IT Band Knee Pain (Foam Rolling, Stretching, and Strengthening)

Life Rule: If something hurts, you should probably just foam roll it.

(source)

Foam rolling addresses muscle tightness/knots/scar tissue by literally rolling them out (I’m not saying it’s fun, but it is effective). And that fabulous foam roll is especially effective for Ilotibial Band (IT band) problems, which in my experience account for about 90% of running problems.

So the dreaded runner’s knee? Nope not a thing. Your IT band is tight. Hips hurt? Again, probs your IT band.

I’m blogging about this now because, well, my knee hurts a bit. But don’t worry, this is a constructive post, not a whiny one! Basically, I’ll do the Googling so you don’t have to.  (So says the girl immobilized by the ice pack tied with a scarf to the side of her knee.)

What is an IT band?

The Iliotibial band is a layer of connective tissue that goes from the lateral hip and attaches down below the outside of the knee. Runners usually feel IT band pain in the side of the knee, but it can also hurt up in your hip where the IT band connects.

What causes it to hurt? 

• Muscle imbalances (Quadricep muscles that are too strong in relation to the Gluteus Medius and Minimus);
• Running downhill fast;
• Running on flat even surfaces (i.e. pavement) while heel-striking/over-striding.

How do I treat this problem?

1. Rest. A couple days off to let the area calm down should do it. But time off without any foam rolling or stretching probably won't do anything.

2. Foam roll. Aah the aforementioned foam roll. There could be a knot at anywhere between your hip and your knee, so just use the foam roller to find it, then roll over that place repeatedly until you want to cry/scream/have to stop (I told you it’s not fun).

• Sidenote: I had an injury in college that was originally diagnosed as a knee problem. So I did the prescribed stabilizing and strengthening exercises for a couple weeks, but it did not get any better. Then long-suffering ever-patient cross country athletic trainer (God bless Brian for not murdering all of us) decided to start back from square one and re-evaluated me. He was testing the muscles in my leg when he came across a giant knot – Mollie, what is this????? Ummmmmm? My leg is just like that? No. And then we progressed to an extremely bruising series of Active Release massages and a lot of “foam rolling” on a PVC pipe. Painful, but it worked!

3. Stretching (source)

• Stretch #1: Pull foot up toward your butt. Cross your uninjured leg over the injured leg and push down, hold for 30 seconds.

• Stretch #2: Cross injured leg behind and lean towards the uninjured side. This stretch is best performed with arms over the head, creating a "bow" from ankle to hand on the injured side (unlike how it is depicted).

• Stretch # 3: Cross injured leg over the uninjured side and pull the leg as close to your chest as possible.

4. Strengthening

• Side leg lifts: Lie on the ground on one side with legs straightly aligned. Contract your hip muscles to open your hips and raise your top leg. Keep leg straight and lift to a 45-degree angle from the ground. Pause for one second, then slowly return your leg to the starting position.

• Standing side leg lifts: Stand with both feet together. Lift one leg out to the side while keeping your body upright (don’t lean!) It is more important to maintain good form than to lift your leg high. Slowly lower and repeat on the other side.

• Single Leg Step Up

Also read my post: “Hip Flexor and Piriformis Stretching and Strengthening.”

How do I prevent this from happening (again)?

• Get off the road or treatmill and run on uneven surfaces (grass! trails!) to strengthen your balancing muscles.
• Avoid over-striding and heel-striking.
• How old are your shoes? How many miles are on them? Could it be time for a new pair?
• More info from the Runner's Corner.

Hope this is useful!

New Running Orthotics!

I have incredibly strange feet. In technical terms, I pronate a lot. Every physical therapist or athletic trainer who’s ever looked at me thinks they’ve discovered the diagnostic jackpot when they look past my hips/hamstrings/knees/shins and get to my feet.

Mollie, wow, do you know about your feet??? They ask in consternation, with a hint of glee at their discovery.

Yes. I dash all hopes of uncharted territory to the ground. I’ve been wearing special made orthotics since I started running in Junior High.

That usually ends the discussion –- my feet are strange but someone else has already addressed the issue -- and the well-meaning PT or AT moves on to other potential injury-causing culprits.

But what if it’s been my feet all along?

When I went to see John about my hip/hamstring problems, he very quickly honed in on my feet (he is a chiropractor and Certified Chiropractic Extremity Practitioner - aka foot expert). But instead of accepting that my current orthotics were good, he tested them to make sure.

John did a series of very simple strength tests, first barefoot, then in my orthotics. And lo and behold we found that they’re not good at all! I was much stronger without orthotics than with them, when it should be the opposite.

To make my new orthotics, he measured the degrees my feet are “canted.” For those of you in the know, my feet are at 15 degrees and 12 degrees (normal is 4). For everyone else, that just means that my foot and arch tilt in.

Then, holding my feet in a neutral position, he molded them in foam.

Less than two weeks later, a box arrived on my doorstep – new orthotics, ready for running!

I took them out for a 7-miler on Sunday. They definitely felt different than my old orthotics, but not uncomfortable or overly strange.

And on Monday night I brought them to John along with my old orthotics. We did the same strength tests – this time in my old orthotics then in the new ones. The difference was huge. It’s too early to tell you if these new orthotics will change my running life…but right now I’m feeling pretty optimistic!

Do you run with orthotics? Has anyone checked them recently? 

Hope and Physical Therapy

I know there’s been a lack of running posts recently. One reason is because I’ve been pouring my running-thoughts into my Examiner page (please subscribe, or at least check it out!). But the real reason is that I haven’t been running.

And trust me, no one is more upset about this than I am.

This is the longest-lasting running problem I’ve ever had. I kept thinking it was getting better, that it must be getting better. But no. 

My most recent recovery plan was given to me by my college athletic trainer in Boston (I actually do more there than just eat dessert): one week off completely, two weeks of cross training. So I did that, then went out for a test run only to learn that nothing had changed. No better. No worse.

 ArrrrggggggGaaaaaahhhhhhhhhh.

What’s a runner to do?

Answer: Descend onto a deep dark pit of misery.

And deep and dark this pit was. (I’m not recommending this. Just stating a fact.)

I mean, it got to the point where I was walking down the street in my fat pants (ugh that hurts to write, but not running + this = fatpants. Let’s be real here.), and hating anyone and everyone who was out running. From casual joggers with fanny packs to elite athletes, I hate them all. Because they can run and I can’t.

I don’t absolutely 100% need running. I can be a person without it. (Though I do have a hard time being my usual pleasant self.) But I love running, and I don’t like being without it.

BUT as of Tuesday night, there’s hope again! My pelvis might be tilted. (OMG turns out The Importance of Being Even may apply to my hips!) And doing these physical therapy exercises twice a day (and biking – ugh, kill me) might be the fix I need.

I’m not going to cry Miracle! until I’m out on a 100% pain-free run…but let’s just say I’m hopeful. Things are starting to look up.

Read more about pelvic biomechanics here. 

• Lie on involved side.

• Bend knee of upper leg, placing foot flat on floor in front of lower leg.

• Keep involved leg straight.

• Lift leg upward.

• Return to starting position.

Perform 2 sets of 10 Repetitions, once a day.

Perform 1 repetition every 4 Seconds.

• Lie on right side with knees bent, feet together.

• Lift left knee upward.

• Lower and repeat.

• Repeat exercise lying on left side.

Perform 2 sets of 10 Repetitions, once a day.

Rest 1 Minute between sets.

Perform 1 repetition every 4 Seconds.

• Lie on uninvolved side, with lower knee bent for stability.

• Keep knee straight on involved leg, lifting leg upward.

• Return to start position and repeat.

Do not roll trunk forward or backward.

Perform 2 sets of 10 Repetitions, once a day.

Perform 1 repetition every 4 Seconds.

• Half kneel next to chair as shown with left leg up.

• Rotate kneeling leg outward.

• Place right hand on muscles on side of right thigh.

• Flatten back by tightening abdominal muscles.

• Move hips forward and shift hips to the right until a stretch is felt in outside

of right thigh.

• Repeat for left leg.

Perform 1 set of 4 Repetitions, once a day.

Hold exercise for 20 Seconds.

• Lie on table or firm bench with half of your thighs off table.

• Position both knees on chest.

• Flatten back against table.

• Lower left leg while holding right leg to chest.

• Return to start position.

• Repeat with other leg.

Do not allow leg on chest to fall outward.

Perform 1 set of 4 Repetitions, once a day.

Hold exercise for 20 Seconds.

• Lie on back with one knee bent.

• Lift buttocks off floor.

• Return to start position.

Maintain neutral spine.

Perform three sets with each leg.

Perform 2 sets of 10 Repetitions, once a day.

Rest 1 Minute between sets.

Perform 1 repetition every 4 Seconds.

• Lie on back, knees bent, arms at side, feet flat on floor.

• Begin in neutral spine.

• Inhale, and start at tail bone and raise on spinal segment at a time until

weight is supported on feet and shoulders.

• Exhale and lower one spinal segment at a time starting from the upper

segments to the tail bone.

• Repeat.

Perform 2 sets of 10 Repetitions, once a day.

Rest 1 Minute between sets.

• Lie face down, knee bent on involved leg.

• Lift leg upward.

• Return to starting position.

Perform 2 sets of 10 Repetitions, once a day.

Rest 1 Minute between sets.

Perform 1 repetition every 4 Seconds.

And I guess I should say: These exercises were designed for me and are to be used only under the direction of a licensed, qualified professional. 

But do what you want.

I'm Injured. Who Done It?

As many of you know, I have been battling a hamstring injury (if your definition of "battling" includes crying in the fetal position).

So running recently has not quite been up to par. I still don't know what's wrong, but I've been considering a few potential culprits. So let's play a little game of Clue.

Is it Mr. Knot in my iliotibial band (ITB) with over-training?  

Is it Mrs. Tightness in my piriformis with not stretching?

Is it Miss Tear in my hamstring with hill repeats? 

I am quite familiar with Mr. Knot in my ITB. Seriously, every problem in my life stems from this area. So for those of you not familiar, here's a little run-down. Your ITB runs from your hip down to your knee. ITB Syndrome is when your knee hurts due to over-training and the resulting tightness in your ITB. It's not quite as dire as this article suggests, but it's not particularly fun either. Icing, stretching, and deep tissue massage are the most common treatments, followed by rehab strengthening exercises. Check out this article for details/suggestions. And here for stretching and strengthening suggestions. 

Mrs. Tightness in my piriformis?

Well, I think that she is my least likely culprit. I mean, my piriformis was definitely tight for a while there, but I think that was more a result of my hamstring issues, rather than the cause of them. If you're wondering,What the heck is a piriformis? It's basically a small muscle in your butt. It can cause piriformis syndrome, which is when the muscle presses on the sciatic nerve, causing pain. But that's not my problem. 

What about Miss Tear in my hamstring? 

This is definitely a possibility. If you already have a tear/strained muscle, you do not want to stretch too much (and if you do stretch, make sure the muscle is warmed up, and then ice afterwards). To prevent tears, make stretching a part of your routine. 

Here are some hamstring stretches: RunnersWorld, and Cool Running. 

Thus far, I think I blame Mr. Knot, in both my ITB and hamstring. However, I've been getting deep-tissue massage, and though it has helped, the problem is not solved. 

It's important to remember that all these muscles/tendons are interconnected and interdependent. Your legs function as one entity, with multiple components. So tightness in your hamstring can irritate other muscles, which can cause you to feel pain in completely other places. Which leads you on obnoxious games of Clue: Running Injury Edition, where you're stuck in a crap-shoot of guess-and-check. 

The case is open, the culprit is still on the loose. Until then, I will be foam-rolling and massaging, and running in a slow short-strided way. Hope your workouts are going better than mine!