I don’t mean to get everyone depressed, but ITBS can be a hellish, enduring experience. Many people get over it quickly (like, three weeks). Some never do from what I’ve heard. Hopefully my cautionary tale will help people take it a bit more seriously than “I just can’t stop running.” Which may work for you, or some, but if it doesn’t, you’re really hosing yourself.
My experience: Hilly muddy remote trail race in the UK. Seemingly unrelated, at mile 8 I slipped and impaled my right hand on a gate latch, about 1/5” deep (and an inch wide…), almost all the way through my hand at an angle. Bled like crazy, I checked and surprisingly I didn’t do any tendon, severe muscle, nerve, or ligament damage. So I run 2 miles to the next aid station, washed it out, bandaged it up like a boxing glove, and, what the heck, kept going. Figured an extra few hours until the hospital wasn’t going to kill me.
Then, at mile 30, within literally about 10 feet of running, my knee went from totally fine to absolutely not being able to support my own weight on it when bent (as in: so painful my leg collapsed and I hit the ground). While that may sound more like acute trauma than an overuse injury, I’m not alone in it coming up that fast and hard. The problem now was I was in the middle of nowhere, with 5 miles to go, but I couldn’t pull out and wait for help: I had to get to the hospital for my hand (doh!). So I locked out my leg, and hobble-ran 5 hilly muddy miles on a locked out leg. Am sure that did my back no favors. Or my knee.
That brings us to Lesson 1: Pushing on with that injury probably REALLY screwed me.
That was 13 months ago. Here’s what I’ve done since then:
- Been through three different physical therapists
- Been to one chiropractor
- Been to my regular doc (who’s pretty good and knows ITBS)
- Done 10+ sessions of deep tissue myofascial release technique (many ITBS recoverees swear by it)
- Done 8+ sessions of Active Release Technique (many ITBS recoverees swear by it)
- Ice 3-5 times/day + ibuprofen
- Had an MRI
- Seen Dr. Michael Frederikson, _THE_ ITBS doctor at Stanford University health clinic. He sees the Stanford track team, and is the lead researcher on the initial scientific papers linking weak hips with ITBS. Also referenced here (reasonably good article): http://runningtimes.com/Article.aspx?ArticleID=3528
- After visit #3, Dr. Frederikson did an ultrasound guided cortisone shot.
- Did the exercises and stretched in the referenced Running Times article for, I dunno, a year now?
- Did multiple multi-month layoffs of running completely, followed by trying to run slowly. As in: start with TWO MINUTES of running, and add a minute every week.
- Tried those IT Band Straps (three different brands) and taping. No help at all (for me)
For the first 10 months or so, none of that worked. Then I finally found a decent physical therapist (probably part of it) and stopped running again (probably part of it). This PT, unlike most of them for whom I now hold little respect, actually did a gait analysis, decent measurements of all sorts of things I don’t understand, and came up with a bunch of issues that everyone else glossed over. Everyone else is like “Oh, you have a bad case of ITBS, you need to do X, Y, and Z.”
With that PT’s help (in my case a combination of realignments, additional hip exercises, a LOT of glute exercises, and VERY slowly returning to running… I’m now up to 2.5 hours for my long run and about 40 miles/week (to put that in context, we’re talking half my volume from before).
So my input to this is follows: Many may get over it quickly as they simply have a weak glute medius, or tight TFL, or something that is actually solved by the exercises/stretches as provided in that actually very good Running Times article. That’s a good place to start. Many may get over it simply by laying off running for a bit and starting back up. Many may get over it by some simple gait changes. But some of us have some little tweaks, weird weaknesses, stuck fibular head (me), misaligned hip (me), ridiculously off combination of super strong and super weak muscles (me), and the cookbook recipes do not work.
If you are having a REALLY hard time getting over it, you need to step back and probably do several things at a minimum.
- STOP running for a month. Lord, at least a month.
- Ice several times/day. I’d stay away from the ibuprofen though.
- Do ALL the strengthening and stretching work in the article above, PLUS
- Do glute work. Lots of glute work. One legged pistol squats. Romanian deadlifts. Lunges… lots of lunges of all different types.
- Find yourself a GOOD Physical Therapist who specializes in runners. They’ll all tell you they’ve worked with/solved ITBS. Because they all have. But they all haven’t had complicated cases and frankly if they don’t do walking and running gait analysis, they aren’t qualified to be telling you what to do for your particular difficult to solve case.
- Then, start running slowly. Here’s my example: running 1 min and walking 5 for 18 min (that’s three minutes total of running). Next week, run 2 /walk 5 for 21 min total. Next week run 3 / walk 10 for 26 min total. Next week run 4/walk 10 for 28 min total. Next week run 5/walk 5 for 30 min. Repeat that week for 3 more weeks. Then run 7 / walk 5 until 30 min. Do that for two weeks. Now run 8 /walk 5 for ~ 35 min. Do that for 2-3 weeks. You get the idea. Do that until you hit whatever your goal runs are; once I hit an hour of running, I was generally good to go. NEVER, EVER run if it even remotely starts to hurt, and if it does, go back to step 1.
Note: Items C & D may not be your issue, but they can’t hurt. Arch work? I dunno. Other stuff? Don’t know. I think it all depends on what YOUR biomechanical issues are that are leading to the injury. Thus, the good PT is kinda key or you’re shooting in the dark like I did for a year.