ITB Issues, What Worked for You?

[JTrue]

So I've been having some ITBS issues for a while, bilateral. Sometimes worse on one side than the other. Mostly just a general tightness, but I've recently flared it up due to training error. Jogging with skis on a pack for 24 miles without much hiking or running this year. I've gotten over the acute phase where I was limping and had lateral pain going down the stairs, but I'd like to get over the general tightness I always feel as well. I race mountain bikes and ride road to train, both of those activities rarely cause a flare-up but they do contribute to the general tightness I feel.

I feel like most of my issue is caused by some sort of dysfunction in the hip. Probably some sort of muscle imbalance combined with tightness. I do the following things as maintenance and they seem to help, but there is always that underlying issue waiting to bite me if I make a mistake or do something stupid. I haven't progressed to one leg pistol squats, because I'm afraid it will do more harm than good. I'm very bad about going to the gym, as I'd rather be out ski touring during the winter or riding during the summer. Maybe I need to make it a habit? More core work possibly? I just went to an ART practitioner today, he worked on my right side which has been giving me the most problems, feels better right now. Any other suggestions on things to try?

• Roll on lacrosse ball(piriformis, tfl, gluteus medius)
• Foam roll quad and IT band
• Clamshell with a theraband
• Lateral Leg raises with theraband
• Sidewalk with theraband
• One leg bridge

[LightRanger]

I had ITB issues in 10th grade when I was running track and XC. Can't remember which side, but it kept popping in and out of the channel in the bone in my hip. Constantly stretching helped--standing, cross problem leg in behind other leg so standing with legs crossed, exaggerated lean into problem hip so you can feel the ITB stretch right at the apex of the hip. Make sense?

That's all I got. Your list looks solid, particularly the foam rolling.

[BraddA]

I hate to say it, but rest, and lot's of it, might be in order before you address your imbalances and such. I was in denial for about a year before I got serious about fixing my issues, and it wasn't until I took almost 18 months off of running that I was able to get back on the ball. I rode and lifted, but running was a no-go. Good luck.

[jma233]

Christopher Powers has probably done the most research concerning the relationship between glut strength and IT band issues. Do a pubmed search with his name and you'll see his work. BTW, the imbalances responsible for IT band syndrome are closely related to patellofemoral pain syndrome and even plantar fascitis/achilles tendonitis so don't overlook those articles addressing these conditions.

Biking is great but there is no lateral stabilization required so you might just start off trying some simple glut med work.

[pinto]

Needles.

Look up trigger point dry needling, or IMS, etc.

[Tuckerman]

A.R.T. is what worked for me. Active release therapy it took a few sessions so in between I also used kinesio tape.

[JTrue]

I think I've got it mostly under control. Back to racing my single speed in the pro class, feels good. I'm still nervous to go for a hike as I still feel like I could flare it up if I do the wrong thing. Following the video below and adding extension, flexion, and adduction. It's amazing, after doing a couple sets of these exercises the tightness goes away almost immediately. I don't really understand it, because it seems like if it was a weakness it would take a lot of time to balance everything out, but I literally notice a difference right after the exercises are complete. I'm going to try to stay on top of doing these exercises, stretching, and rolling.

I went to a session of ART, the guy mostly worked on my hip muscles(glutes, tensor fascia latae, and piriformis) with this pneumatic jackhammer thing. Same muscles that I roll with the lacrosse ball. I wasn't that impressed with the actual ART movements he had me go through, but maybe it helped. I showed him what I was currently doing and he told me I should be good to go, it was the opposite of what I was expecting. It seems like a lot of chiros like to get you in for multiple sessions whether you really need it or not, sort of refreshing. I'll try to follow up with my progress, but I think I'm on the right track. Just can't be lazy and need to do the maintenance religiously.

[kingdom-tele]

It goes away immediately because you are inhibiting the TFL, once the spindles are told to be quiet the receptor thresholds lower and the tone goes down. less tone, less pull, less tugging at the lateral knee.

those are all just fine, best thing in there was the iron cross thing with regard to functional movement.

while your trail running slow down, like really slow, pay attention how you step up, in particular to the rotation in the pelvis,low back, shoulder and trunk rotation. there is a reason your TFL is having to do more work on that side. If your pelvic bone is hanging back all that strength your working on will only add to the power of pulling the f out of the lateral knee insertion

you can have the strongest ass in the world, but if your putting thousands of reps through a system that is poorly coordinated or relying on less efficient pelvic mobility the system will figure out a way, usually at the expense of the hip.

[JTrue]

It goes away immediately because you are inhibiting the TFL, once the spindles are told to be quiet the receptor thresholds lower and the tone goes down. less tone, less pull, less tugging at the lateral knee.

those are all just fine, best thing in there was the iron cross thing with regard to functional movement.

while your trail running slow down, like really slow, pay attention how you step up, in particular to the rotation in the pelvis,low back, shoulder and trunk rotation. there is a reason your TFL is having to do more work on that side. If your pelvic bone is hanging back all that strength your working on will only add to the power of pulling the f out of the lateral knee insertion

you can have the strongest ass in the world, but if your putting thousands of reps through a system that is poorly coordinated or relying on less efficient pelvic mobility the system will figure out a way, usually at the expense of the hip.

Ok, so would you recommend working on hip mobility vs strength for now?

Something like this routine?

[kingdom-tele]

they are all good, but they are all looking at the local joint issues. If you can manage your pain via these exercises than that is usually good enough for most people. The IT band is a dense connective tissue, meaning it gets lengthened by the contraction or shortening from any of the associated musculature it shares a line with (google anatomy trains). This is why it is so variable for each individual. You could have chronic stress from excessive lower leg rotation, hip issues, pelvic mobility issues, trunk rotation issues. Often its all of them to a degree.

using the vid above, great hips, but look at the mobility in his spine, his hip mobility is contingent (as is the pelvis and spine mobility on the hips) on the degree to which he can orient his spine, those are nice whole body/trunk movements.

he mentions the detail to lengthen and release, it is without effort. when you can move in and out of those postures with attention to just taking up the slack in the tissue with as little muscle effort as possible you are going to have a more effective connective tissue creep.

it is always a combo of both J, lengthen where the structure is chronically tight and begin to understand how your functional movement can be adjusted so you don't have to rely on the same movement pattern that has created the structural imbalance

[GimpToo]

Good thread - I've been following as I also have some ITB issues. Curious kingdom-tele, what do you mean by 'chronic stress from excessive lower leg rotation' - how would you describe 'lower leg rotation?' Thanks for all your info.

[kingdom-tele]

Good thread - I've been following as I also have some ITB issues. Curious kingdom-tele, what do you mean by 'chronic stress from excessive lower leg rotation' - how would you describe 'lower leg rotation?' Thanks for all your info.

I should have been more clear, what I wrote was misleading. It is looking at the mobility of the lower leg and its effects on the whole. The tib and fib provide internal and external rotation, it enhances our ankle's ability to invert and evert, it also creates hip internal and external rotation, pelvic rotation, spinal rotation, etc. Our connective tissues respond to loading, whether through associated mucles contraction or merely repetitive lenghtening and shortening, both create the need to increase the tissue density, more density=more snugness. If there are movement patterns that creates limited foot and ankle dynamics the connective structures will shorten over time. Our nervous system will figure out ways to make up differences, if the lower leg is limited the hip will have to do double time. From the other end, if the spine does not help to deliver the pelvic bone and hip socket to the better, more efficient position the hip, maybe the lower leg will have to do the double time.

Unfortunately it is rarely ever one thing, we move as a whole and we all have developed our unique ways of negotiating our environment. The amazing part is we do it differently on either side within ourselves, how J steps up with the right is somehow different enough from the left that it has created the IT response.(not to pick on you J, we are all twisted)

[JTrue]

Thanks for all the info, my plan is to continue with the exercises I'm currently doing to manage pain/tightness along with working on overall mobility. Our fitness center at work offers Yoga classes, so I'm going to make a concerted effort to go.

I hear what you're saying about the whole kinetic chain, and I've got some funk going on for sure. It probably stems from overtraining early on and not paying attention to mobility, plus sitting at a desk all day. I've recently switched to a standing desk that I can also sit at, I switch it up throughout the day.

Yesterday I went on a 40 mile road ride, IT band and quad felt a bit tight during and afterwards. I got a couple twinges during the ride, but nothing I haven't felt before. Went home foam rolled, used the lacrosse ball on tight spots, and iced my knee. Headed out to go climbing, crag is less than a mile from the car. This is the first time I hiked or walked any sort of distance with something on my back since I originally flared it up a couple weeks ago. Got up to the spot we were going to climb, took a step and felt some pretty intense lateral knee pain, enough so that I had to stop walking. It came on without much warning and went away after re-occurring a couple more times. It didn't bother me on the descent although I was careful to go slow. Did something tighten up while I was on the bike and the act of hiking set it off?

[GimpToo]

KT, thanks for the explanation - JT, good luck!!

[butterscotch]

When it flares up:
Rest
Ice
Foam Roller
Then yoga when it starts to get better. Yoga is great for opening up the hips.

Maintenance:
Hip mobility exercises before I work out - the vid you posted is good. Lots of stuff out there.
Foam roller after
A strong posterior chain - squats/deadlifts/cleans/push press/lunges/concept rower.
Not sitting too much - seriously, what caused my last (and only) flare up after my initial injury was too much sitting in a cramped space.

Edit: Since you mentioned hiking while carrying stuff on your back as an issue, consider raising your waist belt. My initial injury was caused by wearing my waist belt too low on a 18 mile day hike (okay, it was obviously tenuous before that but still that extra pressure at the top of the IT band = no bueno).

[neufox47]

Anyone ever used Voodoo Straps for IT band issues?



I'm not a fan of "Cross Fit" but KStar knows his shit and is a DPT.

[kingdom-tele]

he always speaks well. I would disagree that you can't effect structural changes on the IT band, its connective tissue, its properties are no different than other less dense, more mobile CT's, its not about stretching, its about lengthening, lengthening in an active way and understanding how your using yourself inefficiently.

hip airplane variations, half kneel glut work, unilateral bridges with variations of trunk rotation are all active extensor exs that meet IT lengthening criteria.

hard telling through a screen J. you caused the issue via walking, I would lean toward there is something in your originization of walking that is the issue.

[JTrue]

Cool video, good to have some more things to try.

I find that when I concentrate and push my pelvis forward to engage my glutes while I walk my TFL starts tightening up. This also occurs when I run. I guess part of it is to figure out what the TFL is compensating for and fixing that.

I'm back to minimal pain after a day of rest, icing, doing some maintenance exercises. Did some mobility stuff in the gym today along with some pistol squats, only going down until my upper leg is parallel to the ground.

After I'm pain free I want to start using free weights(light a lot of reps) at the gym, but I'm bit worried about my form while doing deadlifts, cleans, lunges, etc. I've had people show me proper form, and it seems like most of it has to do with not rounding your back. What else do I need to look out for as far as technique goes? I really appreciate all the responses, keeps me interested in getting better and not just continuing to "manage" the issue.

[neufox47]

Cool video, good to have some more things to try.

I find that when I concentrate and push my pelvis forward to engage my glutes while I walk my TFL starts tightening up. This also occurs when I run. I guess part of it is to figure out what the TFL is compensating for and fixing that.

I'm back to minimal pain after a day of rest, icing, doing some maintenance exercises. Did some mobility stuff in the gym today along with some pistol squats, only going down until my upper leg is parallel to the ground.

After I'm pain free I want to start using free weights(light a lot of reps) at the gym, but I'm bit worried about my form while doing deadlifts, cleans, lunges, etc. I've had people show me proper form, and it seems like most of it has to do with not rounding your back. What else do I need to look out for as far as technique goes? I really appreciate all the responses, keeps me interested in getting better and not just continuing to "manage" the issue.

Why do you think that going light with a lot of reps is the way to go when you start lifting? Most IT band issues come from very repetitive movements. I wouldn't be doing high weight, but I also wouldn't be doing muscular endurance work (more than 12 reps).

Have you tested your glute strength and activation? I'm no DPT, but one thing that probably can't hurt and can most likely will help is to work on your glutes. Search Bret Contreras and youll have enough free articles to know how to progress through different exercises.


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[kingdom-tele]

Structure follows function.

J, the larger issue is that whatever is causing the IT structure to be pulled is part of your involuntary motor program. the CNS makes adjustments to protect and move as efficiently as it can, we have an enormous amount of variability in those choices from activity to activity and step to step, if you are really curious to know you would be better served having someone work with you, I couldn't comment on what is best for your technique.

your more than you glut mm's, nothing works in isolation. local tissue work is great, as are local exercises if there are imbalances, but your ability to adjust to reduce strain vs repeatedly trying to create more strain makes more sense in the context of dealing with tissue insertion pathology.

good luck, listen to your body and be patient

[JTrue]

Why do you think that going light with a lot of reps is the way to go when you start lifting? Most IT band issues come from very repetitive movements. I wouldn't be doing high weight, but I also wouldn't be doing muscular endurance work (more than 12 reps).

Have you tested your glute strength and activation? I'm no DPT, but one thing that probably can't hurt and can most likely will help is to work on your glutes. Search Bret Contreras and youll have enough free articles to know how to progress through different exercises.

When I said high reps I meant about 15, vs 5.

I've had a PT manually test strength by pushing against their hand, but no machines or anything. Not sure if they really tested the glutes, don't remember what they really tested. When performing clamshells my gluteus medius seems to fire fine, gluteus maximus might be a little under-devoloped and doesn't seem to fire as hard. But I have no idea if that's normal or if it's something I need to work on. I know my quads, especially vastus lateralis are very stong, vastus medialis is pretty well defined as well. I think my hamstrings are a bit weak as they get pretty sore if I work them hard.

All I know is that the glute exercises I've been doing usually help with the tightness I experience during the day, but the effects only last for a day. If I don't continue to do those exercises the tightness just comes back. I've also started to experience some tightness/pulling in my lower back, so I'm probably overcompensating with these exercises.

Structure follows function.

J, the larger issue is that whatever is causing the IT structure to be pulled is part of your involuntary motor program. the CNS makes adjustments to protect and move as efficiently as it can, we have an enormous amount of variability in those choices from activity to activity and step to step, if you are really curious to know you would be better served having someone work with you, I couldn't comment on what is best for your technique.

your more than you glut mm's, nothing works in isolation. local tissue work is great, as are local exercises if there are imbalances, but your ability to adjust to reduce strain vs repeatedly trying to create more strain makes more sense in the context of dealing with tissue insertion pathology.

good luck, listen to your body and be patient

I haven't had the best luck with PTs in the past, I feel like the couple I have seen just go through the motions, prescribe exercises and send you on your way. But maybe I just need to find the right one? I've tried a bunch of different things, targeting the vastus medalis at the recommendation of the PT and renowned cycling doc I saw previously, along with my current regimen. They never mentioned core or mobility work. Had me squatting with a ball squeezed between my legs, etc. Stretching and foam rolling has always been part of it, but never seemed to help all that much. Mobilizing the tissues surrounding the hip with a lacrosse ball seems to work the best out of anything I've tried when it comes to self myofascial release.

Guess I'll search out a PT that is a runner or cyclist, or both. Thing is that there has never been much pain besides this last flare up, but the tightness drives me crazy. It limits how much time I can put in on the bike and severely limits how competitive I can be racing mountain bikes. As soon as I start increasing volume I need to take a step back and take multiple recovery days to get my body back in check.

[marshalolson]

really interesting read here.

i have been suffering a ton of ITB issues myself from a lot of running, and a lot of the info here has been a great help.

my low tech solution is to just power walk 1-2 miles at the start of every run to get my hips loose, and then start running. i can go pretty much no problem for however long (20+ mi) if i do that. if i just stretch and then hit the trail, i typically will have issues at the 4-5 mile mark.

but either way, a lot of these exercises and wisdom is awesome. learning a lot.

[JTrue]

really interesting read here.

i have been suffering a ton of ITB issues myself from a lot of running, and a lot of the info here has been a great help.

my low tech solution is to just power walk 1-2 miles at the start of every run to get my hips loose, and then start running. i can go pretty much no problem for however long (20+ mi) if i do that. if i just stretch and then hit the trail, i typically will have issues at the 4-5 mile mark.

but either way, a lot of these exercises and wisdom is awesome. learning a lot.

Sorry to hear you've come down with a case of the IT Band blues as well. Let me know when you find the magic formula .

I also find if I start off a ride loose with no tightness I can go for a long time, but if I have a hint of tightness before the ride it just grows during it and I feel that unpleasant lateral pull on my knee.

[kingdom-tele]

Perfect marshal, the tissues need time, more fundamentally we need better balance in the input we give our tissue structures, it is hard for people to lose the idea everything should be a sufferfest.

here are a couple of articles you guys might find interesting, they discuss the characteristics and training specifics that address our connective tissue structure.

http://www.scribd.com/doc/60997635/F...myofascial-Web

http://www.fasciaresearch.de/Schleip...lesFascial.pdf

J, you'll notice they mention rolfing, structural integration(same thing) as methods of care, you could look for these practitioners in your area, PT can be reductionist to a fault, they have the knowledge, just need to find one that will reverse anatomy a bit and incorporate a program that has you using your whole structure to influence the issues that need addressing.

[JTrue]

Perfect marshal, the tissues need time, more fundamentally we need better balance in the input we give our tissue structures, it is hard for people to lose the idea everything should be a sufferfest.

here are a couple of articles you guys might find interesting, they discuss the characteristics and training specifics that address our connective tissue structure.

http://www.scribd.com/doc/60997635/F...myofascial-Web

http://www.fasciaresearch.de/Schleip...lesFascial.pdf

J, you'll notice they mention rolfing, structural integration(same thing) as methods of care, you could look for these practitioners in your area, PT can be reductionist to a fault, they have the knowledge, just need to find one that will reverse anatomy a bit and incorporate a program that has you using your whole structure to influence the issues that need addressing.

Cool, I'll give those a read. It's funny you mention rolfing, I'm helping out a buddies girlfriend, she practices massage and I believe is certified in rolfing, but is learning a new technique that focuses on breaking up adhesions just between the skin and fascia. She needed some participants to practice on that were showing symptoms. I've got 5 more sessions scheduled, I just need to update her on how I'm feeling throughout the week. Figure it can't hurt. It's like she's using her nails to rub the skin, creating a sandpaper like feeling, working mostly on the gluteus medius and then some local work on the it band and insertion area. I'll have to ask her about rolfing during the next session.

There is a PT here in SLC that focuses on lower body bio-mechanics, but doesn't take my insurance. Might pay for a couple sessions with my HSA out of pocket. A friend had good things to say.(http://www.canyonsportstherapy.com/s...omechanics.php)

Started Yoga at my gym and downloaded some Yin Yoga DVDs, which mostly focuses on the spine and hips. Starting a strengthening program next week as well, incorporating some of the exercises listed above.

Edit: Some more interesting reading:
http://www.kinetic-revolution.com/it...-the-question/
http://www.easyvigour.net.nz/fitness...s_maxintro.htm