CLINIC: ITB Pain, Going on Two Years

Wed, 22 Aug. 2012 - 4:14 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I’ve been plagued by iliotibial band syndrome (ITBS) for two years now, with pain in my knee that originally began at the onset of marathon training. I took about three weeks off from running after that race, and the pain did subside. Six months later, again while training for a marathon, the pain returned.
 
I’m frustrated because I was conscientious this time around about only gradual mileage increases. Any time I ran longer than 10 miles, I had pain on the outside of my knee. I completed the marathon anyway and then another marathon a month later. Although I have now taken four months off from running, I still occasionally feel knee pain when walking for more than half a mile or so. I have followed various stretching and strengthening programs to no avail. I don’t want to begin running until I am pain-free, but I am losing patience. I would love to know any thoughts you have for healing this type of chronic injury. I would even consider surgery.
 
Stuart Wright
Melrose, MA
 
ANSWER:
You seem to have given the knee appropriate rest with minimal to no results. There are several possible sources of knee pain. At this point, you need to make sure that you are not dealing with another condition, such as a chronic meniscal tear, a sprained LCL, or lateral chondromalacia (a softening of the cartilage). All of these conditions can be revealed through MRI. I would also see a sports medicine podiatrist or physical therapist for an evaluation of your foot posture and other running mechanics. If they are somehow compromised, this could well be the underlying source of the chronic pain. 
 
Brian A. Magna, MA, PT
Avon, CT
 
ANSWER:
I recommend seeing a physical therapist, who can suggest a variety of effective treatments that may help you. Cross-friction massage is a deep massage performed perpendicular to the fibers that are causing you trouble. It is painful, but very effective for treating ITBS. Another option is ultrasound treatment. Iontophoresis treatments, which use special equipment to electronically deliver dexamethasone into the skin at the point of inflammation, are also generally effective. 
 
With any of these treatments, you need to stretch regularly. Unfortunately, many runners only stretch on days they run, but they should really do so daily. Surgery is not something to consider for this type of problem. ITBS can be chronic and annoying, but it is certainly something that can be managed.
 
Ron Kleinman, PT
Akron, OH

(RUNNING & FITNEWS® November / December 2009 • Volume 28, Number 1)

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