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ITBS 3 weeks from IM
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TeamT




Joined: 23 Dec 2010
Posts: 38

PostPosted: Wed Jun 12, 2013 1:58 pm    Post subject: ITBS 3 weeks from IM Reply with quote

Hello all,
I'm hoping for some advice from anyone who's managed ITBS through an IM. I'm 3.5 weeks from race day (Frankfurt) and have had a solid injury-free build up to this race. However, over the past week my right knee has been showing classic ITBS symptoms - I'm pretty famailiar with this having suffered from it a couple of years ago before IM Wales, where it crucified me on the run. It's currently only affecting my running and was sore enough today that I stopped running after 5k to avoid making it worse.
My running has been solid so far and I've put in several good distance runs up to 18 miles, so I think my endurance is OK. Likewise my bike training has included several rides between 100 and 115 miles over the past 3 weeks, so bike endurance is already looking OK.
So... I'm a bit too far out from the race to begin a taper but I'm also worried about aggravating this in the final weeks. I'm getting regular massage on the ITB and will work on stretching and foam rolling, but should I also modify my final weeks of running and cycling at all? Am I better off dropping sessions now and focusing on letting the ITB recover or will I lose too much form over 3 weeks?
Advice much appeciated...
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Jorgan




Joined: 12 Nov 2007
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Location: alles was ich bin, alles was ich war

PostPosted: Wed Jun 12, 2013 2:25 pm    Post subject: Reply with quote

Classic classic scenario! I'm in the calf injury corner 2.5 weeks from Austria, so I feel your pain. I've done one long run nearly 5 weeks out, and I don't think I'm going to get any more long runs in (had planned an 18 & 20 miler).

Well, you've certainly got all the base miles in, so as long as you stay fit and active, you should retain this; my plan is to actually have a more active first taper week than past years to try and maintain that fitness for longer. I think I'd rather have ITBS than a calf injury tbh, as you can manage ITB more, using ice, NSAIDs and the foam roller as it's not purely a muscular thing.

You're just going to need to do loads of foam rollering (but not too close to the event) get a couple of good deep-tissue sports massages before the day, the last being at least 5-6 days out and keep icing it. You could make some 'ice cups' and use them to massage the leg i.e. freeze some water in plastic cups (take it out of the cup first Wink )

On race day I'd use NSAIDs, but that's me. I had ITBS before my first LD race in Roth, and I too managed to get my long runs done, despite some pain. On the day I 'self medicated' and only got a few twinges Wink I used some Sodium Naproxen I had (not OTC in the UK I'm afraid), and I will use some Naproxen this year too, from the stash I got last summer when I did my back-in on the rower. Have you tried Voltarol? (Diclofenac) That's pretty good, as long as you take a prescription dose, rather than the single 25mg tablets they sell OTC.

Disclaimer - I wouldn't recommend any of this self-medicating to you though, I'm just recounting my own experiences Smile
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Stevep




Joined: 24 May 2007
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Location: Brize Norton

PostPosted: Wed Jun 12, 2013 3:03 pm    Post subject: Reply with quote

Ive been suffering with the same im doing IM france,ive not run for over 4 weeks just swam a lot i felt it first at IM Mallorca, its been the worsed few weeks going,lots of ice,massages,rollering,finaly the inflamation is going,my doctor is giving me a cortisone shot this friday,which will get rid of all the inflamation,i am hopefully just going to enjoy the day with no expections good luck i know how you feel
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largeade




Joined: 10 Feb 2010
Posts: 2159
Location: NE Hampshire

PostPosted: Wed Jun 12, 2013 3:13 pm    Post subject: Reply with quote

An ITB strap made a difference for me in the past, allowing at least some running I ensured I walked back at the first onset of pain. It also might allow you to complete the IM in the event of a flare up on the day.
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scratchy




Joined: 25 Feb 2009
Posts: 527

PostPosted: Wed Jun 12, 2013 3:37 pm    Post subject: Reply with quote

Typically how long does ITB inflammation take to go. I first got it on 26th April (only bike affecting). Its been getting better and better but I feel it a bit on rides over 2 hours.

It seems the inflammation is subsiding, but its taking its time (I ice it every night for 15 mins and do lots of foam rolling). I wouldnt even know I have it unless I were to go for a long ride.

Mine was caused through increasing both time & intensity in the TT position. I had ridden many many more miles with the exact same setup and never felt anything. Then after a bit of a piriformis strain which I stupidly trained through, it came on!
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TeamT




Joined: 23 Dec 2010
Posts: 38

PostPosted: Wed Jun 12, 2013 3:56 pm    Post subject: Reply with quote

OK - thanks for the replies and advice. It sounds it's a common boat to end up in. For me I think it's triggered by the final weeks of big miles and hours. I'm fine with middle distance training and had no worries training for the long distance worlds last year, but that final step up to IM seems to trip me...
Jorgan, the NSAIDs are a good option for most, but I have a history of stomach ulcers, so on top of all of the gels and carb drinks I think NSAIDs would be asking for trouble. I'll have to stick to basic paracetamol on the day I think.
I think I'll drop the running for a week and just ride longer instead. Then hopefully I can get a few gentle runs in over the taper. When I had this for IM Wales I learnt that it might not make for a PB but it's still possible to tough it out, so that's the worst case scenario.
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largeade




Joined: 10 Feb 2010
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Location: NE Hampshire

PostPosted: Wed Jun 12, 2013 6:29 pm    Post subject: Reply with quote

Suggest you work on your glutes/core (clams, lunges, planks etc), the last time this was discussed most ITBS people had weak cheeks. It took six weeks for me to get over it.
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IronMike




Joined: 31 Mar 2005
Posts: 1246
Location: Wimbledon

PostPosted: Wed Jun 12, 2013 8:37 pm    Post subject: Reply with quote

It is to do with affecting the muscles around the ITB as opposed to the band itself. The ITB is supposed to be tight. If it wasn't, your knee would collapse, or would certainly be unstable.

In my clinical experience, the greatest cause with triathletes and those types of athletes is weakness to the hip abductors - think glute med primarily. The ITB has an insertion onto the TFL, and if the hip abductors aren't doing their job, or are being overloaded by too great a training load, then the TFL will pick up the slack as it were. This causes the muscle to overwork and then tighten everything up.

There have been studies I have read regarding foam rollering and increasing muscle length in the hamstrings, but I'm not too sure hammering the ITB is the way to go in terms of trying to fix this. Put it this way, you possibly have a muscular weakness, so you work to stretch out the muscles only to tighten them straight back up when you train.

As you are doing Frankfurt (see you there), I would recommend the following:

1) What are the cleats like on your pedals? If your feet are in internal rotation (heel flicking outwards), this will cause tightness. You could try to reposition your cleats so that your heels are inwards (i.e. the heel is closer to the frame than it was). This will bring your leg into some external rotation and may offload the TFL enough to let you ride pain free.

2) Freeze a 2 litre Evian bottle and use this to roll your ITB. As mentioned above, I don't think that hammering up and down till kingdom come is going to fix you long term, but the ice and rollering will hopefully work to patch things up.

3) Ease off the running in favour of getting bike miles in. Running is the most likely to cause you problems as it places the most stress on the muscles mentioned. It's not ideal, but this is the hand you have been dealt. Far better to get a couple more quality bike rides in and no runs than have a mixed bag and get no quality sessions at all.

4) Long term - strengthening the abductors of the hip/have investigations as to why this has happened. In reality, strength work is going to have no impact upon your race as it will take far longer than 3 weeks to start showing. What strength work will do now is further overload these tired muscles and potentially cause you more injury.

Hope that helps.
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TeamT




Joined: 23 Dec 2010
Posts: 38

PostPosted: Thu Jun 13, 2013 7:38 am    Post subject: Reply with quote

Thanks for the comprehensive response IronMike. Very helpful and I'll bear all of that advice in mind over the next few weeks. I think the bike cleats are probably ok - I have no pain at all on the bike. Patching up with rollering and ice will have to suffice for this race.
See you there in 24 days...
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Ade




Joined: 27 Jul 2010
Posts: 521
Location: Leics

PostPosted: Thu Jun 13, 2013 8:55 am    Post subject: Reply with quote

+1 for tfl and hip mobility. Didn't get on top of my ITB issues until I started looking at my hip mobility. I use the foam roller and tennis ball to get at it.

This link may help - the whole site is most excellent

http://www.athletestreatingathletes.com/mobilization-techniques/gluteus-mediusitb-mobilization/
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2Tri




Joined: 20 Feb 2012
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PostPosted: Thu Jun 13, 2013 9:50 am    Post subject: Reply with quote

in exactly the same place doing Frankfurt also, it flared up a few months back and took 3 weeks off with physio treatment, I now roll and stretch every day to try and get it to subside but as my running miles have increased I can feel it flaring up again. Just going to keep rolling as much as I can and stretch as the physio advised. I am run/walking the run anyway due to this issue I haven't been able to run over 10miiles straight without pain. Frustrating niggle that just won`t p**s off! hope it gets better. Ive never heard of a ITB strap but could be a short term solution to get me through frankfurt without perm injury

cheers ade will give that a go
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scratchy




Joined: 25 Feb 2009
Posts: 527

PostPosted: Thu Jun 13, 2013 10:47 am    Post subject: Reply with quote

Ade wrote:
+1 for tfl and hip mobility. Didn't get on top of my ITB issues until I started looking at my hip mobility. I use the foam roller and tennis ball to get at it.

This link may help - the whole site is most excellent

http://www.athletestreatingathletes.com/mobilization-techniques/gluteus-mediusitb-mobilization/


If the TFL is being overworked, would it also be a good idea to strengthen the TFL. Many people think a strong muscle is also short. If you release the TFL and then strengthen it, surely this could also help?

Also, if the glute med is being worked too hard and fatiguing (passing the load to the TFL), should one not also try and strengthen the glute maximus muscles so the medius don't have to take the strain?

It seems the hierarchy goes (thinking mainly about cycling, but probably true for running):

Glute Maximus
Glute Medius
TFL

When the TFL finally gives up, the ITB can flare up.

Is my understanding correct
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peterh1975




Joined: 20 Jul 2009
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Location: Teesside > London > Teesside

PostPosted: Thu Jun 13, 2013 11:19 am    Post subject: Reply with quote

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Ade




Joined: 27 Jul 2010
Posts: 521
Location: Leics

PostPosted: Thu Jun 13, 2013 5:48 pm    Post subject: Reply with quote

strength work for ITBS - I like this


http://strengthrunning.com/2011/02/the-itb-rehab-routine-video-demonstration/


replace 'thera-band' with old inner tube Smile
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2Tri




Joined: 20 Feb 2012
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PostPosted: Fri Jun 14, 2013 1:06 pm    Post subject: Reply with quote

Ade wrote:
strength work for ITBS - I like this


http://strengthrunning.com/2011/02/the-itb-rehab-routine-video-demonstration/


replace 'thera-band' with old inner tube Smile


+1 exactly what I was looking for

thanks
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2013 - Outlaw HIM - IM Frankfurt - Monster Half (Relay) - Newbury Sprint - Oxford HM

http://robrfu.blogspot.co.uk/

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