ITBS recovery methods, techniques, advice

Question

I got into triathlon about 2 years ago and developed ITBS last year. It was severely debilitating. After seeing a specialist, taking the specialists advice, which consisted of: a 6-8 month break, a start back into running/cycling with shorter distances and longer stretch periods prior and after exercise, myofascial release with a foam roller.

It's pretty clear things have gotten a lot better. Having said that, while my right leg is all but recovered, the outer part of my left patella (outer knee) still exhibits pain from time to time after I run. Any advise? I stretch and use the foam foller daily as preventive self-maintenance.

Answer 1

Since you have already had treatment and are doing regular stretching and foam rolling these would be my suggestions:

1. I’d definitely try the kinesiotape that I mentioned in the comments, esp. since ITBFS (iliotibial band friction syndrome) has an inflammatory component and the tape helps improve circulation and lymphatic flow to reduce inflammation.

2. Look at your running surfaces: Level surfaces cause less strain so try to avoid running hills. Run on alternate sides of the road to avoid one leg always being on the outer slope. Try a shorter stride. Increase your runs very gradually. For cycling: Check that your seat is not too high or that your bike cleats rotate your legs in too much.

3. Make sure that you are hydrating well. Icing after your run may help to reduce inflammation.

4. If those don't help, check back with your practitioner to see if this is still part of your ITBFS or something new. For instance, you said the pain is on the side of the patella (not actually over the femoral condyle). If the pain is patellar pain, that may be a different cause. Check for myofascial trigger points in the quads, hamstrings and glutes that may be referring pain to the lateral knee.

   • Check your muscle strength: Weakness anywhere along the chain can throw off your biomechanics and put more stress on your TFL (tensor fascia lata) and ITB. Check your: Abdominals, back and core. Hip strength - hip abductors (specifically the gluteus medius), adductors and rotators, as well as the gluteus maximus. Knee strength - quads and hamstrings.

   • Ask them about shoe recommendations and any alignment problems: esp. leg length difference, foot/ankle - like excessive pronation and whether or not orthotics would help.

   • Check for any residual muscle tightness: - Glutes, Piriformis, TFL/ITB. - Hip flexors: iliopsoas and rectus femoris. - Quads and Hamstrings. - Calf and heel cords (gastroc and soleus)

   • Take your video camera with you so that you can video the correct form of any stretching or strengthening exercises you are given. Also, you can video your running biomechanics on the treadmill to look for any functional alignment problems.

Here is a nice article on the ITB and cycling that includes the piriformis stretch and the gluteus medius strengthening exercises (in addition to the ITB stretches). Hope that helps.