Advice on Overcoming ITBS

[Meerkat]

I apologize for making such a long post. I just want to paint a complete picture of my symptoms and injury, as well as what I've tried based on my prior research. I've been dealing with pain on the outside of my right knee when I run for almost a year now. It's been diagnosed as ITBS after an X-Ray on my knee. I've researched countless articles and reports online about ITBS and nothing seems to solve it. It's the most frustrating injury I have ever dealt with. Thank you for your time in reading this. I'm thankful for the opportunity to post here with a chance of solving this once and for all.

To give a little backstory, prior to this incident, I was running a 12:30-13min 2-mile, fastest 1 mile was 5:30, and I was doing MMA regularly for almost 3 months prior to injury. I bruised my ribs a year ago and took about 3 weeks off running, crossfit, and MMA. I returned to working out for a week after I bruised my ribs to prep for a 7.5 mile ruck for time as part of the GAFPB. Finished it in 1:20. Immediately after taking the ruck off I felt a tightness in my right calf and when I'd squat, my Achilles would twitch. Figured it was muscle fatigue and tightness from my month off. Ran sprints the next day and was fine, but my Achilles felt off. Had it looked at and everything was fine. I was told to stay off my feet as much as possible, wrap it, ice it, and take ibuprofen to be safe. I was told it could be slight Achilles tendinitis and to keep an eye on it. I stretched it out daily and took a week off working out again. After that I had it looked at again and was told I could workout again.

When I started running sprints again, I had no issue. I was taking it light for the first month or so, furthest run I did was a very light 3 mile run at a 9min/mile pace. No issues. Then I tried my old work load once again. The track by me was closed, so I was running on the sidewalk like I had many times. 2 miles for time at a 6:30-7min/mile pace. During the run I noticed my right mid foot getting tired before the rest of my body, then at 1.5 miles in I started to get pain on the outside of my right knee that was getting increasingly worse every time my leg moved in stride. I pushed through it for maybe another tenth of a mile when I stopped and walked for a little. Went back to running, it was fine for a little, then pain. And I went in a cycle like that all the way home. Iced my knee and took it easy for a week. Went to the doctor, got X-Ray's and he said I had ITBS. I was told it wasn't a meniscus issue nor was it a PCL, ACL, MCL, or LCL issue. Ever since, I've been struggling with ITBS. I've been to physical therapy for 2 months, I've researched so many different ideas on overcoming ITBS online, tried insoles, stretches, foam rolling, suggested online regiments and nothing seems to work. I wore a knee brace for a while and it took the pain away 100% during runs, but I started to feel like my stabilizers weren't getting enough of a workout and my knee was getting weaker and it would feel worse when I didn't wear the brace. My right calf would also get tired and cramp quicker than the left when I'd wear the brace. I've spent so many hours researching everything at my disposal to find a method that works only to be disappointed. I searched on here prior to making this post and only found minimal talk about ITBS within threads about another issue. And I've also seen a lot of conflicting reports. Some sites say to swim to lessen the impact, whereas others say swimming will only make it worse.

I'm about 6-7 months into consistent working out again. First 2 months were spent preparing for a PT test. Ended up running a 14:43. Far off from my 12:30s-13:00s I was once able to run. After passing my PT test, I was taking it extra light with working out for the next couple of months. Doing some hip stability exercises, combining the Army's Preparation Drill, HSD, MMD 1, and cardio on a treadmill or elliptical. When I'd do distance runs I would use the elliptical, and sprints I'd use the treadmill. Wasn't having issues with my knee, so I stopped running on the elliptical. But my longest run didn't go longer than 2 miles as a precaution. Was incorporating stretches and exercises I learned from online to strengthen my stabilizers.
2 months ago I stepped it up to the THOR3 14 week program. I'm in Week 8 now and I've been following it almost to the T, except for the distance runs. The distance runs I have toned down and as soon as I feel any minor flare up in my knee I stop the run, walk it out, do cool down stretches and ice it. I have noticed that by applying Icy Hot to my knee prior to a run, I can run longer before I get a flare up.

Lately I've noticed my right mid foot, right hip, and right quad getting sore during distance runs, but only really bad on the right leg. I notice the soreness becoming less as I strengthen it with squats. At this point, my furthest run nonstop has been 2.5 miles. I'll stop, walk, then go back to running and can get to 3-3.5 miles. During this time I have also gained a lot of muscle weight. 2 years ago I weighed 140-150. Last year I weighed 160 prior to injury, and now I am up to 175-180 with 10-12% body fat. I feel like part of my issues might be due to the weight increase.

My knee has been feeling really good lately, so I decided to challenge myself with a 5mi run at a 9 min/mile pace. Ended up getting a small flare up at the 1 mile mark, but walked for 15 seconds and ran again without issue until the 3 mile mark. Every time my right leg came forward in stride, I would feel the pain get worse. It wasn't necessarily the impact affecting me. It was more of the movement of the knee in stride.

If I had to describe the pain, I'd say it's almost like pressing on a bruise repeatedly. Except after stopping my run the pain goes away and there's no bruising.

Has anyone else been able to overcome this? I want to get back to 100% and make this just a distant memory. I have seen mixed reviews online about whether to push through the pain or not. Some say it'll cause more damage, others say the knee will begin to adapt by pushing through it. I have been opting for not pushing through it because of the chance I could cause a permanent injury and kill my dream of passing selection.

I see this as just a hurdle in the road that I'll overcome on my journey. I just would like some guidance from those more experienced than myself to overcome this more efficiently.

I would like to thank you for reading this post. I appreciate your time in effort in at least attempting to help me.

[Scimitar]

Meerkat,

ITBS is a pretty common issue, especially with the volume you seem to have been doing, and treated well, can be overcome, over time....I repeat, over time.

Firstly, don't push thru the pain, you will damage the bursa and require surgery, anyone saying otherwise is just plain wrong.

Unfortunately, this is about the only thing that isn't debated about ITBS rehabilitation.

What precisely have you been doing to rehabilitate?

Please break the information down by timeframe
Bullet points - screeds of "and then, and then" is not helpful
Do not include run times etc, not helpful. I just need to know what Rehab you've been doing and when, i.e. Foam rolling, gait training, or correcting hip flexibility / strength imbalances, (month 1 = tried hamstring stretched, month 2 = tried this and this, etc...)
Most importantly, have you had any MRIs on the Bursa, and what medical professionals have you seen, who are they exactly, and what are their specialities.


I lost my opportunity at Selection due to what I'd consider criminally poor medical advice, on my own ITBS. It went undiagnosed for almost 2 years, after seeing 3 different sports specialists. So I've walked a similar path. Hopefully I can help.

Cheers

S

[Patriot007]

I am not a physical therapist or orthopedic surgeon. My advice comes from years of suffering from ITB/ patellofemoral and finally beating it.

Rest is most import to begin. However, without changing anything even a slow gradual return to activity will be a slow gradual return to the same pain without fixing your deficiencies.

Seek a physical therapist trained in FMS (functional movement screen) or similar methodology.

The old mantra of a weak VMO and tight TFL/ITB is a ridiculous oversimplification.

If you have a structurally normal/uninjured knee like I did the issue likely lies in the hips (strength and mobility) and or (less likely) the ankle rather than the knee itself. The knee is a hinge joint so the hip is the major player. Wish I knew this from my first therapist and not my 3rd or 4th. Like everything else not all physical therapists are equal.

I also slowly (over months to a year) transitioned to zero or low heel drop shoes and think this helps as my shoe is not forcing my foot/ankle/knee/and hip into a position it doesn't like. If you decide to do this I recommend you do it very slowly or become a casualty of the "barefoot fad".

[Meerkat]

Scimitar,

Thank you for taking your time to read this and help me from your past experiences. I really appreciate it.

I have not had an MRI done on my Bursa.

I was diagnosed at an Orthopedic Center. It was the recommended sports med center in town. The doctors who looked at my X-Ray's and felt my knee were specialists in Sports Med and the Hip/Knee area.

I also had the trainer for my brother's high school football team take a look and he also sided with it being ITBS. He said my IT Band was "As hard as a rock." The trainer also felt my ligaments and never mentioned a possible issue with my bursa. He also recommended a physical therapist that specialized in sports injuries.

The physical therapist also tested the tendons and ligaments in my knee. Nothing hurt to the touch and nothing felt torn. He also said my IT Band was tight and agreed on ITBS.

From my research, if it was bursitis, I would have swelling and tenderness to the touch in my knee. My knee does not hurt to the touch nor do I have swelling.

As you can see below, I was trying to incorporate hip strengthening into my overall workouts as I got into heavier workouts

Month 1 (March 2014)

Footwear for running was Nike Free 5.0's

Stretches:
Hurdler/Modified Hurdler 1x each leg, 30 sec holds, daily
Single Leg Over 1x each leg, 30 sec holds, daily
Calf Raises 20x each leg daily

Exercises:
Sprints 2x week
3mi run 1x month


Month 2&3 (April & May)

My stretches were:
Hurdler/Modified Hurdler 1x each leg, 30 sec holds, daily
Single Leg Over 1x each leg, 30 sec holds, daily
Yoga 1x per week



My exercises were:

30-45mins prior to MMA (3x per week)
Body weight wall squat & hold for 2 mins x3
Balance squats (Put a bosu ball down, so the ball side is down, and squat light weight. 40-65lbs while balancing on it) 10 reps x3
Lateral Lunges 10 reps (each leg) x3
Sprints Ladder (10m, 20m, 30m, 40m, 50m, 50m, 40m, 30m, 20m, 10m)
3x per week

MMA Classes (2hrs, 5x per week)
Classes consisted of:
Jog up to 1mi
Sprints
Body weight round robin (push-ups, air squats, squat jumps, pull-ups, sit-ups, lunges, high knees, bear crawls, burpee's)
cardio (pad work/heavy bag work)


Month 4 (Mid June - End of June)

I was on AT. I continued with my hurdler/modified hurdler and Single Leg Over/Iron Cross in the morning
Did not do strength training for my ITBS.
Did not do MMA or any structured workout
During AT I completed a 5mi ruck as the only PT day we had. No issues with my IT band.


Month 5 (July)

No daily morning stretches
Running 3x per week (on a track with a knee brace)

Warmup:
Army's Preparation Drill
Hip Stability Drill

Exercise:
1mi-2mi

Recovery:
Army's Recovery Drill

I attempted a 3 mile run using the road/side walk and stopped about 1mi in due to an ITBS flare up.

No weight training

No MMA


Months 6, 7 (August - September)
(Official ITBS Diagnoses happened in Month 5)

Physical Therapy 3x per week:
Elliptical. 5 mins, switching directions every min.
Squeezing a foam ball between my knees while doing a squat leaning on an exercise ball held between my back and a wall
Hip ups with feet on an exercise ball
Walking 100m on my heel's
Calf raises 10x each leg
Standing on stability disk's while catching a medicine ball
Ankle left right up down, 10x each direction with a resistance band
Ending with hamstring and calf stretches where I'd lay down and the Physical Therapist was stretching my legs.


Month 8 (October)

Continued Physical Therapy as in Months 6 & 7.

1-2mi run 2-3x per week (with knee brace) depending on soreness

Foam rolling daily


Months 9 & 10 (November & December)

Cardio/Leg Days (3x per week)
Elliptical for 5mins, switching direction every minute
Seated Leg Curls 10reps x3
Leg Extension 10reps x3
Leg Press 10reps x3
Hip Abduction 10reps x3
Hip Adduction 10reps x3
Treadmill .5mi run at a slower pace
Foam rolling, hamstring stretch, single leg over


Month 11 (January)

Footwear Change (Nike Revolution 2)
THOR3 Program (Modified 5k Distance Run Days)
Foam Rolling Daily
Ice and heat therapy
Taking Ibuprofen before runs to reduce pain & any possible inflammation of the IT Band


Month 12 (February-Current)

Foam rolling daily
Applying ICY-HOT to the affected and surrounding area
Tried Dr Scholes Active Inserts

Mornings
Lateral leg raise 30x each leg (w/Resistance Band)
Bent leg raise 30x each leg (w/Resistance Band)
Hip Thrusts 25x each leg
Side steps 10x each leg x5 (w/Resistance Band)
Pistol Squats 5x each leg
Heel to butt kicks standing 20x each leg
Single Leg Over 20x each leg

Nights
THOR3 Program
Prior to the Dynamic Warmup listed, I do the Army's Preparation Drill
Prior to the run/cardio days I do the Preparation Drill & Hip Stability Drill


I just bought Nike Air Max Tailwind 7's and was planning on phasing those in as they felt more comfortable on my foot and I felt like my Nike Revolution 2's were getting worn out.

[Scimitar]

OK, a lot of information there.

Well done on the formatting.


FIND REAL HELP
Firstly, I am not a medical professional, nor am I an ITBS specialist.

However, many so called Orthopaedic or sports doctors or physiotherapists haven’t got a damn clue what they're doing, but don’t worry they’ll take your money anyway. Also the tendency to conveyor belt patients, causes poor diagnosis and prescriptions, and lengthens recovery time.

Frankly, I saw some bullshit in your description that makes me concerned.

I would strongly advise you finding someone who specialises in ITB, and I mean specializes, they don't just say they do on their website, but they blog about it, and even write articles, or papers about it.

I myself got completely f**cked around by many so called specialists, and I have read many many other reports likewise. It wasn't until I sat down with an actual ITBS specialist that I saw results, by then it was too late.

A Specialist may only require one visit, and then he'd work thru your local Physio. But be prepared to have to go out of town to find someone who actually focuses solely on this issue. ITBS is very complex, and there is still no definitive science on much of it. Hence the need for someone beyond just the coal-face to look at you. Do not however talk to a surgeon; they'll just want to cut you, which may be a solution, but not yet.


NOT RUNNING
It amazes me that they've got you running on it at all. You SHOULD NEVER run thru that pain, EVER, knee brace or not.


LIFTING
I noticed you didn’t lift because of it. I'd go to this website,
www. startingstrength.com, and politely and professionally pose this question to the main forum for the founder Mark Rippetoe, I would imagine he'd tell you it’s ridiculous that they have you not lifting with that injury. But I'd rather leave that to him to decide as a professional.

Further questions welcome, please report back on your actions and injury progress

S

[Scimitar]

From my research, if it was bursitis, I would have swelling and tenderness to the touch in my knee. My knee does not hurt to the touch nor do I have swelling.

Doesn't mean you havn't damaged the Bursa. But that's for a medical professional to decide.

I'd also like to say it is typical for recovery to take months, even 6-12 months, and it is an injury you may need to manage for you're whole career, should you enter a combat arms CMF.

It likely hasn't helped that you have run on it to the point of pain again.

S

[Meerkat]

Further questions welcome, please report back on your actions and injury progress

S

Firstly, thank you again for all your advice. I have spent this past week finding new doctors with more knowledge on my condition.

The best doctor I have found in my area is Dr. Jordan Metzl. I actually own a book by him titled "Running Strong." The only issue is, my health insurance will not cover a visit to him.

My plan is to get MRIs and X-Rays done through doctors covered under my insurance, so when I visit Dr. Metzl I have all the materials needed for a proper diagnosis that won't break the bank.

However, during my appointment with a new doctor this week, I was told I do not have ITBS. Instead the condition I have been dealing with is hamstring tendonitis in the knee. He did not want to conduct an X-Ray or MRI on my knee.

It was recommended I do strength training and take Aleve twice daily.

Of course, I will be going for more opinions to confirm either diagnosis in my knee.