Dealing and Running with Iliotibial Band Syndrome
Am I nuts to even attempt this? Not really. Because of the dreaded ITBS since the Milo Marathon, I haven’t been running a lot as much as I should or wanted to. I’ve counted the days turn to weeks, and weeks turn to months. I’ve gained weight – at least 5pounds, and a little depressed inside. Tried running but I could only last for 2miles (3Kms) until the pain on the outer side of my left thigh would come back. I tried pacing Beth on her 10K race but after 3kms, I found myself walking more than the latter half of the race.
After 2 months of almost zero running, I raced the Urbanite 5K. I did an unexpected fast time of 24minutes, so I thought I was on my way to running longer again. So I joined Beth and banditted the GMA7 fun run – I only lasted 7miles and the pain came back stronger than ever. Then Sir Jovie “Bald Runner” saw me limping with pain, and felt sorry for me. He introduced me to his Coach, Titus Salazar, who claimed to heal me in a matter of weeks. I was so excited to be with the great coach so the next day, a Monday Holiday, I went to Ultra to have my ITBS treatment. I was in a real surprise. Coach Salazar pressed and squeezed my left IT-band, from the outer side of my knee slowly making to my outer thigh, and then finally making its way to my hip-joint. I was literally screaming with pain. If I were a girl, I probably would have cried. But of course I didn’t. I was a marathoner for crying out loud, I could endure 4hours of pain. But after 10minutes, it felt like an hour of excruciating pain. Then when Coach Salazar finally stopped, I felt really relieved. I walked for a few seconds, the tightness was gone! Although the pain turned to bruised feeling, the ITBS problem seems to have reduced itself. After 2 or 3 days, I went back for another excruciating treatment. I had my doubts, but I was desperate to try anything—ultrasound and hot-compress, they don’t seem to work. However Sir Jovie assured me and said I should relax and stick with the treatment.
Coach Salazarl, i2runner, Beth, and BaldRunner
I figured in order to be able to continue running, I need to find the root cause and formulate a solution to it. So I then tried to research about the ITBS on my own, reading books and internet pages. I got a lot of feedback from my previous ITBS blog, and then also from emails. I apologize for the naked illustrations, I don’t know how to put clothes on the models.
Below is the list of information I have gathered so far in my personal research:
- Iliotibial Band (IT-Band) is a band of connective tissues that runs from the hip-joint through the outer thigh, then all the way to the outer top of the lower leg, the tibia-bone. Hence, it’s called “ilio-tibial”. Its main function is to stabilize lateral movement of the legs.
- Iliotibial Band Syndrome (ITBS) is the painful inflammation of the IT-band. Because this is a connective tissue, it takes a lot of time to heal as compared with muscle aches or injury. I even heard this one triathlete claim to stop running for 6months because of ITBS. This is just a nightmare to deal with.
- Root-Cause. The conventional accepted cause was believed to be the rubbing “friction” of the IT-band from a bony protrusion somewhere in the outer knee. Meanwhile, a good friend reader of this blog, Rafael Castaneda, a fast Boston Marathoner who lives in Alaska, emailed me an excerpt from the new book “Runnersworld’s Runner’s Body”. It said that a study from a group of scientists Wales are suggesting rather than friction, the cause could be compression of layers of tissue in the outer thigh in between the IT-band and the thigh muscles. If so, this would explain the pain coming from the whole area of the outer thigh that have the IT-band connected. The article also mentions that rather than imagining the band connecting the hip-joint to the bottom of the thigh, the IT-band also has connections into the whole outer thigh muscle as well.
- Running Biomechanics – under-pronation, repeated running on banked roads, and adduction. Generally all of the information I’ve gathered all agree that ITBS, whether caused by friction or compression, is due to bad running biomechanics. Rather than over-pronation, most studies suggest evidence of under-pronation among injured runners. Because of this, I went to SecondWind Running store to have my gait analyzed. Well, according to Hector, I was slightly over-pronator in the left foot. This is just getting me more confused. Another factor most studies also see is running too much in a banked/crowned/cambered road. I’m guilty of this, I mostly run facing the traffic or “counter-flow” in the shoulder of the road. Because of these two factors, I’m no longer using the Nike Lunar Glide and switched back to Nike Lunar Trainer, which because of its soft cushioning and its flexibility should allow me to over-pronate in a cambered road. Another biomechanical factor they mentioned that needs special consideration is “adduction”, which is the turning inward of the toes, which twists the lower leg, therefore further stretching the IT-Band. I had this obvious problem as evidenced in my photographs of the latter stages of the marathon. Lastly, they mentioned running faster reduces the ITBS pain, although no explanation could be found. I proved this to be correct when I ran a mini-5K race organized by Mizuno Running Clinic last week, where I ran faster than 8minutes per mile, in a much cambered road in BHS.
- Conventional Solutions. Most articles would recommend stretching the IT-band, using ice, and anti-inflamatory medications. Some have various stretching technique from websites to websites. Finally, they also recommend the “foam roller”. Meanwhile, the solution to the adduction is abduction. Abduction is the action to open the legs. Weak muscles would result to inward pointing of the knees and toes/foot. Strengthening of the gluteus maximus (butt) is recommended by doing exercises that opens the leg while lying on one side of the body, an additional weight load is optional.
- Unconventional Solution. Coach Salazar called his treatment “hilot” in tagalog, which gave me a lot of excruciating pain, but was only temporary. I believe most doctors would go against this method. However, in what I’ve read, especially in the “Runnersworld’s Runner’s Body”, they mentioned going for “deep-tissue” massage, and in some internet sources, some runners who undergone this also reportedly screamed during their treatment—similar to what I’ve experienced. What “hilot” or “deep-tissue” massage was doing, according to the new book, was somehow lengthens the IT-band. This way, it would be long enough to prevent compression or rubbing of the tissues, whichever one is correct. Some articles also claim “ART” or Active Release Tension, which aims to remove the scar tissue. I remember Coach Salazar mentioning this during my treatment, like he is feeling a lot of scar tissues surrounding my IT-band.
With this information, I was also able to judge for myself which ones I would believe and which ones to throw to the bin. So far, I find stretching to be ineffective, sometimes even worsening the condition of my upper IT-band just below the hip-joint. All of the stretching poses in the internet and books seem to only stretch the upper IT-Band, so the middle and lower band remains painful. What I do find to work is Coach Salazar’s “hilot” deep-tissue massage method. It releases the tension in my lower and middle IT-band. Right now, I found a way to do this by myself—with my left IT-band injured, I raise my left leg on a stool or stair. Keeping the leg straight, I then have my left foot point to the right which puts my IT-band on top-view. I then have my both hands press my thumbs unto the IT-band up and down. I try to press it as hard as I can to feel the pain, just as Coach Salazar did to treat (torture) me. The difference, I think, is I am somehow holding back because of the pain. It would still be different if it was the coach who would do it, as it would remove the scar tissue. Afterward, as Coach Salazar mentioned, I take anti-inflammatory medicine to reduce the inflammation the deep-tissue massage may have caused.
Suspecting banked roads to be the real cause of my problem, I switched from the left to the right side of the road. I believe cambered road that have an angle “/” forces the left foot to step more to the right side, therefore over-stretching the left IT-Band. Why? My theory is the left leg tries to be as perpendicular to the ground as possible. So when the road is angled, the leg will create an angle as well. When I’m now in the right side of the road, where the camber is “\”, the left injured leg is no longer over-stretched. However, this is dangerous since I am now running with the flow of traffic—I could no longer see the vehicles approaching me. So purchased “blinkers” that are originally designed for bicycles, and I then placed them on my left butt, so approaching vehicles have no reason not to see me in the dark.
Even with all these information, I have discovered another solution for myself—running while trying to keep the knees bent at all times. This solution shortens the range of motion of the IT-Band during the running cycle, which therefore again avoids the rubbing or compression of the tissues. However this requires forefoot running and an upper body that leans slightly forward for balance. This, my running friends, coincidentally what is called the Pose Method of Running. The problem I only see in this is it requires a slightly faster paced running. Either that or I’ve just improved my running efficiency. No matter what, it helps me with my ITBS.
Pose method – Forefoot striking, knees bent, and body leaning forward. Bald head optional.
So in summary, I now do a self-“hilot”, take anti-inflammatory over the counter medicines, run on the right side of the road, and run faster with the Pose-Method of Running. So far, this is working for me. I have been able to run for 8days straight, the last one a 5K race. The longest run so far is 10miles(16Kms), so I think I’m on my way to my previous running streaks. However, when I do still encounter a curved road with camber of “/” on both sides, I have 2 choices—walk until I get a flat or “\” road, or just run faster. I think Running Faster is the best solution.
Update 11/11/2009:
Stumbled on a nice post by thebullrunner, she shows a proper way to massage the IT-Band with a foam roller. I’m thinking of buying one, though my ITBS is OK now, this could be good for ITBS prevention.
http://thebullrunner.com/2009/11/05/how-to-use-the-foam-roller-for-runners/
Comments (43)
this is very helpful. thanks! its zexy time!
Hahaha! How are you Mr. Borat or Bruno?
Oh yes, you probably also have an ITBS. Do you want me to give you Coach Salazar’s number?
nice blog entry natzi!
very helpful and enlightening
apir!
apir! hehehe.
hi natz,
nice post, have tried the hilot approach as well. i have suffered from ITBS on my left leg naman.. I guess nagselos dun sa right, kaya eto trying to recuperate.. Very frustrating as i cant complete my training as planned.
regards,
mark
Sir Mark, sorry to hear that. You mean to tell me you had ITBS on your right leg before, and now it healed but now you also have ITBS on your left leg?
Very nice/helpful blog Natz. This will defintely help our runner friends cope up with their ITBS. I like the deep tissue massage also but it is really painful when done with hard pressure.
By the way, bakit female yung model mo? Pwede naman lalaki ah.
regards,
Neil
Hi Neil, thanks. I read somewhere that ITBS is the second most common injury of runners, next to “runner’s knee”. This is a really hard injury to analyze, and if you search it in Runnersworld.com, there are so little information about it. Even if you search in wikipedia.com, the information there isn’t helpful at all.
About the model- sige next time male model naman. Gusto mo ba naked din? hahaha!
yes natz and i am too frustrated now..
Sir Mark, that’s really frustrating. I have some questions for you:
1)What side of the road do you run, are they cambered as well?
2)What is your running gait – are you a supinator, neutral, or over-pronator?
3)What is your current running shoes?
4)What is your weekly mileage for the past 2months?
5)What is your average pace?
6)Does your feet point inwards as well when running, especially the one with the ITBS?
Agree Pose Method. After my own marathon debut, I studied this running method and picked the best from it. That is leaning forward, bend knee and higher back kick. Seems to help me prevent that painful butt issue I had before. At first it seems to require much effort but with drills, you’ll get used to it.
Agree about the road thing. As for me, if you saw me running last Ecodash and RotaRun, I was running almost near the middle of the road (that part with white broken lines) as that part of the road is flatter. Just be wary of incoming vehicles though.
1. usually counterflow, there were times that roads are cambered..
2. as per runnr’s gait analysis im overpronator (i bought a stability shoes for that)
3. NB 1025
4. weekly mileage ave to 30-35km
5. Ave pace – maybe 7:00
6. Not really
Mark, I think stability shoes could be bad for ITBS – we may need to wear softer cushioned shoes. I will write a separate blog to explain my theory, and it involves understanding of our biomechanics.
I have more questions:
a) Although your mileage doesn’t look so high, did you suddenly increase it by more than 10%?
b) If you try to keep your legs together while standing straight, which ones touches each other more: your feet, your knees, or both? The first one indicates bowleggedness (”sakang”), the second one is knocked-knees (”pike”), the third is normal.
Sam, if you’ve learned to do the pose technique, you should have no problem using the Newton Shoes again! Please do so and let us know how well you do this time!
I just realized I’m having lower back pain because of Pose Method. I may need to review the technique again, I could be doing it wrong.
nice website nats… subong ko lang ni nakita ah. i also got connective tissue injury in my ribs from (of all things) changing a flat tire
and it took almost a year to heal the connective tissue damage, had to undergo “hilot” therapy from a chiropractor coupled with ultrasound.
Rey Garriel, ikaw ni? Wow thanks for visiting! grabe, so the triathlete who didn’t run for 6months was probably right. This is bad news for us indeed. I guess we do need to deal with the problem and live (run) with it. Changing a flat tire can have eccentric body movements, so yes I agree, it can damage your connective tissues.
oo it’s me, saw your post at fb and it led me here. funny thing pa nats, it’s not even my car’s tire. i was just helping out a total stranger who knocked on our apartment door (true story). talk about good karma, hehehe… anyway, at least chiropractor therapy was covered by medical insurance. just take it easy, sooner or later maayo gd na. alalay lg anay and give it time to heal. cheers!
a. guilty..
b. both (normal)
thanks
Rey, thanks. Ayos, buot ka mang guid ah. If you injured yourself while just removing the tire, it must have been really painful. Ahhh…
Yup, I think I’m recovering indeed. Good thing I could still run even though I’m not totally healed yet. Just increasing my mileage ah… kaw man parts, jogging man kamo da ni elanie, to keep yourself fit and young. check nyo man gali website, http://takbo.ph, ilonggo man ang tag-iya sina, taga USLS man
Sir Mike, so that’s it! Increasing your mileage by more than 10% increases the risk of injury. I know you’re excited to run the marathon, but please take care of yourself
Now you should learn from your mistakes and be wiser next time. I also have been guilty of increasing more than 10% mileage increases in the past, and my previous injury was “runner’s knee”. For me what works best is only 7% increase per week. Take care bro, I hope you get well soon–hopefully not more than 1month.
Hey Natzter! Congrats on your rapidly improving ITB. Excellent, well-researched article btw. The thing with ITB is that different people all have different recovery times and responses to treatment. It is by no means an exact science. I would like to think I’m one of the lucky ones. It went away after cutting mileage by 80% over a span of a month and a half while continuously massaging it with a salonpas roller. Unconventional but hey it worked hehe. Good job on the 16k bud, you are well on your way!
Just back fromKenai River Marathon ,a friend told me about ART treatment for the ITB . You can check the internet about it. Good luck…
Luis, yes you’re so lucky with your ITBS that I feel jealous about it! hahaha!
Sir Rafael, OK I will. Thanks. So how was the Kenai River Marathon? You seem to run a lot of marathons, how many are you planning to run this year?
It took me half a year to completely heal from ITBS. It was the toughest and longer injury i had to deal with. I tried foam rolling, stretching 3x a day, therapy, acupuncture, dry needling, mesotherapy. What finally got me healed? Combination of deep tissue massage (3x a week, once or twice will leave you with tight ITB after each run), weights, and regular stretching. Great that you met Coach Salazar early into the injury.
Hi Jaymie, thanks for your feedback. I think I do remember reading your blog about those techniques not working for you. For me, even the ultrasound didn’t seem to work. It was really frustrating. I also tried foam rolling, which does seem to work, but now I’ve learned how to deep tissue massage myself, so now I do it nightly before I go to sleep.
6months of your injury must have been really hard for you. I have this injury for 3months already–also depressing for me, but I guess I’m lucky indeed to have been treated (and tortured) by Coach Salazar
Hi Natz , I finished 3:35:26 ,too cold 41F or 5C with the windchill feels like 37F or 2C . Last 9 miles encounter headwind and cold lost 2mins . Qualified to run Boston Marathon 2010 and 2011, and finished 3rd overall. The IQC Marathon will be my 4 ,was planning to run 5 but got injured last June.
Hi Rafael, that’s awesome! Another fast time! You’ll need to adjust to the warmer climate here when you join the QCIM. But I see that you’ll be running it as a pacer with an hour slower than your usual marathons, so I guess it’ll be your marathon recovery race?
I remember trying to run in Belgium at 5′C, I only lasted for 5minutes
Funny and educational
Hi Bea, i’t not so funny if you have it, but I try to smile even if I was shouting in pain
Hi Natz, your tips are good and zexy too, this may help me improve my running. Now I know why you mention the “body leaning forward”…
Sir Zum! Thanks for visiting my blog. Yes, please try reading about “Pose” and “Chi” running. I have a copy by the way, I will them to you next week
hi natz, sometimes it takes a longer trip to get to the right path. thanks for being the bida. BQ?
cheers and God Bless.
PTL
hi coach! Ever since I’ve posted this blog entry, a lot of runners were asking me for your number. I hope they have contacted you already. Looks like this problem is really more common than I thought. Thanks a lot for the wisdom. When I get back to my previous training level, I’ll need your help to BQ–Barbecue? Hehehe.. Halong lang da ah…
I’m a runner from Cebu. Your analysis on the injury is very educational. Everything you said on biometrics fits mine too. Got the injury a month ago. Frustrating really that had to submit myself to rehabilitation/physical therapy. NSAID’s, stretching, foam rollers and massages all help.
Sir Epoy, thanks for visiting this blog. Please keep in touch if you plan to come here in Manila. So how’s your ITBS right now? Mine just returned recently because I forgot to keep on deep-massaging myself, because I was feeling better already. Then one day it got tight again an during one downhill run the pain came back. Now I’m giving it 3days rest until the soreness disappear, and then redo the deep tissue massages, and then I’ll be back running again.
Anyway, there is one thing Coach Salazar also told me, he recommends brisk walking if running becomes too painful.
Hi Natz, I’m back to running again. Ran 5k three time this week and seems the pain didn’t return. The stretching and foam rollers (works like a massage) really helps, I don’t now about the ultra sound if it did. I’m now running on flats. Since my place is in the mountains, I skipped running them for now with so many uphill/downhill not to mention cambered surfaces.
I only do brisk walking in my place currently because I really fear now it would recur if I ran there. Hopefully this Sunday I try to attempt a flat 10k before going back to those LSD’s next week. Going for a full marathon this January the Cebu Marathon. info: http://www.cebumarathon.com
Wow! I just read this now, thank you so much for this!
I have a similar experience when the outer part of my left knee just “locks up” at 6kms. I have to agree that running on angled roads is one of the main causes for this. I also have a habit of running faster on my lsd’s which does not help with the many stop lights on my route.
I have a similar remedy of always keeping the knees relaxed and properly bent, as well as maintaining a correct angle when stepping forward with the injured leg. Did the same thing to on running on the other side of the road( but wouldnt that just injure the other leg?haha)
Mine doesnt hurt as much anymore but it I can still feel it there, quite annoying. Marathon training in the North America for next year here and I sure hope to wake up one day with all this gone as I start preparing for the races.
Hi Runbug, thanks for visiting this site. So you run in North America? Cool! Yeah, mine also still have some pain although I could run with it. I’ve heard some people injuring the other leg when they switch the other side of the road. That’s just too unfortunate. That hasn’t happened to me yet, my left leg just seems to be really strong. Maybe we just need to really slow down ramping up our mileage to prevent the other leg from also being injured. Good luck with your ITBS.
Right now, my ITBS seems to be better, but one time while I was running downhill fast, I think I have created another injury on my left leg, it seems to be an LCL – Lateral Collateral Ligament injury. It’s still on the outer left knee, but the pain seems to be deeper, and it is painful even during the start of running, unlike in ITBS when it only occurs after a certain distance of running. The pain is also there even when I walk. And my left knee seems to feel a little lose. I think I’ll take 2 weeks off from running and see what happens. Ligament injuries sounds scary.
Hey man. Just came from Coach Salazar this morning for my second session for ITBS and it was excruciating! I hope I get rid of this problem once and for all though, with therapy and strengthening exercises. I just wanna thank you and bananarunner for leading me to Coach. Much appreciated man, and see you on the road. Hopefully, we’re both ITBS-free by then!
Hi Domino, told ya it’s really painful. Probably one of the most physically painful sensation I’ve ever encountered. But how is your ITBS right now? The BullRunner has posted a foam roller in her blog, looks like a good thing to try. I’m thinking of buying one also. http://thebullrunner.com/2009/11/05/how-to-use-the-foam-roller-for-runners/
I just bought one yesterday. Haha. I hafta say, the roller feels great. It doesn’t put you in nearly as much pain as Coach Titus does but I seriously think it works! I looked up bullrunner’s site and I’ve been taking pointers as to how to use it there. I ran with Coach Titus yesterday and my ITB felt tight BUT not painful. For now, the ITBS is gone– for the moment and I’m kinda crossing my fingers right now hoping it doesn’t come back. Are you running any races soon? If I see you, I’ll come up to you and say hi.
Hi Domino, sorry for the late reply. That’s great to hear you’re doing OK now. I’m not entirely OK, I think I have a new unknown knee problem. The pain feels like it’s inside the knee bone. So it’s a little scary on my part. The good news is I can still walk fast.
I’ll be running the Fit N Right this coming Sunday. I’ll just do a fast 5K, so my knees won’t have to suffer much. Are you going there? Hope to meet you soon!
I’ve never imagined i will go back to this page to check your tips on ITB. Now that i have ITB, i’ll have to do this.im now focusing on doing strict Pose Method run.
Cheers!