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ITBS: recovery and re-injury question for those in the know(10 posts)

ITBS: recovery and re-injury question for those in the knowJS Haiku Shop
Apr 11, 2002 7:16 AM
so, here's how it went:

week 1
injury: first time with this problem
took 5 days off the bike
next ride, bad by 25 miles, pain

week 2
took 7 days off
still feeling strange, made otrho appt
ortho says physical therapy
started PT same week, 2 sessions, mostly stretching & massage
PT says it's ITBS
frustrated with slow results, but hung in there

week 3
2 more PT sessions, stretching, massage, and exercises
rode 30 end of week 3, soft pedaled "bad" leg, no problems
knee feeling fine

week 4
clean bill of health from ortho
rode three days, ~30 milers, progressively harder, no problems
feeling stronger than before the problems started
saturday pushed 30 *hard* miles, little discomfort
sunday rode 30 easy, but hilly, pain

week 5 (this week)
off the bike again, pain/discomfort on front outside of knee, same type pain as before

daily: stretch, ice, stretch, ice, stretch, ice, repeat

here's my question:
for those "in the know", besides stretching, icing, massage, and very specific weight-bearing exercises, what else did the PT sessions accomplish that i couldn't do on my own? do i need to go back to the doc, or just try to manage this? going to the doc is across town, taking time off work and missing time at home, etc., but--if it's necessary to get better again, then--so be it.

i'm wondering if PT just educated me as to the importance and manner of stretching, advising me on pedaling mechanics (that i obviously overlooked whilst going hard on saturday), and kept me occupied while i was healing from the first injury?

reading more about ITBS, sounds like there's a "bursa" (or more than one) on the outside of the knee that the ITB rolls over at about 30% knee extension. from the way this stuff reads, the pain/discomfort i'm having in the knee is related to the bursa being inflamed from friction. am i just waiting for it to become "not inflamed"?

TIA!

J
You cured the symptoms but not the cause.Pack Meat
Apr 11, 2002 9:56 AM
Go back to basics and check your bike fit. An injury like this could be caused by your saddle being to high or to far back or both. I had this injury two years ago and went through the same rest periods that you did before attempting PT. One session of Pt with message, stretching and ultrasound was all that it took to fix me up. I got my fit checked and lowered my saddle about 1 cm and moved it forward a little. I was good to go after the one PT session and the saddle adjustment. After a hard ride or a hard week I definitely feel some tightening so I strech a lot.It's a frustrating injury because off the bike you feel fine but when you ride it hurts like a beatch
look at bike fitSteve Davis
Apr 11, 2002 10:06 AM
I've had problems with ITBS and solved it doing just what you are doing, but also changed my bike fit. Consider lowering the saddle and/or moving it forward a bit. Also, look at your cleat adjustments. Sometimes, ITBS can be helped when your shoes are "toed-out" a bit. Some suggest widening your q-factor by placing 2mm washers between your pedals and the cranks.

There is a new book available through Roadbikerider that addresses ITBS very well. I bought the paperback edition and have it at home so I can't quote it, but it also mentions another condition that is sometimes misdiagnosed as ITBS but manifests itself with pain a little lower than what is common for ITBS. In both instances, the remedy is to lower the saddle. The book is by Andy Pruit, MD and is very good, IMHO.

http://www.roadbikerider.com
re: ITBS: recovery and re-injury question for those in the knowfunknuggets
Apr 11, 2002 11:15 AM
As everyone mentioned, positioning is key in resolving knee problems. Ibuprofen in regular intervals could help the inflammation in this case, but could I suggest you check into something? Have you ever thought about looking into a chiropractor, a common malady is hips being out of line. The pain from this could manifest it self in a number of ways, one being with knee pain due to your strutural compensation on the affected or unaffected side. Just a thought since the traditional methods are not seeming to work.

My first visit to a chiropractor is next week... keep us posted as to your results!
re: ITBS: recovery and re-injury question for those in the knowLandsharkrider
Apr 11, 2002 1:04 PM
I went through this for almost the last 7 months (it first happened on Sept 20th - I remember like it was 5 minutes ago). I did the same thing with going to the Ortho Dr and PT - nothing helped. Even tried cortisone and Vioxx and nothing made a difference. It got to the point that I did not even turn a pedal from mid Nov - through early Jan.

In early January, I did some research and finally got serious about stretching. I stretch every night for 30 minutes while watching TV and do a good bit before every ride. I'm finally now at the point that I can ride pain free even though once in a while I get a twinge and can tell it is still there. WIthout the serious stretching, nothing would have changed.

Here's a good place to look:

http://www.pponline.co.uk/

Good Luck!
re: ITBS: recovery and re-injury question for those in the knowLandsharkrider
Apr 11, 2002 1:05 PM
This has good info too:

http://groups.yahoo.com/group/itbs/
ITBS...i finally shook it after 2 yearsmlbd
Apr 11, 2002 3:45 PM
i've had ITB on and off for over 2 years. it mostly bothered me when running, but it was a bit of a problem on the bike too. the secrets for me were the following. first, i STOPPED running. running was giving me the most trouble. i also stretched religiously. not just the ITB, but i worked hard on improving overall flexibility (yoga helped with this). I also did some resistance training this past winter (coupled with 2 months off the bike). these all helped, but as i increased my miles again the ITB began to threaten again. it didn't really hurt, but it didn't feel good. then i lowered my saddle about 2cm and the problem has been gone for 1 month of hard riding.

ice and ibuprofen definitely helped with the pain but you have to loosen up the ITB to get rid of the problem. lowering the saddle results in less strain when pedaling. Also, i've read that positioning your cleats so that your heals are slightly in toward the stays is supposed to reduce tension on the ITB.

good luck.
re: ITBS: recovery and re-injury question for those in the knowSharkman
Apr 11, 2002 8:37 PM
Re your question about is there anything unique in physical therapy that you cannot duplicate on your own - I just went through a year plus of visits to the ortho and PT to deal with shoulder impingement syndrome, the end result of thirty years of abuse to my right shoulder.

Saw the PT for nine weeks last fall, ultimately no help so went back to ortho and had surgery in January. Went to PT for three weeks afte that, and came to the same conclusion you did, namely that I could do everything I was directed to do in PT on my own. So I asked the PT, who is a good guy and he agreed.

I finished the post surgery PT on my own and am now 100%. I would give it a try.

Good luck

Bob
re: ITBS: recovery and re-injury question for those in the knowRojoRacer
Apr 11, 2002 9:25 PM
JS,

I've suffered with ITBS for ~2 years also. As you would imagine I've read up on it quite a bit, and tried many things as a result of the advice of friends, doctors, physiotherapists, osteopaths, and others.

The one thing that is apparent is that there are many causes of the symptoms associated with ITBS - and the bad news is that what works for one person may not work for another. This is to be expected as the ITB itself is a "band" that runs from your glutes to below the outside of your knee and is under the influence of more than 1 joint, and more than 1 set of muscles.

For me, the symptoms of pain on the outside of my left knee occured for the first time when I was stupidly began running for longfer distnaces than I had been training for (trying to push myself into fitness). I could not jog for a mile without this dull pain; and it stopped me from running, from cycling long distances, from walking confortably, and even from sleeping confortably. In fact, my whole lower left leg became twisted outwards in a complication related to ITBS.

I tried looking at my position on the bike to no avail, tried stretching the ITB to minor relief, tried taking 2 weeks completely off to no relief, tried ice, tried deflamatory creams, tried deep tissue massages, tried getting cleats with float to some relief, tried visiting a podiatrist to no avail.

About three months ago I went to see an osteopath. She looked at the alignment of my lower spine, hips, and legs and concluded that I had a twisted hip which could be the cause of the ITBS. This condition might have resulted from me not stretching properly. By this I mean not stretching all muscle groups when stretching - specifically I placed little attention on stretching the glutes.

So ever since, I have been religiously spending half an hour in the morning, and half an hour at night, stretching all muscle groups. The extra stretching of the glutes has IMO relieved the ITBS in my case.

To answer your question, the sessions with my osteopath were based around manipulation of my joints (hips, knees) and correcting their misalignment. To this end, I am of the opinion that this manipulation did help the misalignment of my hips. IMO you should keep seeing this PT if you are satisfied that you are getting positive results. If you are not getting better then what's the point? I actually went to two other specialists (for a period of about 2 months each) before finding my current osteopath, who had the experience/training/vision? to suppose that the problem might not be where the immediate symptom is.

From my experience, the question I would ask you is: are you stretching all possible muscle groups related to the ITB ?

Hope this helped..

-RR

PS: Having been relieved of the ITBS, I am now doing what I've been wanting to do for those 2 years .. riding long distances (upto 110 km) and racing!
thanks, all...JS Haiku Shop
Apr 12, 2002 5:15 AM
the stretches i'm doing are:

* calf (sitting)
* groin (butterfly/sitting)
* hamstring (runner's stretch/sitting)
* piriformis (sitting/laying)
* quad pull/itb (laying on side/assisted with other leg)
* itb (standing, stretched leg crossed in back)

doing these right now in the morning, at lunch, sometimes after work, and before bed. 3-4 times daily, then icing througout the day. wearing elastic brace to keep my patella in place, per doc's orders.

after discussing with my wife, she's advised me (threatened, really) to get back to the ortho. better safe than sorry. seems i'm driving her nuts, off the bike. her take is that if two weeks of PT worked before (regardless of their actual benefit), what's the harm?...my take is "whatever gets me back on the bike faster".

my neighbor is also a PT (geriatric). she says in her experience, this is a typical "athlete's syndrome"--meaning injury from overuse or over-hard use, recovery in PT, return to activity as strong or stronger than before, a few days taking it easy, then going all-out-gonzo in "play" and re-injuring. my response: d'oh!

thanks again, all...updates to follow

J