IT band - SOLVED!!

[RyanH]

Superdx, I'm doing the same, full core regimen for the next month. What are you doing for workouts?

@mr4fox
I decreased my stance (q-factor). Pronation could be an issue as well as saddle height.

I dropped my saddle 4cm which put it to a slightly ridiculous level of almost level with the bars on Sunday with the theory from a slowtwitch thread about avoiding the ~30* angle where the ITB goes over the nub in the knee. I was able to ride 15 mi without stabbing pain, but I had ITB tightness around mile 10 so I cut it short. Interestingly, a muscle situated near my calf became very sore afterwards.

There's now some a glimmer of light at the end of the tunnel so the next step is to seek out a bike fitter that can work with me on position and then as I (hopefully) recover, begin getting my position back to a more race like position.

[superdx]

I'd suggest staying off your bike until you get a couple weeks of the strengthening in, no point aggravating it further especially when the strengthening is supposed to align the back muscles.

The PDF contains are the exercises that my physiotherapist has recommended me. I really have no strength in lower back and hips, so not sure they are appropriate for you.

It takes me about an hour to go through them, and frankly I'm quite beat by the 45 min mark that I can't do the full reps. Really need to keep it up. But I can feel that is having an effect on the ITB. There's pain but it's not debilitating pain that you get from cycling. More like "this is an improvement" pain.

https://dl.dropboxusercontent.com/u/138 ... ndrome.pdf

[superdx]

I'm about 3.5 weeks into the strengthening exercises, 1.5 hours 3-4 times a week. Physiotherapist recommended I cut it to 30 mins, but doing it daily so there's no need to "recover" from the routine. I'm not feeling any pain anymore from sitting or getting out of my car (no idea why this causes so much pain). I can still feel that the ITB area is not the greatest. There's a 13km charity bike ride this Sunday, and it'll be the first time I've been on bike in over a month. Here's hoping I can complete it without debilitating pain.

I'm still struggling to figure out how it migrated from the left knee to the right knee, and with significant increase in pain to boot.

[Mr.Gib]

superdx, Just like you, my ITBS suddenly flared up in my left leg while I was in therapy/rest/recovery mode for the right leg. Read my post again on page one. For some people ITBS is inevitable. Go ahead a try conservative therapy but don't fear a surgical solution. I was told some of the Kenyan distance runners are having the surgery just to avoid having to deal with a flair up close the Olympics or world championships.

Some people get lucky and a simple bike adjustment is all it takes to solve the problem. But if the knees are healthy, riding a slightly improperly fitted bike should not lead to complete debilitation.

[superdx]

So 3.5 weeks of core really didn't seem to make a big difference. ITBS on the right knee is still flaring up pretty bad, even after just a light ride.

I'm going to see a 2nd physiotherapist and start looking at surgical solutions because this is going nowhere.

However, if the cause of ITBS really is in the hips/glutes then I don't know what good surgery is going to do. The fact that it migrated from left leg to right leg seems to indicate that the knee is just a symptom. Maybe hip surgery?!

[mr4fox]

I'm curious to know if your knees caps track in a straight line up and down when you pedal?

[superdx]

Yeah they do line up straight. We did a video analysis with an iPad app that draws lines for athletes.

[Mr.Gib]

However, if the cause of ITBS really is in the hips/glutes then I don't know what good surgery is going to do. The fact that it migrated from left leg to right leg seems to indicate that the knee is just a symptom. Maybe hip surgery?!

Hip surgery??? Don't even think about it!!

It doesn't matter what the cause is. What matters to you now is the solution. The source of pain is inflammation of the bursa-like tissue under the IT band adjacent to the lateral femoral epicondile. The nerves in this tissue transmit a pain message to the brain that is completely disproportionate to the injury. Remove this tissue and presto the pain is gone and cannot come back.

Even if the hips, glutes, etc. are tight, your symptoms may simply be from how your IT band travels around your knee or the shape of the bones in your legs, or the nature of your bursa-like tissue, or how your nerves work, or how your brain receives pain messages. No doubt there are some who have a flare up of ITBS, do a couple of glute stretches, etc. and never have a problem again. However, the fact that you have been fighting this for months and not got the slightest bit better tells me that you solution is surgical.

In the past surgical techniques consisted mostly of cutting a piece (resection) out of the ITB where it crossed the femoral epicondile. Some surgeons even shaved the epicondile (don't do this). Success rates were decent. More modern technique involved the resection plus removal of the bursa-like tissue underneath (excision). Result were effectively 100%. Recently a surgeon in Belgium did 32 surgeries where only the bursa-like tissue was removed and no resection was conducted. Result were 100%. (This last technique was arthroscopic which meant superfast recovery. All others are open surgery.)

I had the resection and the excision on both knees 5 months apart. Pain for 3 days, limping for week, on the bike in 4-6 weeks. Going 100% in 10-12 weeks. Done.

[superdx]

That's really useful information, I'll look into it after my trip at the end of May, as I do need to be able to walk around during those couple days! I plan to take my bicycle as well, hopefully can do at least 2 rides before ITBS knocks me out.

I also found some straps on Amazon (PattStrap?) that apparently restrict the movement of the ITB so it doesn't cause as much pain, apparently it's very effective for the majority of the reviewers who left a comment.

Right now the right knee is pretty painful even just walking around, so I'll give it a rest for about a week before starting up core + foam rolling. Foam rolling seems to help a lot, but I think I twisted my elbow on the first couple tries. Now I have to wait for THAT to heal, f***!

[Mr.Gib]

Pat strap might work for walking - doubt it will work for cycling.

If your have pain just walking around you're screwed for a while.

[superdx]

We tried a PattStrap hack last night. My physiotherapist brought a bandage-like wrap and applied it around my knee. Then he rolled it upwards so that it was super tight. This is actually the correct "medically" approved way to apply this in the field for runners who get injured mid-race or something like that.

Man the pain from the rolling was indescribable. Leg hairs were literally being ripped from my leg! I was literally doubled back over in pain. Don't know how women do this. I would have gone with a razor..

Anyways, it was on super tight, much more tightly than a PattStrap or any kind of similar device. We went for a 24km ride, and wow. No ITB pain. The strap was pretty painful itself, and this morning I think there's still some soreness from where it was strapped on. But aside from a slight discomfort (literally 1%) in the ITB area, I'm not feeling anything at all. It seems to have worked.

Obviously rolling up this bandage isn't a workable solution every time I go for a ride, and I'm not a big fan of shaving my knees just for this. The PattStrap and two other similar bands will arrive next week from Amazon and we'll see how those work out. But, I was almost in tears after the ride yesterday. I was able to walk normally, there was no ITB pain and hopefully I can ride my bike at the end of May when I visit Japan!

[RyanH]

I seem to be on the other side of this now. I think I would have been riding back in February had I:

1) Taken 6 weeks off
2) Did the exercises everyday.

Last week was my first week on the bike in 6 weeks and my 3rd ride in 2 months. Saturday I did a 25mi ride with slight tightness at mile 20. Sunday I did a hard ride of 38mi (the Sunday throw down ride that caused this all), commuted twice this week (40mi each day) and rode 58 mi today.

I still have some mild irritation kicking in the longer distance, but I'm hoping being more diligent about the exercises will help (I haven't been very diligent).

All in all, I think trying to ride here and there was a bad idea. I think the area needs to be strengthened first before it can recover, which means at least 6 weeks off.

ITB issues at this severe of a degree really sucks.

[superdx]

Congratulations! That's wonderful news!

The Amazon IT band straps arrived today, and one I bought locally in a store. Will give all 3 a try tonight and see which one pans out.

[superdx]

SUCCESS!

So no, the 3 straps I bought online pretty much did nothing. The rotation of the knee is too different from runners, and the straps were designed for that. They stayed on ok, but about 10km in, I was already feeling some discomfort. We tried repositioning it a couple times but didn't do much. One position seemed to have a good effect was at the top of the knee cap, but by then the pain had set in and had to call it a night. But, I was still able to walk normally afterwards, so the bands were doing something, just not enough.

2nd try, my physiotherapist used a plastic tubing, kind of like the ones they use to tie your arm before taking blood, and wrapped it around the top of the kneecap. It was on tight enough that there's resistance when walking, and you definitely know it's there. The idea of the tubing was to restrict movement of the knee so that I was using VMO(??) muscles instead of my calves, and also to stop the rotation of my knee, apparently I keep leaning inwards when I cycle, and I suspect it's because I'm so fearful of the pain that my leg is moving in funny positions, which aggravates the ITB. NO PAIN!! While my physiotherapist got the position right the first time he tried, it took me like 4 tries to get it put on properly, with the right tension and the right position.

3rd try, Labor Day holiday, I went for a 25km ride in the morning and a 22km ride in the afternoon. I used both the tubing and the Pro-tec ITB strap (since it was the thickest and seemingly most durable), the tubing was at the top of the knee and the strap was 2in. above the knee as in the instructions. 1st ride my group pushed pretty hard, keeping speeds of 40km/h+ on flats. 2nd ride was mostly hills, and 2nd group pushed hard there too. NO PAIN!!

The tubing does have some small problems because it's pretty much right up against the skin and it become sore after awhile. We'll try to remedy it next time by wrapping some thick bandages around the contact points, but the bottom is I CAN RIDE AGAIN!! My fitness levels are so poor I could literally feel the 5 lb I gained over the past 7 months of no cycling. Got to get back in shape!

[aussietim]

I thought I would put up my experience which has been similar, although lucky not as severe.

Recently while slowly commuting (albeit after heavy weekend cycling, +200 km) I started to get sharp pain around the top of my knee cap on the inside of my knee. Having previously had an ACL reconstruction on that knee I was very worried. I spent the next almost 2 weeks week off it not cycling or running. At the end of the two weeks I had a 40km TT which I was optimistically still intending on racing. After putting the race wheels and setting up my TT bike I took it for a test ride and the pain came back almost immediately.

I saw a physio immediately. The pain was caused by a very tight IT band which was pulling my knee cap to the outside, it presented it self more acutely when my other muscles were more fatigued and not able to compensate. The likely cause, after winter I quite my gym membership in order to cycle/run more, stopping almost all strength work and due to increased work my stretching/foam rolling became almost non existent.

In lots of these issues, the IT band is generally not the main problem (it is just a mass of fascia) but it is just a link in the chain being affected by further upstream links like the hip flexors and glutes. My calves were also extremely tight contributing to the alignment issues.

In about 4 weeks I am back cycling 100%. My rehab has included lots of stretching, foam rolling, hip mobility and proproception exercises for glute activation. I know the jury is still out on foam rolling as there is not conclusive research as to its benefits. However, I have found it a great tool for self management of alleviating tightness. I do not actually spend much time rolling my IT specifically but work through the other links in the chain, all the way from my upper back down to calves.

What I have learned is strength training its a vital tool, not just for increasing muscle/power but maintaining and improving bio mechanics. I think strength training, stretching and foam rolling should be considered an integral part of a training plan not just an auxiliary activity which it sometimes becomes. Especially when you become pressed for time, it is the first thing to go.