My Nemisis

If you exercise, or (in my case) run long enough; you discover your Kryptonite. You may have begun your athletic endeavors feeling a bit like Superman, but give yourself time, we all have a Nemesis or Nemeses (that's plural for Nemesis, not just a different way to spell it)

I discovered my arch enemy 2 years ago. I ran 14 miles indoors on a small track. So small, that it takes 14 laps to make I mile. That's a lot of laps, turning, & leaning. The last few miles my left knee was hurting, but that was to be expected, right? - I WAS RUNNING 14 MILES INDOORS! - I mean really, pain was part of the deal I'd made with training for an early spring marathon.

The pain in my knee subsided some after the run and I just felt sore, achy and tight the rest of the day. I went to bed feeling accomplished and relieved to have one more long run out of the way. Sometime in the middle of the night, II was jolted awake by a stabbing pain on the outside of my left knee. It was the most intense pain I had ever felt in my knee, or any other body part for that matter. I did what anyone does with leg or foot pain in the middle of the night. I moaned and rocked back and forth and tried to massage it. Nothing helped and by morning I couldn't even walk on that leg.

After internet searches, doctor's visits & x rays, I learned that I had ITBFS: Iliotbial Band Friction Syndrome, commonly called IT Band. A term I had never heard of became common overnight (literally overnight).

Rachel Toor, an runner and author explains IT Band like this, "it's like having someone put a stick in your bicycle wheel - especially on the downhills" Now if you have struggled with IT Band, Rachel's comment will make you cringe because of it's accuracy.

So what exactly the IT Band and why does it cause SO much pain?

The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). Its purpose is to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways).

As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.

Iliotibial band syndrome is common in runners as 20-30 degrees is the approximate angle at the knee when the foot strikes the ground during running. In persons who run regularly this may lead to irritation of the ITB commonly known as iliotibial band friction syndrome.
The classic symptoms of ITBS are pain along the lateral (outside) aspect of the knee joint, sometimes accompanied by a clicking sensation. The click is a result of the ITB tightening and snapping across the joint during running. The symptoms are often worse when running up or down hills.

ITBS is typically progressive, starting with tightness and often advancing to the point where the pain is debilitating. The ITB will become tighter when it is injured. The tightness, however, is more than likely a result of the injury and not the actual cause. The cause of this injury actually lies in the function of the ITB.

Signs and Symptoms of Iliotibial Band Syndrome:

• Pain on the outside of the knee (at or around the lateral epicondyle of the femur)
• Pain normally aggravated by running, particularly downhill.
• Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
• Weakness in hip abduction.
• Tender trigger points in the gluteal area may also be present.

Just recently I ran 6 miles on that same dreaded track - yes it was stupid of me; and SURPRISE the IT Band pain returned after 2 years of keeping it pretty much at bay. So, here I go into another round of "Irritated IT Band Training"

There is a ton of information about the best way to deal with IT Band, I've found some of it helpful but I've also had to create my own recovery regimen.

So here's my advice for my Nemesis ITBS:

1. Begin with rest and stretching. That means NO running, stretching about 3 times a day and only doing cross training that does not aggravate the condition to maintain fitness.

2. Massage and Foam Roll - Elite runners suffering from ITBS get a professional massage every day. However that isn't in my budget, so a foam roller is the next best thing. http://www.smiweb.org/
3. Strengthen your hip abductors and quadriceps. One of the first exercises to do is a side leg lift. More instructions on stretching and strengthening can me found at: Stretching and Strengthening Exercises for Iliotibial Band Syndrome.

4. Examine your shoes. Often people suffering from ITBS benefit from a cushioned shoe as opposed to a motion-controlled shoe. If you are unsure about which running shoes is which; go to a running store to be fit for a shoe or read up on shoe reviews at http://www.runnersworld.com/topic/0,7122,s6-240-400-0-0,00.html
Dr. Doug Richie, President-Elect of the American Academy of Podiatric Sports Medicine (www.aapsm.org), has never been able to establish a clear-cut relationship between any foot types and the propensity to develop this injury. He states, however, that he has almost never seen this injury in runners with flexible flat feet that overpronate; most runners with ITBS would be classified with feet nearly normal or with a slightly higher arch

5. Avoid running on treadmills and small tracks. - Running outdoors provides more variation and any problems you have with stride are less likely to become a serious injury.

6. Examine your stride - you should land on the ball of your foot, and your foot should land directly underneath your body. Overstriding or heal striking can aggravate ITBS.

7. Run Faster, Not Longer. For some reason running faster with short quick strides is less aggravating to the IT Band than running slowly for a long period of time. So.... speedwork is your friend while you recovery from ITBS.

8. Don't sit too long. Your hip flexors become tight and eventually shorten with prolonged periods of sitting. If you have a desk job, get up and walk around as often as possible. Besides helping your IT Band it's good for you anyways.

9. Use KT tape. KT tape uses kinesiology technology and supports your whatever body part you put it on without restricting that body part. Check it out at http://www.kttape.com/

10. Wear CWX Stabilix Tights. These tights also use kinesiology technology and are well worth your money.

Seriously, # 9 & 10 have saved my running lifestyle. CHECK THEM OUT!

Well, enough sitting for me, I've gotta go foam roll my stinkin' tight IT Bands and head out into the cold for a winter run.