IT Band problems

Sprains, contusions, cysts and tendinitis
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daisey
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IT Band problems

Post by daisey »

Has anyone had an inflammed IT Band? I slipped the other day on wet grass causing this to happen. It has progressively become worse. I usually sleep on my right side and cannot do this now because of the pain. It feels like a constant pull on the lateral side of my knee, which in return is making my kneecap constantly hurt.

What is the usual treatment for this?

How long does the pain usually last?

What treatments gave you relief?

My OS is out of town for another week or so, is it okay to just let PT treat this, or should I try to see the OS that is covering for him?

Any information will be greatly appreciated.

Thanks,

Daisey
05-2002 Chondroplasty and plicae excision Rt knee
07-2002/11-2002 multiple rounds of physio
11-2002 Open MPFL reconstruction
11-2002/05-2003 Physio
07-2003 Cortisione injection due to return of pain
2005-2007 Cortisone injections bilateral knees
2007 LR LT knee
5/6/2010 TKR scheduled LT Knee
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Heather_M.
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Re: IT Band problems

Post by Heather_M. »

IT Band...the bane of my existence. One question though--how do you know it's what's causing your pain? Just curious....

Anyway, I've had ITB Syndrome and scar tissue exacerbating it for about a year. The only thing that really works for me is stretches done by the PT. I can stretch it a bit myself, but my PT does a modified Ober test and that is pure bliss.

Treatment can include rest, ice massage, tissue work, stretching, ultrasound, iontophoresis, and gait training (if you walk with your toes poined up instead of pushing off of them w/each step, that is a sure way to flare the IT band). Also, try to point your toes with your other PT work for a while, it may help things calm down. Resistant ITBS is often treated with cortisone, by my doctor warned me that this is VERY painful and ended up doing it while I had anesthesia for something else.

In all this time, the IT band stretch, ultrasound over the spot, and ice have probably offered the best relief for me. Others may have better success with something else. There are a couple of stretches you can do yourself at home--look up on the kneeguru main page. If you can't tolerate them, my PT gave me a cheater's version that I can try to describe to you.

You probably are all right with the PT treating, unless you are unable to walk or anything. The OS would probably send you to PT anyway ;-) Ask your therapist for the modified Ober test as a stretch--it works the WHOLE IT band from hip to below knee. It's intense, but it helps so much.

Let's see if Snowcat has anything else from her 1+ year with ITBS. As you can see, and inflamed IT band can last for a while and make your whole knee feel miserable.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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daisey
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Re: IT Band problems

Post by daisey »

PT said that it was my IT Band. We started some stretches with my other PT and ultrasound today. My Pt is also doing some tissue work. The stretches have helped some, but it is still pretty uncomfortable.


Thanks for your reply,

Daisey

05-2002 Chondroplasty and plicae excision Rt knee
07-2002/11-2002 multiple rounds of physio
11-2002 Open MPFL reconstruction
11-2002/05-2003 Physio
07-2003 Cortisione injection due to return of pain
2005-2007 Cortisone injections bilateral knees
2007 LR LT knee
5/6/2010 TKR scheduled LT Knee
snowcat
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Re: IT Band problems

Post by snowcat »

Hi Daisey,

Like Heather, I've been dealing with ITBS that developed as a complication of a lateral release about a year ago. Here's what I've tried:

Rest: Probably the most important thing to do initially. Stop any activities that seem to irritate it, if possible...for me that even meant no walking for a while :( . I had to stop cycling too. Of course you can't stop sleeping ;). Try to sleep on your uninjured side with a small pillow between your legs to reduce strain on the ITB.

Ice: My favorite part of the day!

Ultrasound: didn't do much for me.

Stretching: I do lots of stretches (I think I have 5 different ITB ones)--it can give me instant (though usually short-lived) relief. Some say it's impossible to stretch the ITB itself, but stretching surrounding areas helps too. Having my PT do the modified Ober on me helped for a while.

Strengthening: Hips, gluts, and abs! Hip strength (adductors, abductors) is SO important. My gait has improved since I've started strengthening these areas. Simply walking with my abs tightened makes a difference (yes, it's a bit awkward). I had to stop a lot of the strengthening exercises I was doing, like leg presses, because they aggravated the ITB.

Taping: I've tried a few things here:
-Knee: Regular McConnell taping to correct a laterally tracking patella. My PTist surmised that this would put a continuous stretch on lateral structures including the ITB, and it helped me a lot.
-ITB: My PTist put 3 horizontal strips of tape across my thigh, starting a couple of inches above the knee, an inch or 2 apart. The tape pulled front to back and was supposed to unload the ITB. It made my ITB feel better but bothered my knee tracking/gave me chondromalacia pain again.
-Feet: Low-Dye taping!! What a miracle. Low-Dye stops overpronation and gives me instant, 50%-or-better relief.

Cortisone: Some say cortisone just masks the pain while you do more damage; some say it can calm down inflammation long enough for the ITB to heal. The injections give some people instant relief. It gave me an instant nightmare...made my probs 100x worse, even put me back on crutches! But apparently I am unusual (or "interesting" as the doctors like to say...great :P). Not many people seem to have reactions as bad as mine.

Gait Training, Orthotics: You can try various gait-adjustments but be careful not to overcompensate; any gait change effort should be accompanied by a related strengthening program. As soon as I had my gait analyzed (by a specialist...not all PTists are great at this), it was clear to me why my ITB is aggravated over and over, just from walking. I'm getting custom orthotics, which should have an effect similar to the Low-Dye taping.

One more thing here--a lateral heel wedge in your shoe can take the strain off the ITB. It typically helps people with leg-length discrepancies (a big cause of ITBS) but helped me even though my legs are the same length.

Soft Tissue Work: Absolutely essential. And as brutal as it may be, even MFR is not always enough. Researchers have concluded that many long-lasting cases of ITBS are a form of tendinosis, not tendinitis. That means that it's not an issue of inflammation so much as it's a problem with microtears and adhesions. More aggressive massage methods designed to break these adhesions include Active Release Therapy (ART), Augmented Soft Tissue Mobilization (ASTM), and I think maybe Rolfing (not sure though. I think Heather has tried Rolfing?) I'm trying ASTM. It's pretty brutal--I leave bruised, in pain, and exhausted. (I think I've described it somewhere on this board and I know I've posted about it on the yahoo board--see link below--if you want details). But, it's helping. I could barely walk when I started ASTM (along with the new strengthening program and Low-dye taping) at the end of June; now I can go for short hikes (short, slow, fairly flat hikes punctuated by lots of stretching--but that's still a tremendous improvement)!!

Yahoo has a board devoted to ITBS, which has been a great help to me:
http://groups.yahoo.com/group/itbs/

If you address your ITBS right away, it may resolve quickly. Hopefully you will never have to learn as much about it as I have ::) . Good luck!

snowcat


Last edited by snowcat on Wed Aug 28, 2002 9:56 pm, edited 1 time in total.
5/00: partial lateral menisectomy (R)
7/01: LR, partial lateral menisectomy, cyst draining (R), followed by ongoing problems with illiotibial band syndrome & adhesions
6/04: Much better!
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Re: IT Band problems

Post by snowcat »

Hey Heather, when you say to "point your toes with your other PT work for a while," do you just mean for straight leg raises? Anything else? I'll take all the help I can get :)

Thanks,
snowcat
5/00: partial lateral menisectomy (R)
7/01: LR, partial lateral menisectomy, cyst draining (R), followed by ongoing problems with illiotibial band syndrome & adhesions
6/04: Much better!
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Heather_M.
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Re: IT Band problems

Post by Heather_M. »

Yes, it includes other things. I've found that I tend to hold my toes up when my knee hurts, almost like I've got a blister on my big toe or something. It tended to carry over into EVERYTHING I did, and it was really stressing my ITB. To calm things down, I had to focus on pointing my toes for leg exercises, and also making sure my toes were pointed forward and in contact with the ground for ANYTHING I did (like squats--when I did them, calf stretches, hamstring stretches, stool scoots, step ups, rolling on the therapy ball--everything).

I also kept my toes pointed for leg raises, abduction, adduction (sp), hamstring curls and flexion exercises, biking (big one!), and ITB stretches. It goes against a lot of PTs' ideas of proper form for some of these exercises, so check with yours. But it REALLY helped calm my ITB down for a while. Then we gradually started adding flexed feet and I've been tolerating *ok* but not great. I can't tolerate biking without pointing my toes and ITB stretches without pointing my toes.

Thanks for reminding me of the ROLFing, I'd forgotten. The thing that most helped was the radiating pain in the thigh and hip, and also the overall tightness. It was a huge breakthrough--after 4 ROLFing sessions my PT was able to touch the knee to the table during the Ober stretch--and I didn't scream. However, I'm now back to excruciating pain at Gerdy's tubercle (I hate that I know all these terms now!!). It's really debilitating, and phonophoresis (ultrasound with cortisone cream) along with ice and stretching help--with painkillers added in the evening.

I'm at a loss as to what to do now. The one thing that brings this pain on the worst is sitting at the computer and working. But I simply can't take any more time off, so the knee is just going to have to deal. Any ideas?

H
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell
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Re: IT Band problems

Post by snowcat »

Great--thanks, Heather. I noticed my toes sticking up on my squats and hip-hikes. Oh, and biking too. I'll check with my PT. I've always flexed my feet for hamstring curls (even though I know you're not supposed to), so I'll have to stop that too, when the day comes that I'm allowed to do them again, anyhow.

I got my orthotics yesterday, so I will let you all know how they do after the break-in period!

Hmmm...I wish I had some good ideas about working. I'm always shifting my position, putting my feet up on various things, but on some days certain pains are unavoidable. It doesn't help concentration though. Sometimes I wish I had a brainless job during this period of my life...since, for some reason, having a difficult knee makes it more difficult to use my brain too ::)

snowcat


5/00: partial lateral menisectomy (R)
7/01: LR, partial lateral menisectomy, cyst draining (R), followed by ongoing problems with illiotibial band syndrome & adhesions
6/04: Much better!
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Jennifer
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Re: IT Band problems

Post by Jennifer »

Be sure to have yourself assessed for periformis syndrome at the same time. I tend to have the IT Band tendinitis and the periformis syndrome at the same time. The are different stretches that work on the periformis and I have had good results with them. I have also had iontophoresis and have found it to be amazingly calming when it is utilized up near the hip and then down by the knee. As a last resort the OS will do a cortizone shot in the periformis and once you get through the first few days it really takes the edge off the pain so you can do the stretches. The periformis isn't really absolutely necessary mechanically so there isn't the worry about damaging it with the cortisone.

Ice is still the best for the ITB when it occurs by itself. Ice whereever you get warmth from the tissue.

Good luck.

Jennifer
11/98 LR+chondro(L);Maquets T3 5/99(L),5/00(R);8/00 bilat hdwr removal;7/01 chondro+therm shrink(L)10/01-therm shrink(R);2/02, LR +chondro+menis repair(R);7/01 access navic excis (L) foot;11/02, bilat Baker's Cyst Asp;12/03 Roux-type T3 +meniscus trim(R),12/04 Roux-type T3(L) :o :o :o
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Re: IT Band problems

Post by Heather_M. »

Snowcat and everyone else,

I found a great resource with some excellent stretches for IT band problems. You must try....

The best for me is the modified Thompson stretch (buried about 1/2 way through)--my PT did it today and we were both amazed at the relief it provided. He plans to use it on all his cyclist and running patients from now on. I just wish it was something I could do on my own, but the ITB is one of those things that you need help to stretch really well.

Here's the link.

http://www.physsportsmed.com/issues/200 ... ricson.htm

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell
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Re: IT Band problems

Post by snowcat »

Wow, I'd forgotten everything I've tried for ITBS...rereading that article reminded me! Another really helpful tip in the article Heather posted the link for is self-massage using a foam roller. You can also use a taped towel roll (my PT gave me one) or a tennis ball--it really helped loosen things up for me for a while; in fact, now that I have the reminder, I think I'll start doing it on my other leg, which has been doing a bit of snapping too :(

As of a few months ago I still couldn't tolerate the Thomas test-stretch...but maybe I will have my PTist try again now. That was the most painful stretch for me right after my LR, then it got better, but it was unbearable again when my ITBS got really bad. I can't even do the quad stretch where you rest your foot on something behind you and stand tall...major pain in the whole lateral knee area, especially a bit above the knee--same pain I get with the Thomas. Heather, you won't get quite as good of a stretch (depending on how flexible you are with it), but you can lie like that on the edge of a bed or something and just practice bending the leg like that (I was just inspired to try it and I can do it now!!).

snowcat
5/00: partial lateral menisectomy (R)
7/01: LR, partial lateral menisectomy, cyst draining (R), followed by ongoing problems with illiotibial band syndrome & adhesions
6/04: Much better!
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Re: IT Band problems

Post by Heather_M. »

Snowcat,

I'll give the Thomas test another try on my own (I have a very high bed). When I did it on Sunday I put a lot of stress on my lower back, but today my PT showed me a couple of tricks to correct that. I really like the Thomas because it stretches the scar tissue around the upper lateral port from my surgeries--it's sucked down onto the bone, but gets a great workout with this stretch. I also get a lot of pull above the kneecap, another location of lots of adhesions--I can see why you found it hard to tolerate. It's intense.

You can also do the Ober stretch by yourself on the bed or couch, but I didn't get a great deal out of it because I couldn't keep my leg parallel to the floor. My PT said to loop a dog leash (!) around my ankle and provide tension to keep the correct posture. What do you know, it works! I think in my next life I'll probably be Gumby or something....

As for the foam roller thing on the floor, I found it causes blinding pain below my knee. Also, I have to hold myself up with both arms doing it, and I've got a bum shoulder (torn rotator cuff and labrum) that screams. My PT is pushing me to start doing this stretch, but the place where my ITB pain is worst is below the knee, and I really can't take any pressure there--especially after the PT has been digging plastic instruments into the area! He swears that the ITB is so long that I'll get relief below my knee even if I can only roll my hip on the foam thingy...we'll see.

Who knew a long band of gristle and sinew could cause such a fuss!

Heather
Last edited by Heather_M. on Wed Sep 04, 2002 7:49 am, edited 1 time in total.
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell
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