ITB Pain - what have I missed?

[pfitz4883]

I am a runner and have had ITB pain for a few months now. I have seen a physio since for a while. I have done strengthening of glute medius (apparently they were quite strong in the first place), ITB/glute stretching, had acupuncture, use a foam roller, had a cortisone shot, I have good orthotics. But I still have the pain and it is not improving and I can only run for about 2 mins then have to stop because the pain comes on. I don’t know what else to do, and now I am considering have surgery. Is there anything else I have missed?

[feiflyfly]

where about is the pain? at the top part of the thigh around hip? or around the knee joint?

if the pain is at the side of the knee and comes on after doing a few repetitive knee flexion/extension, eg when running biking, that may suggest ITB friction syndrome, taping can be quite helpful.

[alophysio]

Hi - Surgery!!!! On what?

Please don't do that unless you have been through some other treatment strategies.

Glut med might be "strong" but is it working as it should when you run?

You mention ITB pain - i am assuming near the outside of your knee...what about your SIJ, pubic symphysis, L/S, T/S and ankle joints? Have these been assessed properly?

Anyway, some things to think about. You shouldn't need surgery surely!

[pfitz4883]

The pain is located on the side of the knee joint. Yeah have been told it is ITB friction syndrome before.

I have been assessed. They found i had a slightly weak glut max so i have been working on that for a while, otherwise nothing else unusual has been found. I might have a look at how well my glute med works during running.

Thanks for your help

[sixphysio]

i agree you have to look above and below the knee. the knee is usually the victim of dodgy stuff elsewhere, unless trauma is involved.

think of it like this; every time you bend and straighten your knee your itb flicks over the lateral tubicle. this is whether you are walking, up and down stairs - whatever. if you don't have control of your hip or ankle then this is still the cause of the your problem.

rest is all well and good, but the establishing the cause; and not just treating the symptom is called for.

cheers

sixphysio

[morwenna]

My husband was having lateral knee pain which we decided was ITB pain too.

His responded very well to stretches and doing clam-shell exercises etc, plus I did some deep massage to the whole length of the ITB .... he didn't like that!

We (a colleague and I) also decided his main provoker appeared to be over-pronation of his foot, so he's now wearing medial arch supports. He is 58 years of age and has been able to return to running and playing field hockey painfree after 3-4 weeks of this, whereas before this he was having pain and limping even when walking.

[Sports_Rx]

I've suffered ITBS also and as a runner I can sympathise. I've been self-treating with deep tissue massage, foam roller, strengthening glute med, Ab, Ad, VMO and ITB stretching (this made it more painful at the knee even when I wasn't running). I have seen a physio colleague for acupuncture and another podiatrist colleague for prescription orthotics. NONE of that helped!

The only thing that's helped is changing my running style. I researched Dr Romanov's POSE method (google it) and since running this way I've had no ITBS problems. I'm now up to 40mins pain-free running, all be it after a slow build up. I adapted easily to Pose however I'm trained in biomechanics; it can require perseverance.

ITBS is so multifactorial - you need to address the friction point to start with though. If there's pain there, stop. Then look at the mechanics side of things, gait etc. As Alophysio said, strong muscles doesn't necessarily equate to correct function. Screening for Lx, SIJ and hip rotators - assuming your physio's done this. Find the cause then you can treat it - easier said than done though...

[alophysio]

Hi Sports_Rx,

I too have been training my patients to run in a similar way to Pose running style. I refer to an exercise sports scientist / running biomechanist who trains my patients if they want to go that extra step further of video analysis and programme setting.

Pose running and similar variants are (and i am guessing people will want to know) based on keeping your landing under your centre-of-gravity. If you land with your foot out too far in front, it creates a braking force which jars your joints.

I have personally tried pose running and will take time to build up the necessary strength to run this way. I have hypermobile feet and weigh 105kg so it will take me AGES to build up to it! hahaha