For those that have experience with ITB issues

I have worked through ITB issues for 2 years. Last year, the worst, I had switched from Brooks Adrenaline to Saucony's Trigrid.  It was in the Saucony's that I suffered the ITB injury. AFter 6 weeks of rest, a fantastic massage therapist, and a NEW pair Brooks, I have had minimal problems. I do find that if my shoes are broken down and squishy or if my Smart Feet insoles are broken down, that I am much more susceptible to ITB pain.  I have now learned to replace my shoes every 250 miles, because that's what my body needs. And I'll never stray from my Brooks again.

 Your ortho could also give you a cortisone shot in your ITB, but this would just eliminate the pain, but not really fix the problem.

As a 4 time Physical Therapy patient with ITB problems I would suggest a couple of things.

1) Stretch, stretch, stretch. I would always start to have problems as the weather would cool down and not stretch diligently. Every time in PT they would say it could have been prevented had a I stretched more.

2)Shoes- I wore Mizuno Wave Riders for years, probaly a good 15 pairs worth but a doc told me to move to a stiffer shoe like the Aiscs Fortitude but a good shoe guy could tell you whats best for your foot

3)Orthotics- I had a mold made for my foot and my right foot collapses when I run so I had orthotics made to prevent that

Most likely it all goes back to #1

My experience with ITB issues have been limited. I attribute some of this to having a strong swim background and very flexible legs. I have had ITBS over the years and it is a very frustrating thing to heal from. Stretching is a good prevention but I would stay away from stretching once it is injured.

My experience has been that once I injure the ITB the only thing that helps recovery is rest. This advice came to me from a radiologist that I work with who is a marathoner of 30+ years. NO ICE, NO STRETCHING, NO ADVIL, just REST. Stretching just re-injures healing tissue and ice slows down the blood flow that is trying to heal the injury.

In my case, I took 4 or 5 days off of running. Completely off, no "testing " it. Biking and swimming did not irritate my ITB so I was able to continue working out. (Thank god for being a triathlete. ) After 5 days I ran for about 1/2 mile, it felt good so I continued without any problems.

Previous bouts with ITBS had me stretching, going to a PT, icing and not enough rest. I would start up running and be back in PT in a couple weeks.

Make sure you aren't increasing your mileage running too much too soon. My coach is pretty strict with the 10% increase rule and has me stick to that.

Once your ITB is healthy, stretching and ice after runs are all good things. It is different once you are injured.

I am not a physician and this is only my $.02 from MY experiences.  

I have some twinges of it every now and then (usually when I'm tired, when my shoes are wearing out or my form breaks down).

There are two stretched that I do that help get rid of it for me.

1)  Typical bend over and touch your toes with feet together.  But to make it stretch the tendon/muscles that are the ITB, cross your legs over.  Simple as that.  Stand up, try it and you'll instantly feel it if you have ITB issues.  Light stretching before my runs when it's bothering me, more afterwards.

2) Little more involved, and better results for me is the standard calf stretch modified.  Do the old "holding up the wall" with one leg extended back and the other in front bent.  This stretches the calf muscle.  Here's the twist to activate the ITB stretch ..... Bend the knee on the leg stretched back.  This will stretch the achilles first of all.  Now straighten out the leg that is in front while keeping the back bent (you may need to bring the back leg in just a bit to do this).  Boom, you'll feel it in the ITB.  To get even more feel for it?  Twist your hips slowly in rotation away from the leg in front (i.e. - if your left leg is forward, twist lightly counter-clockwise).  You'll REALLY feel it then.

These have worked for me when I've had issues with it.  And massage/ice the whole tendon after long workouts.  All the way from the hip down to below the knee.

Interesting as I had my gait analyzed yesterday by a bio mechanical specialist. I've struggled on and off with running issues for 13 months and have an Ironman in 7 months. I've seen an ortho, neurologist, a podiatrist, gone to PT for 7 months, seen a second PT and no one could help me figure out the cause and get it fixed. Some came up with part of my problems but she was the first to put it all together. I have very tight ITB but thus far hasn't caused me any problems the PT say it is because I have very strong quads, but needs to be addressed as it is a matter of time before I have issues from it.

This women zeroed in on the many gait issues I have do to my body's unique things. I posted in my blog about what happened and what she found and I'll repost it here since you are asking about it.

My suggestion is to see the best person you can who studies bio mechanics and figure out the why behind your issue. Due to my body I'm tight from my heel cords thru my ITB and my hip. I drove 160 miles each way to have this done. If you live near Waterbury CT I'd go see here. Sue7013 has a medical friend in DE who does similar evaluation if you could go there.

Her advice keep stretching and Yoga like I've started doing is great and wear orthotics.

"Gait analysis was interesting. I was video taped walking and running barefoot on a treadmill. My feet were examined, measured, casted, photographed and done all sorts of things to. I supinate not over pronate like some have said and have some other interesting tweaks..like super tight heel cords which is the reason why get Plantar Fas. and achillies tendinitises + I have a short 1st metatarsal and then add in mid-foot landing and my achillies and everything gets stretched over and over and really over stretched. My right leg is a little shorter than left which is why my right leg gets bothered the most with PF and AT.

She says I recoil very quickly, my heels barely touch the ground and that my calves are well developed in part do to the way I walk/run. I almost cross over with my feet while running and walking in part to try and get my 1st metatarsal down to help push off but I push off not on the right joint but end joint of my big toe.

Orthotics and keep stretching are key. Funny thing she says you will get injured (over use injury) just nature of being endurance athlete for what you are training for and the hope is with orthotics and the right shoes you keep it at bay longer.. She doesn't like my Newtons..too flexible soles. My old New Balance soles were to inflexible so I went from one extreme to the other. She thinks since my legs/feet have been okay with Newtons it could be that I haven't done a lot of running in them and they may work with orthotics may not.

She has this cool way to classify feet (both the heel and forefoot 24 different types) and I have #5 feet (forefoot valgus deformity small amount and rear vorus devormity large amount of inversion) . It means that I typically won't have knee issues riding which I don't. I can try orthotics in my bike shoes but don't need them. Stiff soled shoes should help and my balls of my feet used to cramp in my old tri shoes. Once I changed to wide men's carbon soled bike shoes I've been fine which agrees with my type of feet and what she said.

I was impressed with this women. She has been studying bio mechanics of walking and running for 20+ years. She saw me as a favor to my referring doc and didn't even charge me for the 1.5 hours I was there."

Over last 3-4 months I had concluded that I needed to address the whole string of me from my feet to my hip & back as everything seems to be tight and connected. I had back surgery about 11 years ago. Interesting how she saw me as connected whole person with issues in various places that effect my running and hopes to make it possible to stay injury free more.

I just got the Spinnervals Flexible Warrior 1 Yoga DVD (from BT store). It has 3 different workouts and one is for flexibility. It focuses on your legs/hips mostly. The 30 minute workout is fantastic and does ITB band stretched as well as addressing all muscle groups in your legs. I'd highly recommend it.

There's a lot of things that could have happened with the change in shoes, and biomechanically you might be predisposed to frequent ITB issues.  I would NOT go ahead and jump on the REST suggestion, as people who are prone to frequent ITB issues know that you can rest till the cows come home, only to flare up on return to activity.

If your have a pronating foot and not the right type of shoe/orthotic, your lower leg will tend to rotate (torsion) causing the knee to deviate inward.  This in turn can cause hip rotation issues, thereby shortening some muscles and lengthening others.  Bring the back in, and you could be predisposed to issues from the top down and from the bottom up.  Trust me, it's not just happening at your source of pain.  There are other areas that need to be examined.

IMO, I would seek out a physical therapist who has had training in gait/running analysis.  If they have OCS and/or FAAOMPT as credentials, even better.  Orthotics training, better still.  Start there, as they'll look at the whole body and not just pidgeon-hole your care by looking strictly at the ITB. 

EABonney - 2007-12-20 12:33 PM

lawyerchick - 2007-12-20 1:47 PM Just a little more food for though - after my latest occurrence of ITBS, I started with a mile. A single mile - and a run/walk regimen of 3:1 run/walk to begin with. I did this on the recommendation of my running coach. That was in August, and I'm now up to 8-9 miles for my long run. I never would have done the run/walk approach without her suggestion, but her specialty is runners with injuries and it's exactly what I needed. 3 miles to start back is probably too much.

Oh yea...3 miles was way too much to start back with. I am not sure what I was thinking, guess I was just used to going for 6 milers and I figured 3 miles was cutting back. The doctor called and the results of my MRI showed lots of fluid around the IT Band but no tears. So guess it is just getting therapy and being trained on how to stretch it properly and getting my gait fixed.

Definitely do everything your PT tells you.  My MRI showed about the same and despite several PT's attempts I still landed at surgery.  ITBS can get very chronic.  So, knock it out NOW.