That four letter word

 

I finally feel back to normal after my frustrating bout with Iliotibial band syndrome (ITBS). The ease with which I manged to complete yesterdays 10 mile run makes the half marathon distance a  routine training run, which is a good thing given I have my first full marathon coming up in less than a month. Having never gone over the 17 mile mark, I’m planning one 20 mile run, hoping that should get me over the finish line (most likely with a lot of hurt).

I thought I’d try to discuss briefly how I dealt with ITBS (an injury I suffered late last year while running a half marathon) and how it’s opened me up to a whole new world of training.

What is ITBS?

Iliotibial band syndrome  is an overuse injury. It typically affects the outside of the knee. Classical symptoms include a very tender palpable point along the lateral aspect of the knee. After the acute phase of the injury, athletes complain of pain that typically starts midway into their run, with little to no pain at rest or on walking.

Why does it happen?

As mentioned it is an overuse injury that typically flares when one increases running mileage. It’s occurs because of constant compression of a pad of fat located under the IT band near the knee.

One of the leading causes of this problem are weak hips muscles. This is seen in people with a crossover running style

Bretta Riches does a fantastic job of  explaining the mechanics that goes into causing ITB. This is definitely worth a read!

What did I do?

1. The first thing I did was get my knee evaluated from an expert. Because the pain was so bad and with my background in medicine I was fearing something more awful.
2. One thing that I learned from this whole episode is to seriously weigh in the benefits of running through pain. If it’s a training run, it’s best to stop when there’s discomfort. If you stop at the first signs of ITBS without pushing that area into a full blown inflammation, your recovery time would drastically shorten to a few days or a week. Once the inflammatory stage sets in, trust me, the road to recovery is a long one.
   ( I by no means am suggesting not to push yourself beyond your limits, that’s what distance running is truly about. There is a fine line between discomfort related to fatigue and discomfort due to an injury. Experience really teaches you the difference.)
3. Patience. It’s a tough word to hear. But from my experience it’s the only thing that really helps the recovery. It took me a good part of 2 and a half months to finally get over this injury. I have friends who’ve been suffering for close to a year. Although they have been constantly seeking treatment, it does prove to be a rather stubborn injury to get over.
4. Stretching – That’s the most common advice I got for treating the injury. It does certainly help. I religiously stretched out my lower leg muscles twice a day for almost a month with extra emphasis to the ITB and even today make sure to stretch as regularly as possible.
   Here are some stretches for the ITB – Stretch1 Stretch2 Stretch3 
5. Foam Rolling – This was one of the most painful things I have ever tried. Foam rolling your IT band out hurts a lot. It does get easier and less painful with time. While some people do argue foam rolling isn’t very effective ( Link found here), which to great extent does make sense, it does feel good after a long run (after you overcome the initial pain of-course). If it’s not causing harm, I don’t see anything wrong in doing it.
6. Pain  and anti inflammatory medication – I never really took anti inflammatory medication for this except for the first few days after the acute pain had set in. This included 400 mg of ibuprofen once a day for about 4 days ( please consult your doctor before taking an anti-inflammatory. These medications can be harmful to the kidneys and if you’ve never taken them you could even be allergic to them) .
7. Hip Strengthening – I think this is one of the best methods to prevent future flare ups of the same problem. There are some very simple exercises you can do to strengthen  your hips. The video can be found here 
8. Gait modification – I do certainly believe having a forefoot gait is the most efficient and safest way to run long term. I was primarily a heel striker but have started incorporating forefoot running into my daily running routine. In order to do that you would have to avoid heavily cushioned shoes with a big heel to toe drop. Also make sure to ease into it, starting with a few minutes of your run and then eventually increasing the time. Forefoot running initially can give rise to achilles tendonitits which I did have an issue with. To avoid this I keep adding a few minutes of forefoot running and then transition back to my natural gait. The goal should be to have the toes touch the ground first with a minimal period of contact for the heels with the floor towards the end of a step. A good video to look at can be found here and here. If not just for ITBS, I think forefoot strikes still are the way to go to have a more efficient and faster run.
9. While I was taking a step back from from running I did come to the realization that while my conditioning was allowing me to run longer, my body wasn’t ready for it. Simply running more does not solve the problem. Cross training is a very important part of being a better runner. I’ve started working on core strengthening and other exercises to make sure every part of my body is ready for the increased mileage. This should  definitely prevent the recurring injuries I get while running longer distance   (remember small imbalances or weakness in your muscles don’t pop up when your running a smaller mileage.) I use an app called freeletics which has a custom built coach to guide you through exercises that use your own bodyweight. Some exercises I do are push ups, sit ups, burpees, pull ups, mountain climbers and squats. The list just goes on. I wanted something I could easily do at home rather than have to visit a gym every time.
   Lesson learned – To be a good runner, I need to improve my overall fitness not just from the waist below.

 

I hope this article helps you in some way if your suffering from this dreaded four letter word. There’s nothing more frustrating than an injury. The key is patience and correcting all your muscle weakness. If you’ve had a similar injury I’d love to hear your experience in the comments section below. Until next time. Happy Running!