The pain remains
November 27, 2011 6:54 PM   Subscribe

IT Band problems: Tried the foam roller, deep tissue massage, building the muscle and stretches (all to no avail). What are other remedies?

I have had a chronic problem with my knee for over a year and a half, diagnosed ITBS. Even without walking, there is always pain and it is always in the distal (outer) part of my knee. It hurts/burns after a long walk or short stint of jogging. I have tried everything to fix the problem. I have tried the foam roller (feels like I am rolling on a speed bump -- ouch!), tried stretches, tried muscle increase, and have worn the doctor-prescribed orthotics for over a year now. The pain is still there.

It always hurts in my right leg, and occasionally hurts in my left leg.
The medial (inner) part of my right leg hurts on occasion too, right under the knee.

For a month I tried resting my leg completely to see if the pain would stop. It is the end of the month now and the pain is still there.

To sum up, things I have tried:

Long term rest
Stretches (I am now very flexible, so that's cool)
Strength Training in hip abductor/gluteus
Foam Roller

If anyone has any experience with chronic knee pain related to IT problems, maybe you could suggest a remedy? I am seeing a 2nd doctor very soon who may have some answers, but I was hoping to get other opinions. Thanks
posted by xinglin91 to Health & Fitness (12 answers total) 5 users marked this as a favorite
My friend has the same problem with you. She finally went to physical therapy. She purchased a treadmill and also some of the exercise equipment they use at the PT so that she can continue the exercises after the allowances ran out.

There isn't really anything that you can do yourself because a physical therapist can watch you and push you to do what you need to so that you can strengthen the muscles to relieve the pain.

Good luck.
posted by Yellow at 6:59 PM on November 27, 2011

YMMV of course, but for me? Barefoot-style shoes. Started with Nike Frees, moved on to Vibrams, never looked back, and haven't had anything more than a minor twinge in years. I don't run a ton, but I run 5ks every other month or so, and have no particular problem.

I was originally diagnosed as a pronator and tried orthotics, and they kinda helped but not a lot. Apparently my feet just want to pronate, goddammit, and when I get out of their way they work just fine.
posted by restless_nomad at 6:59 PM on November 27, 2011

What worked for me was PT and balance training. Core/strength does no good if your balance is off.
posted by roomthreeseventeen at 7:10 PM on November 27, 2011

Hmm, perhaps you don't actually have ITBS, but instead something else, like a bruised bone? IMNAD, but I've had ITBS, that was diagnosed as a bruise. Frustrating, but I'm glad you're getting a second opinion.

Man, Wall Sits seemed to be the solution for me - you did mention strength training. Try those? Incredible things.
posted by alex_skazat at 7:45 PM on November 27, 2011

I should also say that foam roller seemed to be a good thing, long term rest for me did NOTHING.
posted by alex_skazat at 7:46 PM on November 27, 2011

That sounds more like a patella problem than an IT band problem. Gentle leglifts on a machine to strengthen the muscles around the knee?*

*IANAD, just some random dog on the Internets.
posted by Napoleonic Terrier at 8:13 PM on November 27, 2011

Better foam rolling will help. Get a squishier one, lean on blocks to support some of your body weight. PT will help a ton too.
posted by barnone at 8:37 PM on November 27, 2011

Best answer: I'm a massage therapist, so I am familiar with this issue as well as the terminology used to describe it. The outer part of your knee is lateral, the inner part is medial. Distal refers to areas on appendages that are further from the core of your body. Things that are closer to your core are proximal, and things that are further away are distal. So, for example, your feet are distal to your knees.

When you say you sometimes have pain "under" the knee, do you mean distal to the knee? or deep inside your body under your knee cap? Either way, this doesn't sound like IT band issues. ITBS causes lateral knee pain, because the IT band attaches to the lateral knee. You may have two separate problems, only one of which is ITBS, or you may have a problem having nothing to do with your IT band.

You say you have tried foam rollers and stretches; did those result in the loosening of the IT band (on the lateral thigh)? The idea here is that if the IT band is tight, it can pull on your knees or hips and result in pain and misalignment. If you notice your IT band loosening up when you stretch or use foam rollers, but your knee pain doesn't reduce at all, that seems like a sign that the IT band isn't really the culprit in your knee pain. If, on the other hand, the IT band stays really tight, then maybe you need different stretches, a different foam roller or technique, or just to do the stretches and rolling more often or vigorously.

If you actually have ITBS, you should try to reduce the level of inflammation in your body (well, really you should do this anyway, but it's especially important if you have an inflammatory disease). There are lifestyle routes to that (an anti-inflammatory diet; herbs and spices such as ginger and turmeric) as well as medical routes (NSAIDs). Simply icing the knee can help temporarily.

The fact that the knee pain is mostly on your right side seems like a clue. Have you ever had your leg lengths measured? If not, get someone to do it who knows what they are doing (a physical therapist or chiropractor who regularly does this). They should take several measurements starting from different points, and then average it. Even a slight leg length difference can manifest in hip and/or knee pain. If you have a difference, make sure those orthotics account for it. You may need a heel lift.

Take a look at the bottom of your shoes and see if the wear patterns are different on the right and the left. Also, if you can, get a new pair of shoes after any orthotic changes and notice if they wear more evenly. If not, there's still something unbalanced about your gait.

Also notice what activities of daily living might place more stress on your right knee. It could be something as simple as driving, if you do a lot of it. Experiment with different postures and positions for sitting, sleeping, driving, working, etc. And check in with your knee periodically to see if something you're doing is making it worse or better, at a level that you might not normally notice when you're busy focusing on other things. Often people's activities aggravate or relieve their pain but they don't notice it until later, when it either gets really bad (or much better) or when they aren't so busy and have time to notice it.

As for not feeling better despite a month of rest: when you say resting your leg "completely", what does that mean? Total bed rest? Just not running? Cartilaginous areas such as the knee take longer to heal that muscle, because they get less blood supply. Bed rest, therefore, is actually counterproductive because you don't get good circulation. It would be great to do something like easy swimming, that would get your blood pumping but not put much stress on your joints. Also, massage is great for circulation. You should gently massage your leg around your knee several times a day.
posted by parrot_person at 8:57 PM on November 27, 2011 [4 favorites]

I've suffered from this for years in my right knee. I tried one of these and it was like magic - no pain during or after exercise. I tried to buy one but couldn't get it in time for an event I was training for, so stuck with the low-tech method. You need some cheap gauze bandage and some gaffer tape (the tape that is about 2" wide with cloth reinforcing - don't buy the super expensive stuff that is really stiff, just the hardware store brand is better). While standing, wrap the gauze bandage around your thigh directly above the knee cap - not too tight or too much, as the gauze is just there to stop the gaffer tape sticking to your leg. Then, wrap the gaffer tape around your leg (again, just above the knee cap) twice - quite tight but not so that it inhibits circulation. It will restrict knee movement a bit, but not enough to have an effect on walking or running. There's a video showing this here - relevant content starts at about 5:00.

Earlier this year, I completed this event. During our training in the months prior, 3 of the 4 team members struggled with this issue to varying degrees, one to the extent that he was going to withdraw because he couldn't cope with the pain after about 30 km, despite trying all sorts of strapping recommended by phisiotherapists. After using this technique, the problem simply went away for all of us and we managed to complete the 96 km with no knee pain (everything else hurt, though ...). Of course, it doesn't treat any underlying issue, but treats the symptoms perfectly. You might need to experiement with different tension/exact placement. If I was starting again, I would just buy the strap as it's cheaper over the long run and much less hassle, but you could try the tape method to see if it works for you first.
posted by dg at 9:57 PM on November 27, 2011 [1 favorite]

I didn't have problems to your degree, but it was a chronic issue with my running, and taking stairs. What cured it for me was:

1. Really disciplined, regular stretching and
2. Regular, intense foam rolling, at least twice a day.
3. Backing off my running or exercise (sounds you've laready done that).
4. Changing up my running form to a higher cadence (more footsteps), more midfoot orientated stride.

But really, I think parrot_person has it, I think you need more professional assessment.
posted by smoke at 2:19 AM on November 28, 2011

I had a really painful problem with my IT band a year or so ago. Turns out it was because I had advanced arthritis in my lower spine and I was compensating for the back pain by walking strangely...

Anyhoo, doing exercises to strengthen my core to help relieve my back pain in turn "cured" my IT band pain.

Maybe doing some pilates or other core strengthening might help?
posted by Zoyashka at 8:17 AM on November 28, 2011

Best answer: I have been struggling with ITB and anterior hip-flexor related knee, hip and back issues for over 2 years, owing to high mileage cycling and the related complex of weak/tight/imbalanced muscles. I have only made a real series of breakthroughs in the past 3 months when I ultimately decided that "rest" and "time" weren't doing a damn thing except making me fat and weak.

The below long anecdote is merely shared to illustrate how complicated and interrelated this sort of thing can be; the tl;dr version for me was: chronic muscle knots.

The central issue of my whole pain complex and related problems stemmed from the fact that my IT band on both sides is chronically tight. This I am told is a result of the amount of time I spend per week riding a bike, and not an inflammation issue; it is purely mechanical. So I spend a good deal of time (maybe 15-30 minutes 3-4 times/week) on the foam roller loosening it up.

In addition to my tight ITB problems, this is also what I have discovered, in no particular order:

My "leg length" issues (as diagnosed by a well-known, highly respected bike fitter who shall remain nameless) are not, in fact, related to leg length in any way at all, despite that I've thought I had "leg length" issues my entire life. What is, in fact, the problem, as ultimately diagnosed by both a more observant bike fitter, then confirmed by an exercise physiologist who did xrays, is that I have a right-forward pelvic rotation that has caused me to waltz through life leading with my right hip. It's slight, and not related to any major pathology (scoliosis, etc.) but it's enough to cause a whole cascade of side effects, with the upshot that my left IT band is chronically tighter than my right one, my left knee is achey and twingey, and my right glute and piriformis is always tight (as balance/compensation).

I am led to believe by several knowledgeable professionals in the physiotherapy / cycling biz that having this sort of slight "hip forward" or pelvic rotation issue has been found to be BY FAR more common than actual leg "length" discrepancies, and that right-hand-dominance tends to lead to right hip forward in most cases. The mechanics of hip-forward is similar to LLD (one leg presents as "functionally shorter"), but addressing the problem for both running and cycling requires thoughtful gait analysis and resolution; i.e. it's nowhere near as simple as shimming up a cleat or adding an orthotic and calling it good.

What helped in my case:

- A pretty nasty but comprehensive series of PT focussed on the major issues (lower back, hip and glutes on the right side; quad, ITB, vastus medialis and outer knee on the left). This was sort of the big basic "overhaul" so to speak, after which I did the following:

- Obtained a basic understanding of trigger point massage (i.e. what caused the pain/tightness in the first place), and getting a couple basic self-massage tools, such that I can do most of my own self-maintenance and greatly cut down on expensive PT office visits - instead of going twice a month, I now go maybe quarterly, less if I don't need it.

The trigger point thing was the real breakthrough because without understanding how pain can "radiate" (travel) from the source, you can do a bunch of PT that will temporarily relieve it, but you won't zap it entirely until you find the real culprit. A perfect example related to my sore left knee - I had developed terrible, terrible foot pain "hotspots" on the balls of my feet that mimicked plantar fasciitis. It was so bad at times that I was pedalling my bike and walking with a weird duckfooted gait that made my knee pain considerably worse. The pain on the bike was indescribably bad, and I was at the point where I couldn't ride for even 30 minutes without being in agony. It complicated my back problems as well, because, well, duh, that much pain makes your whole body stiff and tense. Anyway, after reading this book, I spent maybe, oh, twenty (eye-wateringly painful!) minutes bashing all the knots out of my CALVES (what?!) one night with this thing, and I haven't had a single bit of foot, knee, or back pain on foot or on the bike since. I know the calf knots were not the ultimate source of all the drama with my back (a bad bike fit was what set that off), but they definitely contributed to the overall bucket of suck.

- Started doing a bit of yoga (for flexibility); but focussed on lengthening and opening the front of my hips and chest, and NOT doing a bunch of "forward bend" crap, because doing those only exacerbates my "cyclist + computer monkey crouch". I focus on lengthening exercises for things like psoas, adductor, pecs and other stuff that's difficult/inaccessible/hypersensitive to work on for a massage therapist (as a girl, it's kind of ticklish and weird to have a PT working around my boobs for a pec massage, and the upper/inner groin is fiddly and weird for most folks, but maybe that's just me).

- Embarked on a course of graduated strength training focussed on core and posterior chain (for, er, strength). Squats and lunges probably seem like a really bad idea for my formerly sore knee, but they really have been the best thing to promote flexibility and strength in the problem areas, and they've all but killed what I call the "random wandering twinge syndrome" that I had chalked up to aging. Kettlebell swings and deadlifts seem like the worst sort of bad idea for my (formerly) bad back (weak L5) but I'm not herniated, only compressed, and "guarding" (resting) those muscles only made my problems worse, not better. You have to make sure you've got good form, and you have GOT to start gradually, is all. Without this kind of range-of-motion therapy, you're only compounding the weakness/tightness spiral that got you there in the first place.

- Started running. Well, walk/jogging right now. Again, this sounds like the worst idea possible for knee problems, but the idea is to promote strength and flexibility, with a side of "I'm a woman over 40 who needs some weight-bearing activity, and cycling isn't cutting it." I started Couch to 10K a few weeks ago, and so far, so good. For someone in my general state of constant activity, it probably sounds silly to do a "Couch-To" program, but like most cyclists I am so stiff and weak in the necessary muscles (not to mention: desk job) that the gradual transition is really what I need to not hate myself and give up from adaptation soreness.

- Thrifted my expensive, bulky, heavily cushioned "heavy pronator" running shoes and tossed my orthotics in favor of a thin, shitty pair of $12 Target gym shoes that fit properly, and more important, let me feel every rock on the path, whether I'm pounding or not and let my weird feet do whatever my weird feet want to do with a minimum of interference. I also got a set of Vibrams from my wonderful husband, but they're just not as comfortable or practical for everyday use on rocky trails and in winter weather.

In summary, if the doc says there's no actual osteoarthritis involved, I think it's best for you to try a few different things until you find what works FOR YOU, and I also think it's good that you're getting another opinion. Work with a qualified PT and/or massage therapist to see if there are imbalances or tightness issues elsewhere that is causing or contributing to the central knee issue.

These things can be super complicated and everyone's got a different set of contributing factors, so as in my case above, tracking down the source can be a frustratingly long and expensive process that seemingly boils down to orthopaedic wack-a-mole. Trigger point therapy was what solved it for me; I hope it works as well for you!
posted by lonefrontranger at 1:33 PM on November 28, 2011 [3 favorites]

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