Chronic ITB -ITBand tightness in a runner. What is the real issue and solution ?

We get dozens of emails daily, and we try to anonymously post a good case weekly.

Dear Drs. Waerlop and Allen:

 

I am hoping that you will be able to help me, by referring me to the right professionals.

 

I am a 45 year old woman who has been plagued by what doctors have told me is Iliotibial  band friction syndrome for the past three years.   When my injury first occurred, I was running approximately 4 miles three to four times per week.  Most of the time, I ran in the woods, but I also ran in the street. 

 

When it first occurred, I walked home and rested my legs for two weeks.  After resting it, I learned that if I wore compression pants, I was able to run for 3 miles with no pain.  So, I cut back on my running and endured that distance for a while.  Eventually, it became so bad that I could not run two miles, so I decided to go to the doctors.

 

 The first doctor I went to for the problem told me to stretch my Iliotibial band and strengthen it by doing the four way leg exercise.  I did exactly as I was told, but to no avail.  I went back to the doctor and he could not understand why I was not getting better.  Since it became apparent to me that seeing him was fruitless, I did not go back a third time.  He told me that the problem would resolve itself within time.

 

For the next year, I self-treated.  I stretched, strengthened my hips and iced my knee.  At times, I could run 3 to 4 miles in the woods wearing a brace.  As soon as I felt any pain, I stopped running, and walked to my destination.  I would rest my leg again for a few weeks, and start back to running gradually, i.e. .5 miles every other day.  I took spin class two or three days per week to keep my cardio level up.  Interestingly, biking has never bothered my knee.

 

Last summer, it became so bad that I could not run .2 of a mile.  In September, I walked about 4 miles in Philadelphia in flip flops (I can hear you gasping now), and my knee began to hurt (you are probably saying no wonder!).  That was the first time my knee hurt while walking.  It was so sore for the next few days that the pain woke me up at night.  Shortly thereafter, I was walking and my back started to hurt so I went to another doctor.

 

The second doctor I went to told me to do a single leg squat and said you have Iliotibial band friction syndrome.  He prescribed physical therapy.  I have been going to physical therapy since the beginning of October.  I returned to running slowly and eventually I was able to run 20 minutes on the treadmill at a level between 7.4 and 7.6.  I ran three days per week.

 

I have also endured the Graston Technique and ART twice a week since November.  My physical therapist feels that it was successful in breaking up my scar tissue.   I can foam roll my Iliotibial band with both legs in the air without any pain. 

 

Yesterday, I tried running outside.  I ran on the flattest road I could find, but was unable to make it a mile.  I stopped running as soon as I felt the pain (similar to a throbbing pain) on the outside of my knee and walked home.  I iced it and took Advil.  I went to physical therapy today, and she cannot understand why I cannot run for one mile outside.  She believes I need to see another doctor for another opinion. 

 

Do you know of anyone in the Philadelphia area who would provide me the type of care that you provide to your patients?  I found you on Facebook  (I am Nellie Eplin) and find you fascinating. 

 

I really want to get this fixed.  I want to run for the rest of my life. It makes me a better person. 

  

I appreciate all of the help that you are able to provide. 

  

Best regards,   

E.L.

_______________________________________________

Response from The Gait Guys:

Dear E.L. :

ITB problems usually, but not always, occur from Weak gluteal support or from factors that allow or promote too much internal spin of the limb.  Sadly the typical response people get are the same as you heard, stretch the ITB out and foam roll. There is a reason this is frequently fruitless to resolve your issues. The ITB mechanism can shorten because there is weakness somewhere in the limb and internal spin and frontal plane stability is lost.  The internal spin issues can come from flat feet, hyper pronating, tibial torsion issues and valgus knees to name a few let alone general eccentric and isometric weakness of the muscles controlling internal spin rate (glutes and medial quads for example) .

The TFL-ITB are internal rotators, provide stability through limb rotation and provide some lateral stability. When the gluteals get weak you lose some of the lateral plane stability (mostly gluteus medius) and you lose some of the ability of the gluteals (iliac div. of g. maximus and posterior g. medius) to control rotation (eccentrically control the rate of internal spin).  A few weeks back we did a several part series on the functions of the gluteal, here is the link of the first one & the second one and their effect on the IT Band-TFL mechanism.

We would start with reading these 2 blog posts and then go back to the 3 part series on the Cross Over Gait which you can find here on our Youtube channel.

Without an examination we are guessing but perhaps the 2 blog posts and investigating these 3 videos we did will help you to look at Cross over gait issues which can be a big component of excessive internal spin. Within the videos you will see some exercise skills that might help you. 

Good luck,  We are in Chicago and Colorado. We do not know of anyone that does our kind of work in your town. Sorry

Good luck and keep in touch with us regarding your progress and discoveries, in the mean time investigating our ideas above rethinking the stretching - foam roller approach for the brief time might help you.

Shawn and Ivo, The Gait Guys …. helping solve one unresolved case at a time.

* (in all case discussions our disclaimer applies, available on our website).