We've been around runners and triathletes long enough to know about the dreaded - ITBS.
Well so we thought , after listening to one of the world leading Physical Therapists and leader in research on running biomechanics Dr Rich Willy - School of Physical Therapy at The University of Montana in the US, what we thought about treatment for ITBS doesn't seem to be the case, now.
Firstly we suggest if you have symptoms of ITB or persistent pain when running or recovering it's best you seek professional advice and as we've previously stated we think seeing the teams in NSW at Aevum Physiotherapy, or iMovePhysio and in Qld, Pogo Physio are your best go to's for running related injuries.
So the skinny on ITB -
Will present as pain on the lateral side of the knee (outside of the knee).
Will normally present during a run - normally at the same time/total k's each run.
Presents more when running downhill.
More predominate in males.
Very common with trails runners given the amount of downhill running involved.
IT'S A TRAINING LOAD ERROR.
1st Myth - It's a Friction Injury - Dr Willy states, studies now tell us its a Compression injury.
This is important given the advice and treatment previously and still given.
- Foam Rolling and Soft Tissue work (massage) is not recommended*.
2nd Myth - The problem is the ITB being tight - once again Dr Willy mentions this is not the case. Running is made of differing sources/parts of the body that store and release (energy). The ITB being one of these places, so it doesn't make much sense having a stretchy flexible ITB - and thus stretching it when/if you have ITBS, similar to what we know now of the Achillies Tendon and it's treatment.
What could a Physio do... Well a good physio will have you walking out with a plan that could look something like PAIN Management => Load Management => Return to Run Program.
What you should DO - Keep Moving
What you should STOP - Going downhills or stairs (when possible)
Physio's can use several tests to help diagnose ITB -
The Nobles Compression test is one.
However, a runners history and recent running log will in the majority of cases result in a correct diagnosis. Chatting recently to both Aaron Babb - owner of Aevum Physiotherapy @aevumphysiotherapy and Co-Owner of iMOVE Physiotherapy @imovephysiotherapy Michael Rizk they both priorities a runners history and training load in clinic when assessing and treating.
Pain Management is important for runners and, well, humans in general. But as runners it definitely doesn't mean Stop Moving. Keeping a good degree of fitness is not only good for the body but is very very important for the head. Walking uphills or on a treadmill with an incline is something Dr Willy suggests. Some non-weight bearing hip exercises are also suggested early on in the pain management phase. Interestingly Willy also suggests including the Thomas Test/Exercise as part of a runners rehab.
The Thomas test can and still is used to help diagnose ITBS - although Willy isn't a fan of the test, he does however suggest using it as an exercise. Start at 10 reps and build to 20.
Once you're able to get around without pain - such as walking down a flight of stairs,
start to decrease the incline on your treadmill or the incline on the hills you're walking up - starting at 5%, you should look to work your way down over a couple of weeks.
Way back when it was about KT26s and not the Nike 4% or Next% - Rest was normally what an injured runner would be told - these days it's, continue to load. That doesn't mean continue running, it means continue moving and doing some weight bearing exercises to help the injury. Think about it, a run that takes approx 40mins will mean a runners foot strikes the ground approximate 7,000 times - Willy refers to each foot strike as "a load cycle", so continuing that load cycle all be it in a reduced capacity, will;
1) Keep the body moving
2) Assist in recovery and most importantly keep you sane! Because runners hate not being able to run right??!!
Education is key - Why or How did this occur and lets prevent it from happening again. Knowing how much to do, how many ks to run and what sessions to do is something running coaches do. It's something we at runLOCAL pride ourselves on whether you're about to launch into your 2020 running program or trying to reset after an injury. We're here to help with Personalised Running Programs or we offer a supported one-off return to run program. Simply send us an email - email@example.com. Spaces for 2020 online programs will OPEN SOON.
CrossTraining is something runners love to avoid or put off but can ensure you're not starting from scratch when you do get back running - Swimming and Boxing are great non weight bearing exercises to do to keep that aerobic fitness.
A fantastic exercise to do once you're through the Pain stage is the Split Squat.
Sometimes referred to as the Bulgarian Split Squat. In the early stage of Load Management start with the rear leg (the rear leg is your injury leg) on a table and then progress to a lower chair then add in some hand weights. The key is having the weight go through the rear leg - lowering and raises very slowly ( 3 secs down / 3 secs up ).
It's recommended to do both legs
start by doing 2 sets of 6-8 reps, 3-4 times per week.
progress over 3-4 weeks to doing 3-4 sets of 6-8 reps with a decent weight (slowly remeber)
PlyoMetrics Baby! As we mentioned earlier, running is about Store and Release so get a good 2-3 weeks of Plyometrics in to ensure you do hit the ground running (and bounce back 😉) - Lateral Skaters are a great exercise that can be progressed by using a band overtime.
Back to Running Woohoo!!
You've been walking on the tready or hills - reducing the incline and slightly increasing the pace. You've been doing some hip exercises along with some cross training AND you've been diligent with your Split Squat exercise. You've got yourself a coach to manage your load or return to run program and you're ready to go..
Before you get too excited, if you're a trail runner you'll have to avoid the trails a little longer and yes that means grass and soft surfaces - Dr Willy states that the advice on easing back into running on grass isn't as good as a flat bit of road or path. One up for the road runners!!
Increase your cadence - yep science and studies now tells us that increasing your cadence can reduce load - so in the early stages of your return to run program try increasing your cadence by 5-10%.
Now, to answer something we mentioned earlier - *Should you Foam Roll the ITB - NOPE! It's a compression injury so foam rolling is not suggested. Dr Willy also mentions massage is not an effective way to help ITBS either. He does go onto say that if you are "a consistent foam roller and it makes you feel good - then continue rolling as you would normally".
We hope that helps you either now or in the future or even a friend you know that's suffering from one of the most popular running injuries. Like we said at the start, ITBS is a TRAINING LOAD ERROR if you're not sure what your running should look like week to week - get in touch, we'd love to help you runHAPPY an runPAINFREE.
Damon and team.