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S&C UnderGround >> Damn, bad news at the ortho...


12/30/12 9:58 PM
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big_slacker
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My hip/IT band stuff is teh suck. I'm out of running for 3 months. Kills any early season tri stuff for me, I'll have to start out doing base miles end of march. :(

Oh well, good news is I'll me doing a lot of biking and swimming + upper body lifting, so all is not lost. Injuries blow.
12/31/12 4:55 AM
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Ham and Egger
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Sucks.
12/31/12 11:34 AM
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sly fox
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sucks, but you'll be back :)

12/31/12 1:13 PM
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Badmonkey
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"hip/IT band stuff is teh suck"

Could you give some more details about the injury/problem please?
12/31/12 2:48 PM
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big_slacker
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Edited: 12/31/12 2:48 PM
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Yeah, for many years I've been a mountain biker/road biker. This year (2012) I decided I wanted to start doing triathlon and that means running. I started out slow with a canned training plan but felt the mileages were really low since my cardio was already there from cycling. So one day I decided to just run in a heartrate range and just see how far I went before I felt tired. I got almost 10 miles in but started having a sharp pain on the outside of my knee when going downhill.

I immediately stopped the run because holy crap! Having read over the years about athletes blowing out knee tendons and never being the same I didn't want that. Googled, its a classic symptom of ITB syndrome which is basically a tight IT band (connective tissue that runs from your hip to you knee on the outside) rubbing across the knee joint.

Online there are a variety of 'cures' which are to lay off for a week or two, stretch it, foam roll it, do strengthening exercises for hips/hams/glutes (mine are pretty strong already from squats/deads but I did the exercises) and bands/braces.

No workie, even after 3 months of this I could feel the knee pain coming on even after short distance/intensity runs, usually in the 2nd-3rd mile range. So I finally went to a local sports doc (there is a big endurance sports community here and I was referred by a local athlete to this guy) and got checked out. He did some easy tests and was able to determine right away that I had no joint issues but just an extremely tight IT band and some hip muscle mobility issues.

He said before anything can happen the band needs to loosen up so I've got a stretch to do 10 times a day. After that the inflammation needs to die down and he said that can take a LONG time, especially if it gets re-aggravated by continually starting running again too soon. In my case the typical 1-2 weeks obviously isn't cutting it so a longer rest period is needed.

If I had an important race he said he'd cortisone shot it but that was just a bandaid fix for an event. I don't have any races planned in 3 months anyway, so no big deal. The more I think about it I'm just happy I can still ride bikes and there is no chance of it needed to get cut on to fix it. Count your blessings. ;)
12/31/12 2:59 PM
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Badmonkey
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Interesting... Thanks.

I ride a bike lots and have felt that area getting tight and needing extra work/massage/foam rolling over the last couple years. A few weeks of daily foam rolling/stretching and weekly massage made a world of difference for me. Good luck with the recovery.



12/31/12 5:02 PM
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martinburke
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I usually do much less work directly on my clients' IT bands than other therapists. The band itself is basically made of the same stuff as that shipping tape with the fibers embedded in it, so you'll get far more bang for your buck by concentrating on the muscles and soft tissues attached to either end of the IT band.

First check if your tensor fascia latae, gluteus min. & med. are loaded with trigger points. Look both in the muscle bellies and along the attachments up under the iliac crest. Dig into those, and then do some MET-type stretches on them...and then repeat the process.

Then check the area where gluteus max. tapers down on to the back edge of the IT band. Gluteus, IT band , and the lateral hamstrings all converge here, and it's a common area for trigger points to accumulate. Same as before: dig, stretch, dig, stretch

Now check the back side of the fibular head. There's lots going on in here: the IT band takes a little dogleg here, gastroc and hamstrings overlap, and you have peroneus longus adding to the clusterfuck. Dig around and you'll probably find all kinds of trigger points in there.

Check the deep tissues of the calf. In anatomy books, those tissues have no direct connection to the IT band, but they do in real life. I only have one thing to say about working the calf: google: "bone saw calf smash"

Now dig around the base of the first metatarsal( that bony prominence on the lateral foot). In particular look around the medial side of that base; this is where the peroneals and its fascia interact with abductor digiti minimi(AbDM) and flexor digitorum brevis(FDB). AbDM is tiny, but it has to provide support to the outside of the foot during heel strike...so it tends to glue down pretty damn hard.

It's small, but that little fucker can cause issues all the way up the body to the top of the hip.
2/17/13 8:59 PM
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big_slacker
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Edited: 02/17/13 9:04 PM
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I just wanted to bump this back up and mention that martinburke's advice here is GOLD. Despite the stretching things didn't really start getting better till I focused on pretty much everything he has listed here, including the calves which you wouldn't think would have an effect on this injury.

We're approaching the date where I can start to run again and I doubt I'd have been ready to go had I not taken this advice.
2/17/13 11:23 PM
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Chocolate Shatner
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b_s,
 
Don't worry man, but don't neglect it. ITB forced me out of the Army years ago, when the orthos there didn't recognize it for what it was, told me it was all in my mind, and told me to go run anyway. Hard to run fast enough when 100 yards into a run it feels like Barry Bonds is whacking your knee with a bat constantly. Once I found out what the pain was coming from (sadly after discharge), the problem got fixed relatively quickly.
 
On the other hand, now that you have it  diagnosed, taking care of it really isn't all that hard. The advice you've already read is good, just note that for different people different treatments seem to work. I've helped people quite a few times, and some have responded better to foam rollers, some to massage, some to stretching, some to corrective exercises.
 
Me personally, I responded best to this particular stretch.
 
My variation is instead of twisting and stretching the low back like the pose shows, basically use your arms to do a RNC on your knee. So, when the right leg is up, your right arm wraps around and secures a RNC on your leg, and vise versa. Seriously, this fixed me up in about two months. At the same time, I avoided running, doing like you mentioned of a lot of swimming, biking, elliptical trainer, etc.
 
Best advice until the ITB is gone: if it hurts, stop doing it. 
2/21/13 8:28 PM
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HERTSWENIP
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Edited: 02/21/13 8:28 PM
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See an ART certified chiropractor (bonus if he's also certified in graston technique; similar concepts but graston uses metal tools and they compliment each other very nicely.). Seriously, you will be AMAZED. Results are immediately noticeable.
2/22/13 6:56 AM
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glass neck
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Chocolate Shatner

just wanted to thank you for that stretch & image you posted

i'm pretty mich a "connoisseur " of stretches for ITBS, and although i've done that one before i've never focused on it or really sat in it for a long time

it has been GREAT for me the past few days

after dealing with ITBS for years and years, i have pretty much traced it down to my glute area and that stretch has realllly been nice and hit my main trigger points

thanks again
2/22/13 7:12 AM
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Adventure Runner
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big_slacker - Yeah, for many years I've been a mountain biker/road biker. This year (2012) I decided I wanted to start doing triathlon and that means running. I started out slow with a canned training plan but felt the mileages were really low since my cardio was already there from cycling. So one day I decided to just run in a heartrate range and just see how far I went before I felt tired. I got almost 10 miles in but started having a sharp pain on the outside of my knee when going downhill.

I immediately stopped the run because holy crap! Having read over the years about athletes blowing out knee tendons and never being the same I didn't want that. Googled, its a classic symptom of ITB syndrome which is basically a tight IT band (connective tissue that runs from your hip to you knee on the outside) rubbing across the knee joint.

Online there are a variety of 'cures' which are to lay off for a week or two, stretch it, foam roll it, do strengthening exercises for hips/hams/glutes (mine are pretty strong already from squats/deads but I did the exercises) and bands/braces.

No workie, even after 3 months of this I could feel the knee pain coming on even after short distance/intensity runs, usually in the 2nd-3rd mile range. So I finally went to a local sports doc (there is a big endurance sports community here and I was referred by a local athlete to this guy) and got checked out. He did some easy tests and was able to determine right away that I had no joint issues but just an extremely tight IT band and some hip muscle mobility issues.

He said before anything can happen the band needs to loosen up so I've got a stretch to do 10 times a day. After that the inflammation needs to die down and he said that can take a LONG time, especially if it gets re-aggravated by continually starting running again too soon. In my case the typical 1-2 weeks obviously isn't cutting it so a longer rest period is needed.

If I had an important race he said he'd cortisone shot it but that was just a bandaid fix for an event. I don't have any races planned in 3 months anyway, so no big deal. The more I think about it I'm just happy I can still ride bikes and there is no chance of it needed to get cut on to fix it. Count your blessings. ;)

I say it a bit on here, but find an Ironman and Masters level certified Active Release Technique practitioner in your area.

http://www.activerelease.com

If you are in eastern Mass, I can give you the name of my guy. He handles the MIT track & field team, Saucony's racing team, the Boston Athletic Association racing team, and a bunch of local professional and amateur athletes. I race a bit, and it has worked wonders for me. It has also worked wonders for every single other racer I've sent. Health Insurance will cover it the same chiro care.

One of my racer friends is a very marathoner. She wins some of the smaller ones. During one marathon she blew out her knee so bad, she had to stop at mile 18, and this is a girl used to running through pain (she raced 30+ hours on a fractured heel). The doctors thought she had a torn meniscus, she was in a full leg brace and on crutches. While she was waiting to get in for an MRI, I got her to see my ART guy. He said it was the most blown out IT band he's ever seen. No exaggeration, she was running the next day... I've had similar results with IT band tweaks, quadriceps tendinitis, and tennis elbow that I've had him treat. I used to need knee braces while running. Now I don't.

I'm actually headed in in a few hours to have him work on my ankle. I sprained it bad climbing 3 weeks ago. The second I came off crutches, I made an appointment.
2/22/13 1:15 PM
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glass neck
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AR

care to give a quick description of what goes on when you visit your ART guy?
2/22/13 1:57 PM
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HERTSWENIP
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I'm not AR, but I'm an avid fan of ART and have been receiving treatments for various injuries since 2006, with astounding results.

Diagnosis/evaluation will vary a bit depending on the training and educational backround of the practitioner. Some use FMT (like jon petrick, the guy that treats local ufc guys and is the official chiro for TUF).

What they have in common is they will listen to your verbal injury description, palpate the soft tissue with their hands, move your limb so that the affected muscle complex is in a shortened position, then apply pressure (*they call it 'tension') while you lengthen the muscle using the antagonistic muscle group. The process is repeated as they move in a specific pattern down the muscle complex. For unusual positions sometimes they will assist you lengthening the muscles in the proper movement pattern (ie glute medius).
2/22/13 2:00 PM
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HERTSWENIP
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It 'hurts,' but feels good like a deep tissue massage kind of way; you feel great after the session.

The most uncomfortable muscle groups to treat for me were my biceps (both practitioners said this was not common), subscapularis (pressure is applied in the armpit), and the hip flexors; they dig their hand into your gut/pelvis
2/22/13 2:21 PM
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Adventure Runner
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glass neck - AR

care to give a quick description of what goes on when you visit your ART guy?

HERTS gave a pretty good description. Think of foam rolling on steroids as you move the effected area through a particular range of motion.

Like he said, it can hurt like hell. It can feel weird too as pressure is applied to areas where it just doesn't feel right at the time. The funkiest place was when I had quadriceps tendinitis from an ultra mountain race I did. He started applying pressure right around the kneecap as I started sitting in the edge of a table in the top position of a leg extension. Then I'd curl my leg as he continued applying pressure in an upward motion. It hurt and felt weird, but I was able to run pain free after.
2/22/13 2:25 PM
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Adventure Runner
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^^ I can attest for the hip flexor ART hurting. I tweaked my hip flexor at another race. Holy dog shit does having somebody knead the hell out of your pelvis crease hurt like no tomorrow. It works though. I had known about ART for years, but I just never pulled the trigger. When I finally did, I kicked myself for waiting so long. I don't even go for just major injuries. Even those nagging small little tweaks you pick up training can be taken care of in a session or two as opposed to taking weeks to heal or just turning into a minor chronic thing.

I've sent so many of racing friends there with great results that they'll tell him about my injuries before I do. He saw me sitting in the waiting area today and was like "I heard you hurt your ankle". haha
2/22/13 2:41 PM
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glass neck
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Thanks fellas

I will look into it
2/22/13 6:54 PM
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big_slacker
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Thanks, I've been meaning to try ART. I'm in the seattle area where there are a lot of them, but it's looking more and more like I'll be back in tahoe permanently soon. There is an ART certified chiro there. I'm a little leery of chiros (the basis of the whole think is stil scientifically unproven) but results are result and it's not *THAT* expensive to try.
2/23/13 5:16 AM
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Chocolate Shatner
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glass neck - Chocolate Shatner

just wanted to thank you for that stretch & image you posted

i'm pretty mich a "connoisseur " of stretches for ITBS, and although i've done that one before i've never focused on it or really sat in it for a long time

it has been GREAT for me the past few days

after dealing with ITBS for years and years, i have pretty much traced it down to my glute area and that stretch has realllly been nice and hit my main trigger points

thanks again

No problem man. Thanks for the update.
2/23/13 5:11 PM
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Adventure Runner
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big_slacker - Thanks, I've been meaning to try ART. I'm in the seattle area where there are a lot of them, but it's looking more and more like I'll be back in tahoe permanently soon. There is an ART certified chiro there. I'm a little leery of chiros (the basis of the whole think is stil scientifically unproven) but results are result and it's not *THAT* expensive to try.

I was the same exact way with chiro's, which is also why it took me so long to pull the trigger on the ART. It's all in the practitioner themselves. Chiro adjustments... They work. All that other sublixation quackery though is silly. Luckily my ART guy/chiro gets a good chuckle from that type of stuff too.

My mother lived in Seattle until a few weeks ago. She had a good ART/chiro that she went to. I can get that name if you want.

And btw, I totally agree with the stretch CS posted. I've done it before and after every run, bike, or hike for years. It makes a big difference.
2/23/13 11:00 PM
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HERTSWENIP
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Edited: 02/24/13 2:23 PM
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Aye, ART is not based on subluxation quackery. See the ART site for a description, it's based on the very plausible physiology of breaking up scar tissue adhesions, restoring the proper sliding/gliding between tissues. MD's can and do get certifications for this as well, but they're fewer in number (Cos their primary education taught them surgery and medication are the best solutions. ART has saved me from a couple surgeries with better results), and the results speak for themselves; these days pretty much every pro sports team and olympic athlete has an ART guy.

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