearing Oboz Yellowstone boots right now, and am wondering if trying a zero drop trail runner, or some other type of trail runner or hiking shoe as opposed to a boot, may also be of benefit.

Any input is appreciated!

[Randy Martin]

You are right on with the exercise to strengthen (squats and lunges) and foam roller, not really sure about footwear playing a role. I had the same issue a few years ago and the primary solution was strengthening of my legs.

[Greg Mihalik]

" I know I need to do several things: exercise my legs to strengthen all muscle groups down there to bring them into balance"

Others (Professionals) will chime in, but until then this will provide some background …

Not just "down there". More than likely it is 1) your right side glutes that are not stabilizing your hips, and 2) a long stride that exacerbates the situation.

ITB Stuff

Exercises (except the single leg squats)

AND, shorten your stride. Quick short steps. (Not reaching out with your heels.)

I'm Not a professional. But, been there done that. But these links got the job done.

YMMV.

[M B]

My experience:

Overuse, ie too many miles not accustomed too, results in some tendonitis or muscle strain somewhere in the leg. This causes pain, and makes a muscle limit its firing. Once this happens, a really significant muscular imbalance will exist that then leads to all kinds of bad things. Other muscles become even more overworked and can begin to have the same issues with muscle strain and tendonitis. The kneecap can quit tracking properly.

I not find it to have much to do with absolute strength. Why? Because I have lifted weights for 25 yrs and work my legs good and I still experienced it once. It also doesnt make sense that it does because your muscles are not working anywhere near maximum recruitment for walking. They only fire as much as called upon to. Otherwise we would all punch ourself in the face when we lifted a glass of water. My point is, there are other reasons a muscle can not adequately do its job besides strength, and overuse is one.

What I did experience, was muscle soreness that started in my shin under my kneecap from overuse (consecutive ~25 mile days), after several more days I couldnt bend my knee and the ITB was painful too. I limped 40 miles to finish that trip. I observed my own progress in stages from slight soreness on downhill under my knee, to the point I was wondering if my knee was damaged. I could barely take a step at the end of the day a couple of days, and could only go uphill walking with stiff leg and pulling with my glute. In the end, I knew it wasnt serious because there was no swelling, so I knew it was all tendonitis or muscle strain issues from overuse.

My fix: Start running again and do other plyometrics to condition tendons to increased loads. In conjunction with stretching and foam roller while ITB healed.

Tendons around knee were sore at first,had to layoff several days after a workout like that. After several months, no pain, they have adapted to increased loading and I had zero issues on the last 60 mile 3 day hike. In general, my knees feel better than they have in some years.

Strengthening muscles however, also does strenthen and thicken the tendons (slowly) , which makes them less succeptible to issues.

[Anonymous]

"Any input is appreciated!"

Cut to the chase and PM Jennifer Mitol. She has a PhD in physical therapy and is your best bet for getting useful information. Don't delay dealing with this one. ITB problems at the knee are devilishly hard to get rid of once inflammation sets in and scar tissue starts to build up where the ITB goes over a condyle(can't remember its name) just above the knee joint. Personal experience talking here.

[David Chenault]

Michael, it sounds like you're on the right track. I'd add one thing based on personal experience: don't hesitate to stop, now, if you think it best. IT band inflammation can linger for a very long time. Better one trip missed now than 3 trips missed because you can't hike for three months if you push it.

[W I S N E R !]

Dave C. makes a very good point that my matches my experience. I suspect that constantly pushing without rest stretched my ITB issue from weeks or months into a year. Every time I thought I was "well enough" to do something, I'd go and aggravate it…one step forward, two steps back.

[Dave G]

Michael,

I suffered with this problem to various degrees, for several years in the past.

Greg's links have some excellent information, I would personally substitute exercise 4 in the Fredricson protocol with "Walt Reynold's ITB Special" as shown here:-

https://www.youtube.com/watch?v=SE7uUVhMVkQ

Probably best to let the inflammation settle for a few days (Rest, Ice) before starting rehab.

Also, if you're standing, don't get into the habit of standing on one leg and dropping the opposing hip, this switches off the stretch reflex in the Tensor Fascia Latae, so your hip drops when walking/running and puts your hip/leg in the biomechanically disadvantaged position which causes this sort of pain.

Disclaimer – I have no formal PT qualifications.

Hope you recover soon, but even if you do, probably best to include this sort of protocol on an ongoing basis, or at least for a few weeks before the start of your season.

Dave

[Greg Mihalik]

"Prehab"

+1

Don't stop the strengthening just because the pain goes away ….

[Lisa Frugoli]

I also had an IT problem that started on the trail. Turned out it was my everyday walking to work shoes. The running store fit me in stability shoes and I have a neutral foot. Caused just enough stretch in the IT band to be an issue under the stress of a pack.

When doing IT band stretches, find the ones that you feel. What works for me may not work for you. Any stretch that moves the knee across the mid-line of your body is what you want. Also, strengthen the abductors (outside of the thigh).

Foam rolling also helps. Go really slow & steady. Hold the knots for 30 seconds. It hurts like heck at first!

May take a while, but you'll work through it!

Lisa
NASM Certified Personal Trainer

[Nicholas Viglione]

My two cents for what it's worth…

I was a competitive track runner all throughout high school and college, racing mainly the mile, but averaging 100 mile running weeks nearly year round. I was extremely durable, almost never injured, and certainly never any ITB problems. Fast forward 2 years out of college, running less but lifting a lot more, I developed serious ITB syndrome out of seemingly nowhere. Leg work did nothing, foam rolling was a band-aid at best and the pain returned shortly after. Stretching did so little it was laughable.

After nearly 6 months of this, I was running with a good friend of mine who just so happened to be a physical therapist, when he remarked, "Niko, your shoulders are all out of whack… they're seriously messing with your stride". I stared at him rather bemused as he continued to explain. Apparently, because of the upper body lifting (namely military press and pull-ups), my right shoulder was tight and therefore carrying higher than my left. As a result, my right leg was having to stretch incrementally further to strike the ground than the left, which was causing the imbalance which was causing the ITB pain.

Post run he had me lay down while he stretched my shoulders and worked out the scar tissue around the ITB. He advised me to continue to stretch my shoulders pre and post lift to maintain mobility (I took up heavy bag punching to help as well). Lo and behold, I ran pain free again the next day, and every day since for the past 4 years. I would absolutely recommend going to see a professional and getting a true diagnosis of what is causing it – often times pain isn't located at the root of the problem.

[Michael Gartman]

I would like to thank each of you for your input! Lots of great information and personal anecdotes.

This morning, I went to my chiro, who is a sports trainer as well, and explained the pain to him. I told him I was pain free since I stopped hiking Saturday…He had me lay on a table, and pushed on a spot, and I almost came off the table..lol Apparently, not pain free at all. Anyway he manipulated it a bunch of different ways, used a roller, etc, and then iced it with stim. I am going back tomorrow for more treatment. He said it was definitely my IT Band, and attributed it a lot to a lack of support for the lateral longitudinal arch in my left foot, so that it remained more stable. He also said it sounded like I did too much steep downhill hiking on my first two trips, and my legs were not in condition for that after so much time off during my CPA busy season. Anyway, I will try to pry more info out of him tomorrow about what he recommends other than shoes with better support. I am going to take my boots tomorrow for him to see. They are Oboz Yellowstones, with the stock insert, but also have an extra insole that a guy at REI put in for me to make the boots fit tighter (I bought a half size too big at another outfitter, and they were a little loose).

I am definitely going to incorporate some of the above suggestions about strengthening, stretching, and foam rolling my legs. I am also going to try to change some of my upcoming trips to be a little less brutal as far as elevation change over short distances goes. We have a trip on the first weekend in June to hike Tinker Cliffs and McAfee knob North to South, and that has a pretty steep downhill from McAfee Knob to the Catawba parking lot, so I may cancel that trip.

Thanks again!

[Paul McLaughlin]

My personal experience with ITB fun:
For me it was all about stretching. The PT tested my leg strength and said that was not an issue. Tightness definitely was. So stretching after exercise was the key to improvement for me. Also, The tightness of the ITB put pressure on a bursa sac on the outside of my knee so I had bursitis; and the inflamed and swollen bursa put pressure on a nerve so I had the sensation of liquid running down the outside of my leg – I kept thinking I had cut myself and was bleeding (working in construction, not an unlikely scenario).

Mine still flares up occasionally when I sit too much (office work) and do not walk enough.

[Michael Gartman]

IT Band areas had no pain when rolled. Outside upper calves both had pain when rolled, up where they connect to knees. Quads hurt just above knees, directly in middle.

Not sure what any of this means! Lol

[Michael Gartman]

OK, so I go back to the chiro today and he digs both heels of his hands into the IT band while I am lying down, and proceeds to slowly work his way up from my knee toward my hip, and I swear I almost levitated from the pain!

Anyway, my question centers on shoes…has anyone had relief just from switching to trail runners from boots? I am just curious. Even though I wore my Oboz boots last year with no pain in my knee, I am wondering if a lighter, less rigid shoe might help now. I did go by the local running store and bought a foam roller, and talked with them a little about ITBS. They did analyze my gait, and I am totally neutral in both feet, so they told me if I did get trail runners, to make sure they weren't "motion control" shoes, but instead to get neutral shoes.

[Phillip Asby]

I think the difference between shoes or boots is less key than making sure you are wearing the right support. I wear a neutral shoe and once bought a pair of support shoes – didn't know I was neutral at the time – and almost immediately had knee pain.

Got my stride analyzed – went to neutral shoes and that has helped tremendously with ITB syndrome.

[Rick Adams]

I've dealt with this mostly from being desk bound. I bought an IT band strap for "runner's knee". Problem solved. I bring it on every hike though haven't had to where it in a long time. Have made an effort to walk more often and shorten my stride.

my layman's understanding of the problem is that the tendon becomes inflamed from rubbing against other part(s) of the knee structure. The strap eliminates the rubbing of the IT band against whatever the culprit is. My experience is that the fix was immediate (after the inflammation subsided over night).

[Greg Mihalik]

"… the problem is that the tendon becomes inflamed from rubbing against other part(s) of the knee structure."

Nope.

See the "IBT Stuff" link above.
Well, actually, Read the material in that link.

[Anonymous]

"Nope."

Yup, actually.

http://emedicine.medscape.com/article/307850-overview

I supply this link only to buttress the following personal experience . I contracted exactly this syndrome back in 1986, when I was running a lot of intense mileage. All attempts to rehab it over a one year period failed, and I ended up having a surgical procedure to "release" the ITB where it passed over the lateral femoral condyle. The procedure was an outstanding success as far as I was concerned, because I was back to running in less than 2 months. Although I never returned to racing form, I was still able to run decent mileage at a decent pace, more than sufficient to keep me in condition for climbing and other mountain activities.

[Greg Mihalik]

Nope.

"We've seen how IT band is an often-misunderstood running injury. The common conception is that the IT band is analagous to a thick cable which is irritated due to friction between the band and a bony protrusion of the femur just above the knee. From this point of view, the most logical treatment options are addressing the inflammation and irritation on the outside of the knee. But upon examining the scientific evidence, we've seen that it's anatomically impossible for the IT band to "slide" back and forth across the femur."

In 1986 no one was even thinking about the science of ITB issues, only what sort of surgical procedure might be possible.

In 1986 two ortho docs recommended "releasing" my quadriceps lateralis from my patella to stop my knee pain. I declined.

"Releases" certainly can make pain go away.

[Rick Adams]

The science may in fact be bad, but it sure worked well for me. It could be a simple and inexpensive solution to the op's problem. No harm in trying.

[Anonymous]

"Nope."

Did you read the info in the link I posted above? It was published in 2012, not 1986. I don't know where you are getting your information, but the information I pointed you to is from a legitimate source, and in line with what they diagnosed me with back in 1986. The physiatrist who diagnosed my condition was, and is, very highly regarded, and only referred me for surgery after exhausting all other options. Oh heck, just do a Google search of: iliotibial band syndrome AND lateral femoral condyle. You'll find a whole list of articles by medical professionals that attribute the cause to friction where the ITB passes over the lateral femoral condyle.
It is highly unlikely that they are all wrong.

""We've seen how IT band is an often-misunderstood running injury. The common conception is that the IT band is analagous to a thick cable which is irritated due to friction between the band and a bony protrusion of the femur just above the knee. From this point of view, the most logical treatment options are addressing the inflammation and irritation on the outside of the knee. But upon examining the scientific evidence, we've seen that it's anatomically impossible for the IT band to "slide" back and forth across the femur.""

Source? I confess to initial skepticism when someone refers to the lateral femoral condyle as a "bony protrusion", but I guess that's just me being picky.

"In 1986 no one was even thinking about the science of ITB issues, only what sort of surgical procedure might be possible."

As I said above, the doc who treated me was a well regarded physiatrist, and only recommended surgery as a last resort. Rehab docs take it personally when they have to refer a patient to a surgeon. It's just not in their professional DNA.

"In 1986 two ortho docs recommended "releasing" my quadriceps lateralis from my patella to stop my knee pain. I declined."

I thought we were discussing ITB syndrome. ;0)

""Releases" certainly can make pain go away."

They can also restore functionality. I had difficulty going up and down stairs prior to the procedure. After it I was running within 2 months. Q.E.D.

[Dave G]

Having read both of your links, Greg's explanation of the mechanism of injury is definitely a possibility, Tom's is "accepted wisdom", but really, whether the ITB is inflamed over the lateral femoral condle because it's (1) compressing a fat pad or (2) rubbing over a bursa, the symptoms and treatment would be the same, so no need to argue.

With the greatest respect for both of you,

Dave

[Anonymous]

"but really, whether the ITB is inflamed over the lateral femoral condle because it's (1) compressing a fat pad or (2) rubbing over a bursa, the symptoms and treatment would be the same, so no need to argue."

Well said, Dave. But I have to say that as arguments go this one was pretty civil, and possibly even contributed to a better understanding of OP's concern. Greg and I are both cursed with the snark gene, but it didn't really express itself in this conversation to any appreciable degree. Thanks for keeping it that way. ;0))

[Delmar O’Donnell]

To all:

Very much appreciate this discussion, learned a lot. Add me to the unhappy club of tight ITB owners. Think I'll cope better after digesting this thread. Thanks all.

Question about the band strap: is that a short-term solution to cope until you get stronger/more flexible, or can it be used long-term?

[Author]

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