General Discussion Triathlon Talk » Why my IT Band issues aren't IT Band issues? Rss Feed  
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2011-03-04 12:35 PM

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Subject: Why my IT Band issues aren't IT Band issues?

Below is an excerpt from research I'm doing about a dull pain on my left fibular head. I'm not at all convinved my issues are ITB and have been the doc, PT, etc... with the same old same old, stretching, massaging, mainplating, strenghtening, resting etc... with no improvement. I'm wondering if anyone has any thoughts about the paragraph below.

HI all, I am a Physical Therapist and a long distance runner.  Been running for years and last Saturday about just under a mile had a sharp pain over the fibular head.  I stopped and mobilized it myself and was able to run rest of my planned 8.4 miles that day no other problems.  Figured I'd had a minor misstep or something that I just didn't remember.  Sunday was a different story.  I always run 20 or so miles on Sunday and only 0.3 into it and my fibular head hurt and wouldn't stop.  I had to stop and just knew if I continued it wouldn't get better that day.  I started then to work on what the causes could be and corrected for everything that I could correct.  I'm very body aware and the next day re looked at how I was running and I was doing a mid foot strike and didn't seem to have an issue there.  My shoes were getting ready to need replaced but I'd been using the same brand/shoe for years without an issue.  I did switch to a pair with a few less miles on them, just in case. I also ordered a new pair and did some research and decided on a different shoe (scary for all of us to switch brands from one we know works, but I wasn't willing to give up running) I looked at the cambering of the road and decided to run in the middle when possible or switch sides.  After 10 years running the roads where we lived now I doubted this was it, but who knows?  I also pulled out a knee sleeve to give my knee some support and tapped with the horseshoe pattern (didn't do the one going up the back of the thigh as I had no nerve pain).  Overkill but I wanted to run and missing a run just didn't seem an option to me.  By Tuesday I could do 8.3 miles no issue but the knee sleeve became a bit of a problem as it would start to roll down pinching the behind the knee and it was uncomfortable; so I abandoned it a few days later.  Taping seemed the best but found after a few days that the tape below the knee was the most effective.  The top piece seems to change my patellar mechanics too much and my leg would start to feel tired around the knee cap so I just did the tape below the patella.  Starting just behind the fibular head with a piece of Cover Roll tape and ending just under the mid point of the patella.  I then use two pieces of Leukotape and pull from the fibular head to the mid point of the patella over the cover roll piece.  I pull pretty tightly and do it while standing.  I find a piece of 2" coban then over the tape to give a bit of support helps.  About three times around with the Coban again pulling a bit inwards from the fibular head to mid knee but not hard and always below the knee as I wrap.  Saturday I ran 8.4 miles without one issue and my knee felt completely normal.  Sunday I did 12.3 with out issue and only stopped because it was getting too hot with the sun directly overhead (love the South!).  I know I could have done the full 20 if I'd started a few hours earlier like I normally would have on a long run.  I'll start weaning off the tape this week.  The Coban will be the first to go.  I have no other discomfort in the knee and even when this happened I couldn't reproduce it except with running.  The new shoes are good and I think I have them broken in even though I really don't think it was the issue.  The new shoes have a bit more stability built in then my other ones but not too much so my foot can still move normally.  I've racked my brain trying to think what I did and can't think of a thing.  I train the same and didn't change my mileage or anything else.  I work to keep the muscles balanced and reassessed to see if I had some loss in the hip abductors but they were fine.  I used to be a gymnast so stretching wasn't the issue and my flexibility was fine.  I reassessed the ITB but knew it wasn't it and my ITB really seemed fine.  It will remain a mystery exactly what happened.  Just know fibular head dysfunction can occur and sometimes you won't know why.  It will be very localized to the fibular head and if you find the right therapist they will know what to do.  Luckily I can treat myself and was able to get back to running within a few days with proper taping and will wean off it as I'm able.  While I know I should have rested the knee I'm one of those dedicated runners that just wasn't willing to give up on the open road for a boring bike or no exercise at all.

I'm thinking of trying the taping procedure this poster describes and if anyone has any info that may be relevant, I'd be very interested to hear it.



2011-03-04 4:22 PM
in reply to: #3382821

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Subject: RE: Why my IT Band issues aren't IT Band issues?
Ruling everything else out, like stress fracture or other knee related issues, I would give it a shot.  Acupuncture can be effective for a lot of these types of injuries and pains as well.  Hope you figure it out.  Good luck.
2011-03-04 5:05 PM
in reply to: #3382821

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Subject: RE: Why my IT Band issues aren't IT Band issues?

In all honesty, the excerpt from the PT sounds a bit like gobblety gook...I accept that taping gave him relief (why wouldn't it?), but I don't see any reason not to believe it was ITBS...or something else, for that matter...just curious what led him to rule out ITBS.  Apart from that, he basically says "it's a mystery."  The one time I had a full-on case of ITBS, it was ridiculously hard for me to find that actual injury point (though, unlike this PT, I probably was less educated as to what I might be looking for).

Anyhow...when I went to the doctor with that bout of ITBS, he said it was "probably ITBS...or something like it"...IOW, there are apparently other soft tissue structures there that, when strained, can manifest pain in pretty much the same spot on the lateral aspect of the femoral head.  The thing with ITBS pain in the knee, though, is that it is triggered by a specific point in your range of motion:  IIRC, it's a 30 degrees of flexion of the knee, which is where the ITB has to move over the protrusion (epicondyle) on the femoral head from one side to the other.  So pain descending stairs is one pretty good indication that it is ITBS...if you don't get the stress at around 30 degrees of flexion in the injured knee as you step down with the other leg, then it might be something else.

But the thing is, as my doctor told me:  For other injuries that might cause discomfort in that spot, the basic rehab drill is going to be the same as for ITBS...stretch, ice, rest, anti-inflammatories.  I do know people who've successfully used physiotaping for ITBS, so if you can do it--or have someone competent show you how to do it--no reason not to try it.

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