ITB causing knee pain, how do you fix it?

About 3 weeks ago (when the hiking trails started to be clear of snow) my ITB started causing severe pain in my lateral knee when walking down hill.
I'm sure it's my ITB because I had the problem on the other side about 5 years ago which took a long time (2 years) to get better.

The problem is I'm supposed to start work as a hiking guide in 6 weeks and I really need the job (actually the $) At the moment the pain is crippling when I try to walk down hill and I can't work like that.

Has anyone had any success with fixing this?

Ibuprofen seems to do nothing.
Been to an osteopath incase something in my hips is making the muscles tight.
I always wear good orthotics and it happens in ski or hiking boots and running shoes.

Sports massage followed by regular foam roller sessions? The foam roller does feel like a form of torture but it's worked quite well in loosening my ITBs up

You need to stretch more. Hamstrings, quads, glutes, ITB

*The ITB stretch that I like is basicvally just a modified quad stretch.
*To stretch the right ITB lay on your left side
*grab your lower leg like you would to stretch your quads.
*Once you get your knee fully flexed and hip slightly pulled back, pull your knee directly down towards the floor.
*You may have play around with different hip angles. This one is kind of trial and error to find exactly the right positions.
* But once you get the right position you should feel the strecth right where you are sore

Make sure to strech your hams, calves and quads as well. Glute stretches will also help.

The glute stretch you should be doing is, basically sitting up with your legs out in front of you.
Pull the left foot up and cross it over your right thing, getting it as close to your hip as you can
Then pull that knee snugly up to your chest.
You should feel that behind your left hip.

Some heat before streching and ice after activity may also help.

If none of this help let me know I have a few more tricks in my bag.

Quote:

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Originally Posted by Arno

Sports massage followed by regular foam roller sessions? The foam roller does feel like a form of torture but it's worked quite well in loosening my ITBs up

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Foam Roller has been the KEY to keeping my ITB problems under control as well, but as Vinman noted, overall strengthening/stretching of the other important muscles is also required to balance things out.

Stretch as Vin described. Massage might be the best thing as it will help to loosen up the gammy fascia. There's other stretches as well. At this point, don't push things too much. Can you ride a bike pain-free? Do what you can to maintain cardiovascular fitness.

Best o' luck.

Self-treatment:
Stop running, especially in the case of severe pain if pain is mild, then reduce training load and intensity, and avoid downhill running and running on cambered surfaces.
Take a course (5 - 7 days) of non-steroidal anti-inflammatory drugs (ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist.
Apply ice to the knee (for 10minutes every 2 hours) in order to reduce the inflammation
Self-massage, using arnica oil or an anti-inflammatory gel, to the muscle only (along the outside of the thigh). Do not massage the side of the knee where you feel the pain, as this will only aggravate the friction syndrome stretching of the ITB. Stand with the right leg crossed in the back of the left leg. Extend the left arm against a wall/pole/chair/other stable object. Lean your weight against the object while pushing your right hip in the opposite direction. Keep your right foot anchored while allowing your left knee to flex. You should feel the stretch in the ITB muscle in the right hip and along the outside of the right thigh. Hold for 30 sec. Relax slowly.
Repeat to opposite side. Repeat stretch 2 - 3 times per day.
Remember to stretch well before running
Return to running gradually
Full recovery is usually between three to six weeks

So I've been stretching a lot and skiing less and it seems better at the moment.

Vinman-When I do the ITB stretch I get a strong ache in the area on the lateral knee where I guess the ITB attaches while I hold the stretch. Is this a good thing or causing more inflammation.

When you use a foam roller for this do you work it up and down the lateral quad over the ITB or ?
I've been using a dense rubber ball cause I have one and no foam roller and several places in the lateral quad seem to refer pain to the ITB with somw aching afterwards, I guess kinda like deep tissue massage. Is this good for it?

My biggest fear is that it will fire at the start of a long descent with clients and the pain is like trying to hike with a knife twisting in the side of my knee on every downhill step. Any ideas for an emergency pain reliever if this happens?

I've also been putting a neoprene bandage with tiger balm underneath on the knee which seemed to help when I had the same issue with the other side in 2002. Maybe the heat keeps the tissue strtchier?

I saw an add for a tight band meant to be placed above the knee to help ITB problems, has anyone heard if this is effective?

I don't run at all (!) I think this has come from skiing but I only get the pain when hiking downhill. I think the slight backseat position of my freerides has made my quads very tense when skiing. The ITB is much worse after skiing and I am aware of tension there especially on long traverses and sloppy spring snow.

Biking doesn't seem to bother it and last summer after a lot of biking the right side ITB (flared up in 2002, never completly recovered) was the best it has been. So is biking a lot before I start hiking guiding in 3 weeks a good idea or is rest better?

Thanks for the help so far :)

From my own experience, careful with the biking - if everything is set properly in terms of height of saddle, cockpit length, etc., you should be fine. If not, then it could aggravate the ITB quite a bit if saddle is too low.

As for the foam roller, you put that on the ground, lay on it with the ITB/lateral part of the leg...oh hell....here's the link...easier than descibing.

http://www.power-systems.com/news/01_26_06b.aspx

The roller WILL hurt. It should. Ice after.

As long as you are not having " sharp pain" with the stretch you are fine. You should definitly feel a strong/intense stretch right over the spot you are sore with that stretch. After you are doe with the stretch if it feels better you are also probably headed in the right direction. If not and it is more painful after then stop.

The self massage and is also fine, smae guidelines apply as above.

The compression strap idea can also be useful, but don't rely on it exclusively. Use it as more of a way to do some light activity without flairing up your ITB.

Becareful using the neoprene sleeve plus tigerbalm/flexall/ bengay etc... It is possible to actually cause a superficial burn to the area doing that type of thing.

[soapbox] I don't usually advocate the use of tigerbalm/flexall/bengay and the like for heat tretament. They really don't penetrate the skin more than very superficially. The method in which they do relieve pain is based on the idea that the heat you feel from the product "replaces" the pain sensation felt by the nerve endings. For this type of treatment they are effective. But they do not heat the muscle or tendon or whatever, the heat they produce never makes it past the skin. They provide the nerve endings in the area with some other sensation that pain and essentially block the transmission of the pain signal in the nerve. That is why our inital sensation to an injury is to rub it. It relaces the pain signal with something else. Certain forms of massage works this way as well.

So now for some personal opinion backed by some logic.

Pain relief in this method can be a good thing or not. In some cases these products might make you feel good enough to go exercise again. But has it really done anything except cover up the pain? And if it only covers up the pain, might you actually be doing more damage by exercising while still the site is still inflammed? IMHO a better option for heat treatment is a moist heat pack (moist heat penetrates better than dry). Moist heat can penetrate about 1 cm or more into the tissue and will facillitate stretching as well as breing oxygenated blood to the area.

OK that is my little rant for the year. TIFWIW[soapbox/]

So is the neoprene without the balm acting like a moist heat pack? (it is certainly both moist and hot underneath)
I have had a burn from balm containing capsicain (so don't use it) but TB has been OK but if it isn't actually helping I won't use it either.

I was thinking of using the strap if it was likely to be helpful not harmful for exercise I have to do (quite a bit) in addition to stretching, massage, stretching, icing and whatever else.

If biking causes no pain, is it non-irritating for the ITB?

Quote:

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Originally Posted by Vinman

You need to stretch more. Hamstrings, quads, glutes, ITB

*The ITB stretch that I like is basicvally just a modified quad stretch.
*To stretch the right ITB lay on your left side
*grab your lower leg like you would to stretch your quads.
*Once you get your knee fully flexed and hip slightly pulled back, pull your knee directly down towards the floor.
*You may have play around with different hip angles. This one is kind of trial and error to find exactly the right positions.
* But once you get the right position you should feel the strecth right where you are sore

Make sure to strech your hams, calves and quads as well. Glute stretches will also help.

The glute stretch you should be doing is, basically sitting up with your legs out in front of you.
Pull the left foot up and cross it over your right thing, getting it as close to your hip as you can
Then pull that knee snugly up to your chest.
You should feel that behind your left hip.

Some heat before streching and ice after activity may also help.

If none of this help let me know I have a few more tricks in my bag.

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DING! Excatly what I've been doing in PT to mitigate ITB induced knee pain. Be sure to stretch your calves as well.

Quote:

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Originally Posted by Redskea

If biking causes no pain, is it non-irritating for the ITB?

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Generally if it's not hurting it's probably ok. But I have found that even though I am pain free while on the bike, biking can cause the IT band to subtly tighten and hurt later when I go running/hiking.

Echoing what others have said, you should get a foam roller immediately!! After a couple of serious bouts with IT band syndrome as a competitive runner and trying all kinds of stretches, etc., I found that the foam roller is by far the most effective treatment. At the risk of sounding like it's some kind of miracle cure, for myself and plenty of other folks I know it has been the only thing that really does the trick. Get one and use as directed....

^^^ seconded, foam rollers rule...and ice bath

Quote:

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Originally Posted by Redskea

So is the neoprene without the balm acting like a moist heat pack? (it is certainly both moist and hot underneath)
I have had a burn from balm containing capsicain (so don't use it) but TB has been OK but if it isn't actually helping I won't use it either.

I was thinking of using the strap if it was likely to be helpful not harmful for exercise I have to do (quite a bit) in addition to stretching, massage, stretching, icing and whatever else.

If biking causes no pain, is it non-irritating for the ITB?

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Right I should have mentioned that earlier. It is likely that your positive results were from the neoprene and not the balm stuff. A neoprene sleeve is an easy way to keep the area warm and supported durring activity.

The ITB strap also works, I have used it with several people with decent results. But it will not "cure" your pain. After you stop using the strap it will likely still be there. Stretch stretch stretch.

Biking is prolly ok as long as it is not painful. Just besure to not push too big of a gear and make sure your bike fits correctly, cleats adjusted correctly....

make sure to stretch and ice after you are done.

Stretching is so important whatever the sport, and I have a recent article on that very topic

on my blog http://backbebetter.blogspot.com

You will find articles and surprisingly interesting ads that will help you avoid injuries and eliminate back, neck and shoulder pain.

Please check out the blog, which also has some great full color pictures.

Thank you.

Dave

For 10 years I have been an ergonomic consultant and have been helping people achieve a better back. I hope you like the articles and will click on the ads, which are full of good information about helping achieve a better back. Working in this field has taught me a great deal about the causes, treatments, and products which can help one have a better back and/or neck, shoulders, etc. In this blog I hope to learn from you, as well as give you the benefit of my years of helping people help themselves to get and maintain a better back.

So I had a bit of time off skiing, stretced a lot, used foam roll and ball and my knee was feeling better.

So I decided it needed some ice and elevation...

http://www.tetongravity.com/usergall.../knevinman.jpg

About 4200m of elevation :)

Me just below summit of Tacul, knee feeling good.

And then on the descent the biking question was answered :(

Near the end of the descent I feel and either broke (it feels like a break but nothing visible in the xray) or sprained my wrist. So now I'm in Wales where I've been looking forward to biking and climbing for the last 6 months able to do non-scrambling hill walks only, with my wrist aching like hell.

Something about Murphy's Law and my life :confused:

Anyone got advice for a break/sprain in carpal bones?

well for now just some ice and maybe a splint for a few days. If the wrist is still painful in 1-2 weeks from now get another x-ray. The scaphoid bone is notorious for having a fracture in it that does not show up on x-ray. It also has a very poor blood supply and if fractured untreated can cause some complication that you don't want to hear about.

Ice, splint, gentle ROM after a few days. Don't need to waer the spint all the time but it will help with the pain.

Quote:

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Originally Posted by Vinman

You need to stretch more. Hamstrings, quads, glutes, ITB

*The ITB stretch that I like is basicvally just a modified quad stretch.
*To stretch the right ITB lay on your left side
*grab your lower leg like you would to stretch your quads.
*Once you get your knee fully flexed and hip slightly pulled back, pull your knee directly down towards the floor.
*You may have play around with different hip angles. This one is kind of trial and error to find exactly the right positions.
* But once you get the right position you should feel the strecth right where you are sore

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So if im reading this right about this stretch... I want my top knee (after flexion) to be pulled down towards the ground sorta behind the leg that is on the floor, correct??

yes.....

What worked for me, when I didn't have a foamy roller: 2L soda bottle, nearly filled with water, rest air. Adjust the amount of water to adjust the softness. Rollers are amazingly helpful.

Bumping this useful thread after pushing a bit too hard skiing heavy pow at JH a couple weeks ago. It had been a while since we hit the goods and I just wanted to go bell to bell like the old days. ACL'd knee developed some swelling on upper outside in the bursa area where the IT runs and a tele doctor on the lift at Sun Valley told me what I was dealing with - bless her heart. Have never had any IT band issues. Wife (who has) has been rollerpinning it for me and I have been using the foam roller. Skied this weekend gingerly Saturday after taking the entire week off and it didn't seem to aggravate it at all. Pushed harder yesterday with my usual angulation and still so far so go. Have been wearing a compression sleeve at work just to keep it warmed up. Hoping to keep it going in the right direction. Good tips in here.

Huh, I was just doing research on this too. Ugly, we may share the same knee. My ACL'd knee also has had some sharp pain it but just when hiking this year, to the point I thought it may give out. But it hasn't affected my skiing at all, hope I don't have to stop skiing to fix it. It has often hurt just getting up from the floor since my surgery so it's not completely new. Fack! No swelling though. Time to dig out the roller and see a doc.

For trigger point release, I've found a lacrosse ball or jacknobber substantially more effective than a foam roller. A roller is too "blunt" for me to get a real release now. YMMV.

Stretching like vinman suggested is great. Also great is strengthening your hips. Look into hip CARs and PAIL/RAILs.

[soapbox]
Also, ibuprofen sucks and wreaks absolute havoc on your gut bacteria. I'd use it only as an absolute last resort, IMHO. I've battled my way back from several injuries without it, and I feel so much better not taking it.
[/soapbox]

^ bummer muted. I can ski just fine with no feelings of instability but when it came on the flex in my knee definitely kept getting tighter as the days rolled on.

I was pretty skeptical of the whole foam roller thing but after figuring it out the results are immediate if not long lived.

Auvgeek thanks. Our regular kitchen dough roller works as well.

my itb kills too, from the outside of my knee into my hips. i picked up some good tips from a physio and have been doing a lot of stretches, and also drinking a lot of water. it is helping so far, but the pain in both the knee and the piriformis (sp?) kind of stinks.

Quote:

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Originally Posted by ml242

my itb kills too, from the outside of my knee into my hips. i picked up some good tips from a physio and have been doing a lot of stretches, and also drinking a lot of water. it is helping so far, but the pain in both the knee and the piriformis (sp?) kind of stinks.

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Find that trigger point, as auvgeek notes. The spot that hurts the most when you push on it... and push hard till it spasms and relaxes. Orgasmic.

Quote:

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Originally Posted by Norseman

Find that trigger point, as auvgeek notes. The spot that hurts the most when you push on it... and push hard till it spasms and relaxes. Orgasmic.

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Every time I try that move on the wife I get denied.

Have had a lot of knee & ankle injuries on both sides. I still roll out my IT band every night and before skiing/any sport out of habit... definitely psychological.

Turns out that rolling out doesn't even help/isn't technically possible according to my PT. Probably better articles out there but a decent primer:

https://www.rei.com/blog/run/please-...g-rolling-band

Above link suggests

1. Single Leg (SL) Hops- work on deceleration and alignment (get reps practicing proper mechanics to combat IT band tightness pulling knee)
2. Monster walks- band around feet (as shown) is better than around knees or ankles
3. Skaters (w/ band on ankle)

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Originally Posted by 2FUNKY

Every time I try that move on the wife I get denied.

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Lol!


Sent from my iPad using TGR Forums

Yep, I tried rolling with no luck, then read a bunch more and decided it wasn't worth continuing. Learned to do the trigger point massage and strengthened glute med and it's all good now.

Once in a while I'll get some tightness after getting dehydrated, but a quick jam on the trigger point and the muscle relaxes. Ah

Quote:

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Originally Posted by Norseman

Find that trigger point, as auvgeek notes. The spot that hurts the most when you push on it... and push hard till it spasms and relaxes. Orgasmic.

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Ahhh

And you get the rolling spasm where it keeps going if you move just a little bit north or south. Like you said, orgasmic.


I've found the jacknobber is the best for the glutes and ITB. Love me some lax ball, too, but this thing is just amazing.
Attachment 268506

The other thing that works really well for trigger point release, IME, is acupuncture. Similar to having your PT "dry needle" you, except an acupuncturist with a PhD has WAY more experience sticking needles in people than a DPT.

For hip strengthening, I've become more and more of a fan of "functional range conditioning" approach lately. It's basically trying to expand your active range of motion instead of your passive range of motion -- meaning increasing your strength at your current end range. Yeah, banded monster walks and stuff work alright, too, but this stuff really gets me going.

Hip controlled articular rotations. Feel this in glute med like crazy! Put a second lax ball in the small of your back so your hips don't shift throughout the movement

https://www.youtube.com/watch?v=5jeVyLG3NVk

hip internal rotation/external rotation flow. Keep in mind two things: 1) pinching of any kind is absolutely unacceptable in the hip. Back off if you feel a pinch in the front of your hip. 2) the person doing these is extremely flexible (at least compared to me) so don't really use how deep she goes as a guide. I have to use both hands for support throughout. But I get a huge cramp in my glute med with the IR one -- trying to lift up the back ankle in that position is super challenging for me. Really works my end ranges. Also: in the video, they only show half the positions -- you'd obviously need/want to do all the exercises with your right leg forward and then switch left leg forward and repeat all the exercises.

https://www.youtube.com/watch?v=plakp9by_as

ETA disclaimer: I'm not a medical doctor, this isn't medical advice, always consult your regular doctor/pt before performing anything, wear a helmet when you go outside, etc.-

^^^^^ Good stuff. Thanks.

For sure! Also should mention that I see an amplified effect of this stuff when I do it as a warmup for lifting. Really gets stuff aligned and I feel better in my lifts and sore in the "right" places afterwards (squats actually do make your glute meds sore, never would have guessed!).

Not to belabor the point, but I wanted to follow up with a better explanation of what's going on.

The general idea is that passive range of motion isn't nearly as important for joint health as active ROM. I think this makes sense, especially for athletes -- you have to get used to generating force in awkward positions so your body doesn't break if you end up in that position while skiing/climbing/etc.

There are two concepts that I find super powerful and let you design exercises for pretty much any joint:

1. move the joint through it's full active range of motion under tension (aka muscle contraction). I like to do 20% tension for 2 reps forwards and 2 reps backwards and then 80% tension for 2 reps forwards and 2 reps backwards. That's 1 set and I do 2-4 sets. This is what that first video in my last post showed for the hip, but you can do that with the whole leg (similar to side lying leg lifts, but you make big circles), ankle, shoulders, etc. Just ensure there's no pain/clicking/ pinching in the joint when you do it -- if there is, back off on the ranges you're using. In the world of functional range conditioning (FRC), they call this a CAR (controlled articular rotation). I don't love all the acronyms, but I wanted to mention it if you're google around for more info on this stuff.

2. take the joint to it's passive end range and then generate tension in both direction (towards and against the stretch) via isometric contraction. (This is what the second video in my last post demonstrated.) This similar to classic PT "contract relax" approach to stretching, except you also contract the opposing muscles as well. A favorite example is the classic adductor stretch*. It's typical to contract by pushing the leg into the ground and then sinking deeper into the stretch. But if I do the opposite and try to lift my foot up off the ground, my glutes fire like crazy and cramp up. It's such a simple concept, but I never thought to train my glutes to activate while my hip was in full abduction. [In the world of FRC, I think they call this PAILs/RAILs.]

You can take these two concepts and apply them to any joint. Pretty crazy stuff.

*This position, either standing or kneeling.
Attachment 268572

Disclaimer: I'm not a medical doctor, this isn't medical advice, always consult your regular doctor/pt before doing anything, wear a helmet if you leave your house, etc.

Quote:

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Originally Posted by I've seen black diamonds!

^^^^^ Good stuff. Thanks.

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+2

Sent from my SM-G950U using Tapatalk

Quote:

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Originally Posted by auvgeek

For sure! Also should mention that I see an amplified effect of this stuff when I do it as a warmup for lifting. Really gets stuff aligned and I feel better in my lifts and sore in the "right" places afterwards (squats actually do make your glute meds sore, never would have guessed!).

Not to belabor the point, but I wanted to follow up with a better explanation of what's going on.

The general idea is that passive range of motion isn't nearly as important for joint health as active ROM. I think this makes sense, especially for athletes -- you have to get used to generating force in awkward positions so your body doesn't break if you end up in that position while skiing/climbing/etc.

There are two concepts that I find super powerful and let you design exercises for pretty much any joint:

1. move the joint through it's full active range of motion under tension (isometric contraction). I like to do 20% tension for 2 reps forwards and 2 reps backwards and then 80% tension for 2 reps forwards and 2 reps backwards. That's 1 set and I do 2-4 sets. This is what that first video in my last post showed for the hip, but you can do that with the whole leg (similar to side lying leg lifts, but you make big circles), ankle, shoulders, etc. Just ensure there's no pain/clicking/ pinching in the joint when you do it -- if there is, back off on the ranges you're using.

2. take the joint to it's passive end range and then generate tension in both direction (towards and against the stretch) via isometric contraction. (This is what the second video in my last post demonstrated.) This similar to classic PT "contract relax" approach to stretching, except you also contract the opposing muscles as well. A favorite example is the classic adductor stretch*. It's typical to contract by pushing the leg into the ground and then sinking deeper into the stretch. But if I do the opposite and try to lift my foot up off the ground, my glutes fire like crazy and cramp up. It's such a simple concept, but I never thought to train my glutes to activate while my hip was in full abduction.

You can take these two concepts and apply them to any joint. Pretty crazy stuff.

*This position, either standing or kneeling.
Attachment 268572

Disclaimer: I'm not a medical doctor, this isn't medical advice, always consult your regular doctor/pt before doing anything, wear a helmet if you leave your house, etc.

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This stuff may be interpreted as basically PNF, which has been used heavily in the PT profession since the 1940s. For example, you are combing a “classic PT contract relax” with a hold relax (those two have antagonistic definitions). Just an FYI if you dig this stuff and want to know where it all started

Quote:

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Originally Posted by bourbonisgood

This stuff may be interpreted as basically PNF, which has been used heavily in the PT profession since the 1940s. For example, you are combing a “classic PT contract relax” with a hold relax (those two have antagonistic definitions). Just an FYI if you dig this stuff and want to know where it all started

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okay, fair point. I'll have to look more into PNF. I'm not claiming this is like a totally new invention or anything. I bet a lot of this stuff could also be interpreted as yoga as well, which has been around for millenia. ;)

But I've been to a TON of PTs, and none of them really explained the general principle of trying to gain strength at your end range of motion and trying to close the gap between your active and passive ROM like these "functional range conditioning" guys/girls have. The goal of the PNF through my PTs has generally been to get into a deeper stretch, not to get stronger in that position. Which to me is a big mind shift.

And FWIW I don't have any affiliation with the FRC movement, just trying to educate myself and stay injury free the best way I know how. These approaches speak to me. It's corny, but I feel empowered by understanding general principles about the human body that I can apply to new injuries/ailments, and it allows me to converse better with my doctor(s). For me, understanding leads to doing consistently. If this stuff doesn't speak to you (generic you = anyone reading this), that's fine, and I hope you find something that works for you and helps you heal from any injuries.

Is it the fibula head out of place?