IT band - SOLVED!!

[Mr.Gib]

I thought I would put up my experience which has been similar, although lucky not as severe.
I started to get sharp pain around the top of my knee cap on the inside of my knee.
I saw a physio immediately. The pain was caused by a very tight IT band which was pulling my knee cap to the outside,

This is Patello-Femoral syndrome or similar. Illeotibial Band Syndrome is pain at the lateral side of the knee where to IT band passes over the lateral epicondyle of the femur. Yes, having tight lateral quads or insufficiently strong vastus medialis can really mess up the tracking of the patella and cause all sorts of knee pain, but it's not IT band syndrome. The good news is that that PFS is easily fixed with good physio.

[superdx]

So it's about 2 weeks later, and swapped out to a band that's even firmer. They're called therabands? They come in a few different colors, blue > black > silver (in order of flexibility, silver being least flexible). I was using blue at first, but it didn't seem to last over a number of hours, or hard efforts.

So trying the black at first application, it feels almost too tight and that it would seriously rub off all the skin around my knee, but miracles of miracles, its more comfortable, there is ZERO ITB pain and it stays on better. It's permanently solved!

I'm sure the ITB is still causing an issue, but at least I can work on my bike fitness and core strength at the same time while it heals up over the next couple months.

Crazy what this little tubing of plastic can do. It's literally the best result possible!

[superdx]

It's been just over half a year that I had this problem so I thought I'd give an update. ITBS has stayed away, and I'm still cycling pain free with the help of the Theraband tubing. On some rides I don't even need it anymore. However it appears I'm still very sensitive for bike fit changes so ran into some issues when I was trying different saddles, I can feel the ITBS having a dull ache but when I get home I just do a couple minutes of stretching, go back to my old saddle + position and then it's gone again. Now I'm trying to get back into shape and lose about 10kg that I gained from doing almost nothing last year!

[mr4fox]

Good to hear it's improved and your enjoying riding again!!

Any chance you could post a few pics of how you attach the Theraband?

[superdx]

Definitely! There's a bit of technique to it so I'll ask my physiotherapist for his permission to do a short YouTube video. It was his idea after all so don't want affect his practice by posting the wrong technique.

[Skipton]

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.

I have just stumbled upon this thread although it is quite old now. I have been plagued with this injury for 18 months now and simply cannot get over it and have tried everything. Spent months in the gym strengthening things seriously with squats, lunges, dead lifts and other posterior chain exercises and had no pain in the Gym but as soon as I try to Cycle or Jog it just comes back. I wonder if you might share your surgeon so I can contact to discuss this surgery option.

[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.

I have just stumbled upon this thread although it is quite old now. I have been plagued with this injury for 18 months now and simply cannot get over it and have tried everything. Spent months in the gym strengthening things seriously with squats, lunges, dead lifts and other posterior chain exercises and had no pain in the Gym but as soon as I try to Cycle or Jog it just comes back. I wonder if you might share your surgeon so I can contact to discuss this surgery option.

Sorry for the slow reply.

18 months? WTF. Your GP should have referred you to a sports med. The sports med should have referred you to a surgeon.

My surgeon? Where do you live? If you are not in my city you will have to get your own surgeon. The surgery is as simple as surgery gets. Any surgeon that works on atheletes and knees will have done the procedure many times.

[Skipton]

Yep, I have exhausted every avenue. I think the reason for no surgery is that I spoke to the folks at Fortius who only cut and lengthen the band and do not do this technique and I was against cutting the band as it could lead to more issues medially and long recovery. I am in the channel islands and can get to any one in the uk. If you would be so kind as to private message me that would be greatly appreciated. Cheers

[Mr.Gib]

Yep, I have exhausted every avenue. I think the reason for no surgery is that I spoke to the folks at Fortius who only cut and lengthen the band and do not do this technique and I was against cutting the band as it could lead to more issues medially and long recovery. I am in the channel islands and can get to any one in the uk. If you would be so kind as to private message me that would be greatly appreciated. Cheers

I am in Canada, so my surgeons will do you no good. No need for a PM, I'll post here so all can benefit.

If you are sure that you have IT band syndrome - pain on the outside of the knee that sometime radiates down the tibialis anterior, the procedure you mention - "cutting" and "lengthening" of the IT band - that sounds barbaric and medieval. Maybe that was done 50 years ago. The current correct procedure often includes a "resection". This means cutting a small triangle out of the posterior edge of the IT band where it passes over the bursa like tissue that is causing the pain. The procedure should certainly include an excision of the bursa like tissue in the lateral epicondile - basically they just scrape out whatever shit is under the IT band at the particular spot. Most surgeons do both. This does not affect knee stability. Recovery is just a few weeks at most. Can even be done under local anaesthetic in some cases.

If you have the means, the best surgeons in the world for most cycling injuries are at the hospital in Herentals, Belgium (don't ask how I know ). Dr. Toon Claes and his two sons cover most parts of the body. They will happily take your money and perform the procedure. Prices are very reasonable. The sport surgery clinic there has many other good surgeons as well. The admin staff are wonderful and helpful people. Their English is mostly pretty good, but It doesn't hurt to add Dutch translation in your emails. BUT, surely there is someone in the UK who can help you with this. Find a good sports medicine surgery practice and they should be able to help you. GOOD LUCK. Hope you get it fixed soon.

[Skipton]

Thanks for the info. I will contact Herentals in Belgium as I am getting nowhere with all these strenghtening exercises which basically just flare it up each time I do them so in a viciuous circle of doom! Even just walking hurts today so not good.

[Mr.Gib]

Don't despair, stay positive - this is an very easy problem to fix. You just need the right person with a sharp knife.

[RimClencher]

I have just stumbled upon this thread although it is quite old now. I have been plagued with this injury for 18 months now and simply cannot get over it and have tried everything. Spent months in the gym strengthening things seriously with squats, lunges, dead lifts and other posterior chain exercises and had no pain in the Gym but as soon as I try to Cycle or Jog it just comes back. I wonder if you might share your surgeon so I can contact to discuss this surgery option.

The IT band connects to the gluteal muscles and other muscles around the hips. Instead of just strengthening these muscles, my advice is to really try and loosen those muscles. Loosening those muscles will give the IT band some slack so when it moves against your knee, it does not rub so hard. I say massage, but I mean a deep fascial release that hurts like the best Thai massage (to the point of being barely bearable). Do this: place your entire body weight on a tennis ball, and pinpont in turn different parts of your gluteal muscles and hips, focusing particularly on your sit bone aera (yes, deep in there) and where the gluteus medius connects to the pelvis. After a while, achieving this deep release with your entire body weight balanced on the tennis ball will get easier and not hurt so much. When that happens, swap the tennis ball for a lacrosse ball and keep going.

This advice is based on managing a chronic IT band problem for years in both legs.

[meatloaf16]

I have also been having IT band problems. I did a 50 mile ride with my loaded touring bike with drop bars last weekend. I felt a slight tinge around my IT band until I started climbing at the end of the ride. When I started climbing everything felt absolutely normal for the first time in months. Is there something about my bike position that changed while combing? I was thinking that it brought my saddle back relative to the bottom bracket and also brought my bar position back at the same amount. Does this make sense?

[RimClencher]

I have also been having IT band problems. I did a 50 mile ride with my loaded touring bike with drop bars last weekend. I felt a slight tinge around my IT band until I started climbing at the end of the ride. When I started climbing everything felt absolutely normal for the first time in months. Is there something about my bike position that changed while combing? I was thinking that it brought my saddle back relative to the bottom bracket and also brought my bar position back at the same amount. Does this make sense?

Everyone seems to be different, and recreating the position you have while climbing seems a fairly easy thing to test out so worth trying for sure.
It could also be more to do with how your pedaling and body position change when fighting gravity on a hill compared to fighting air resistance on the flat.
For example, pronating the feet helps IT band pain, and pulling up rather than pushing down through the pedal stroke also helps IT band pain.

[Skipton]

I think I am one of the really unlucky guys to never get over this.

I had bilateral surgery in Herentals with Dr Steven Claes who is about the best knee guy going and my ITB pain has come back. He removed some of Bursa and a small section of the band over the bone but when I tried to increase my training after loads of Physio and strength work post surgery it just flared up again.

I am off to see him next week but having had the surgery I dont think there is now much I can do as the rehab from surgery was good and controlled.

Surgery is not always the golden ticket!