ITB

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Re: ITB

Postby Plastic bike » Thu Feb 18, 2010 2:47 pm

jagguy wrote:I suffer fro ITB syndrome and have seen many physios. I know what I am supposed to do strengthen VMO and stretch ITB and surrounding muscles.

Sounds easy but anyone else had this and can get rid of this for good. I seem to have recurring issues and orthotics havent cured it.

Buy a foam roller from the sports store and roll it out once or twice a week till it loosens up this seems to be the most affective way , I have tried all the stretches and had no luck but the roller works well.
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Re: ITB

Postby anth73 » Mon Mar 01, 2010 11:59 am

Thought I'd give you an update on how I'm progressing with the ITB.

Not good! :(

I resumed my commuting to work last week and made sure I stretched and massaged the ITB a couple of times a day. The guys and girls in the office had a good laugh with my stretches!

Anyway, things felt good and I commuted Monday through Thursday but backed off the intensity and only took Kew Boulevard on the trip home. I covered 116km and felt great, so decided to ride our regular St Andrews loop on Saturday. The journey out to St Andrews was fine however I waited about 10 minutes at the market and at that point my ITB got really sore. I cycled home basically only using my left leg.

I spent the weekend stretching and bought a foam roller from Rebel, which I've christened the Widow Maker. It absolutely kills rolling my ITB with it but I know it's for the best. I was able to commute at a gently pace this morning without pain and will cut my weekly km's by about 50% to give the ITB a break between rides, rolling and stretching.

More news to follow...as well as more rolling :twisted:
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Re: ITB

Postby jules21 » Mon Mar 01, 2010 12:23 pm

are you icing it? i'd hate to think you were suffering all that pain while there were easier rehabilatory options available..
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Re: ITB

Postby anth73 » Mon Mar 01, 2010 2:16 pm

Icing in the first 24 hours to alleviate the inflammation, stretching and rolling to work on the causes of inflammation.
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Re: ITB

Postby greyhoundtom » Mon Mar 01, 2010 4:29 pm

While I do suffer on occasions with ITB problems that mainly affect my left leg and knee, I did find that THIS article provided a good explanation of the symptoms, causes, and possible solutions.

Tom
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Re: ITB

Postby anth73 » Thu Mar 04, 2010 12:00 pm

Another rolling and stretching session after my commute home last night. I must say the roller was much less painful this time around. :D I roll each muscle group in each leg slowly a total of 10 times, where up and down count for one roll.

I've only ridden 60km this week with no significant climbing. Hoping to ride again on our regular St Andrews loop on Saturday but the weather gods may have other ideas by the look of the forecast.
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Re: ITB

Postby Peebee » Thu Mar 04, 2010 12:31 pm

I had severe ITB in my left leg over 18 months ago, touch wood I appear to have now avoided it for about the last 12 months. I found that all the stretches in the world would make the pain less for walking around and gentle cycling, however any effort would see the pain return to the stage it was uncomfortable to move the leg during sleep and I would be woken with the pain. I found climbing made it worse, particularly if I went slower than normal to stay with a group. Going up and down steps was a slow process taking one step at a time to lessen the movement of the leg. Last years TDU ride was coming up so I took a month off riding (during this time,when sitting, I held my leg out straight and kept it there for as long as possible many many times a day - helps when you sit at a desk all day), then did a couple of longer rides and made it through TDU without too much pain. After that I had great concern that I was never going to be able to do long and hard rides anymore and was considering seeking medical advise. After much research, I trialled fitting a wedge under my cleat, lowered my seat slightly (1.5 - 2mm) and spent a couple of months riding flats at very high cadence. After that I gently tried a few smaller short climbs and found myself to be pain free, and now am able to ride up any hill any length and ride over 170km quite comfortably (including this years TDU!). I am no doctor, but I believe the wedge and seat height contributed to the improvement (I notice a lot less movement of my knee at top of pedal stroke) as well as building up the muscles around the knee by doing the flat high cadence riding. I feel sorry for anyone going through it as the pain takes the enjoyment out of riding. Just make sure you pace yourself as there is nothing worse than heading out for a ride, then going further and further from home as you feel good, then it hits and you have to ride all the way back whcih then aggravates the ITB until you feel you cant bend your knee anymore. Good Luck - hope you get it sorted!
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Re: ITB

Postby cavebear2 » Thu Mar 04, 2010 2:33 pm

ft_critical wrote:In my case I fitted wedges under my left cleat, I got my saddle height (fore aft was not any effect for me, nor stem length etc,) right, and moved my cleats back (this reduced the flex of my ankle and hence lengthening of my ITB.
Was the problem with your right leg ITB?
Next pedalling technique. I had been dropping my heels to try to get better hamstring engagement. Fail. Anyway, this was the hardest part, but getting a smooth action on the pedal and not over working any part of the stroke. This really fixed things. Once fixed I was able to bring power back - i.e., turn a big gear on a hill without pain.
Were you dropping your heel before or after you achieved a smooth pedalling action?
My summary is, the problem was uneven leg length. The uneveness was excacerbated by fit, pedalling and biomechanical issues. Recommendation, see a physio and pro bike fitter.
Was you left leg shorter?
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Re: ITB

Postby ft_critical » Thu Mar 04, 2010 3:35 pm

cavebear2 wrote:Was the problem with your right leg ITB?
Were you dropping your heel before or after you achieved a smooth pedalling action?


Hi cavebear,

Left femur was shorter, so this affected me most on fast power climbs where I drove hard out of the saddle. I constructed my own wedge from a rice spoon...
I was dropping my heel in the mistaken belief that it was a way to engage my hamstrings, so prior to acheiving smooth pedalling.

On pedalling, if I had my time again, I would hire a track bike. Indeed I was only just talking to an A rider (a very good local) who is doing just that. I think, just my opinion, that pedalling at very high cadence forces you to use the muscles efficiently. With that in the bag, i.e., the correct technique, you can progress to stressing the technique with 1, 2, 3 phase climbing and other power building training. Just my opinion though.

But of course, first step is fit. And fit is not static, as you get better you can move to longer stem, higher seat etc. People often forget that when discussing fit.

Peebee and I have a simliar experience.
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Re: ITB

Postby anth73 » Thu Mar 04, 2010 4:55 pm

My right leg with ITB is shorter and combined with a slightly high saddle and heavy training load is probably the cause in my case.

Also agree that bike fit isnt static. Having lost weight in since my last bike fit 14 months ago it is probably due for a check.
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Re: ITB

Postby Sia » Mon Mar 08, 2010 3:39 pm

Where exactly is it that you guys are feeling the pain? When mine reappears it's the outside of my knee, where the ITB connects to the knee - not the ITB itself. The pain is there only if I'm riding or going up (or down if it's really bad) the stairs.
I'm wondering if mine is a variation of yours or if it's something totally different.
The exercises that my physio has given me are supposed to strengthen the glutes. She didn't say anything about stretching it though.
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Re: ITB

Postby jules21 » Mon Mar 08, 2010 4:40 pm

Sia wrote: Where exactly is it that you guys are feeling the pain? When mine reappears it's the outside of my knee, where the ITB connects to the knee - not the ITB itself. The pain is there only if I'm riding or going up (or down if it's really bad) the stairs.
I'm wondering if mine is a variation of yours or if it's something totally different.

that's it. it's caused by the tightened/inflamed ITB rubbing against the side of the knee.

Sia wrote: The exercises that my physio has given me are supposed to strengthen the glutes. She didn't say anything about stretching it though.

i was told that weak glutes can lead to poor pedalling/running technique, which puts strain on the ITB. basically your hips should be steady and not wobble/oscillate with your leg action. but i understand that's not the only cause.
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Re: ITB

Postby Dr_Mutley » Mon Mar 08, 2010 5:21 pm

ITBS has a biomechanical cause that needs careful analysis to correct. Cleat angles are usually where the money is. Seat height is usually less of an issue int ITBS than in patella/quads tendintis issues. Once the cause is found, stubborn cases respond quite well to being jabbed up by an experienced operator, or under US.
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Re: ITB

Postby Sia » Mon Mar 08, 2010 8:48 pm

jules21 wrote:
Sia wrote: Where exactly is it that you guys are feeling the pain? When mine reappears it's the outside of my knee, where the ITB connects to the knee - not the ITB itself. The pain is there only if I'm riding or going up (or down if it's really bad) the stairs.
I'm wondering if mine is a variation of yours or if it's something totally different.

that's it. it's caused by the tightened/inflamed ITB rubbing against the side of the knee.

Sia wrote: The exercises that my physio has given me are supposed to strengthen the glutes. She didn't say anything about stretching it though.

i was told that weak glutes can lead to poor pedalling/running technique, which puts strain on the ITB. basically your hips should be steady and not wobble/oscillate with your leg action. but i understand that's not the only cause.


Cheers :)
I wish my physio had explained it this clearly!
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Re: ITB

Postby anth73 » Sun Mar 21, 2010 4:47 pm

Latest update on the ITB and note to moderators, this probably can go in the cycling health section now :)

The news isn't good unfortunately. :cry: I've had a couple of really light weeks and this Saturday was my first group ride in over a fortnight. By the time we'd hit St Andrews (about 30km) I felt the dreaded pain in my knee again. I took it easy on the return leg but the climbs were painful.

More stretching and rolling at home and it is odd. The ITB isn;t anywhere near as painful to roll so I was expecting I'd be better than what was...which is a real bummer!

My lower back andpelvis are still not right so another trip to my chiro is booked in for Tuesday...this is depressing!
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Re: ITB

Postby cavebear2 » Sun Mar 21, 2010 8:25 pm

anth73 wrote:Latest update on the ITB and note to moderators, this probably can go in the cycling health section now :)

The news isn't good unfortunately. :cry: I've had a couple of really light weeks and this Saturday was my first group ride in over a fortnight. By the time we'd hit St Andrews (about 30km) I felt the dreaded pain in my knee again. I took it easy on the return leg but the climbs were painful.

More stretching and rolling at home and it is odd. The ITB isn;t anywhere near as painful to roll so I was expecting I'd be better than what was...which is a real bummer!

My lower back and pelvis are still not right so another trip to my chiro is booked in for Tuesday...this is depressing!

Hi,

I'm having a lot of success with the roller thing and 3 stretches that I've refined. Try push ups with the waist still touching the floor. This is a Yoga stretch, 'The Cobra'. Make sure that you get full extension of the lower back. Arms should reach straight position with the waist still touching the floor. You should hold this position for perhaps 5-10 seconds. If you can't get full extension with straight arms, keep working on it.

(edit: try keeping toes dug in to floor (or perpendicular to the floor) to get a good hamstring stretch as well.

This strengthens the lower back and for me, who has pelvic asymmetry primarily because of an L4/L5 disc injury which is a prime source of my ITB tendonitis (not really a tendonitis BTW) while on a bike. This also stretches my RH ITB very effectively if performed correctly.

As for Chiropractors - :roll:
Last edited by cavebear2 on Wed Apr 14, 2010 12:55 pm, edited 1 time in total.
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Re: ITB

Postby anth73 » Mon Mar 22, 2010 3:39 pm

Thanks for the tip cavebear2.

I came across these guys today in Eltham http://www.cyclingphysiotherapycentre.com.au/Home.html and was wondering if anyone has used them. The main contact is a physio specialising in cycling related injuries, treatments and analysis.

I'm also booked in to see my bike fit dude tomorrow as it's been over a year since I was fitted to my road bike and I'm now somewhat slimmer. I've also decided to ride just the road bike for now (as opposed to commuting on my cyclocross). I'm figuring this helps remove another variable from the weird equation of what the heck is going on at present! :evil:

Once I come good on the roadie I can get my bike fit done again on the commuter to match. I presently have it set up to match my current roadie setup as best I can.
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Re: ITB

Postby eeksll » Sun Apr 04, 2010 2:33 pm

Thought I might add my 2 cents. My ITB never got as bad as the OP's but bad enough for me to go to a physio.

I used the foam roller, on 4 positions
- Completely on your side (almost feel like your leaning slightly back).
- on the front (quads)
- there is another in between the above 2 which hurts more than the ITB.
- Then the inside of the leg (feel this mostly near the knee).

Also don't forget to do the muscle at the hips (right above the quads) and then the same position but on your side.

Other thing is to not just do it slowly, but when you get to a sore point just sit on that section for 30 seconds (but not too much longer). I think if you don't relax and keep your muscles tense (cause it hurts) its not as beneficial. I found when I sat on one section for 30 seconds (advice from physio) it was a bit easier to relax my muscles.

My physio never really suggested stretching but a friend told me a tip about this particular stretch which worked well:
http://www.physioadvisor.com.au/8278950 ... xercis.htm figure 2 someone else posted it before.
the tip is to start in a normal stance, point your foot as far as you can towards the center of your body ( of the leg you are going to stretch, the one that goes behind) I get about 45 degrees in, then cross your other leg over the top.
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Re: ITB

Postby anth73 » Tue Apr 06, 2010 8:22 pm

anth73 wrote:I came across these guys today in Eltham http://www.cyclingphysiotherapycentre.com.au/Home.html and was wondering if anyone has used them. The main contact is a physio specialising in cycling related injuries, treatments and analysis.


I saw Lucas Owen on Saturday week ago and spent two hours being treated for my lower back tightness and ITB soreness, as well as assessing my bike fit and pedalling technique. He picked up a couple of little things regarding my bike fit that could be contributing to my ITB dramas and the tight psoas muscles that are the culprits! My seat was 6.5cm behind the BB so we moved it forward to 5.1cm behind the BB. This also effectively raises saddle height by about 3mm. Given my weight loss it's not surprising my seat had to come forward a little...my "behind" isn't as well padded as it once was :mrgreen:

The pedalling technique analysis also showed I wasn't making the most ofmy power across the pedal cycle and a few tips had my efficiency imrpove by 20%. I can only do this in short bursts at present but now at least I know what a proper pedalling technique feels like.

the big test was our Saturday bunch ride to St Andrews and I'm pleased to report I was able to complete it pain free :D :D :D . I'll assess this over the next month before I call it a complete success but at least we're moving in the right direction now. My lower back is still tight, however the stretching program Lucas gave me is improving this.

All in all, if you're serious about your cycling and want to improve, or are troubled by poor bike fit, back soeness or the like, give Lucas a try. Some of his cost is covered by private health insurance depending on your cover but I certainly found Lucas to be one of those rare individuals who is really passionate about his craft!
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Re: ITB

Postby cavebear2 » Wed Apr 14, 2010 1:09 pm

Here's another ITB stretch Try this - centre bottom of page 2

It works effectively for me if I keep the leg that I am not stretching relaxed/bent with only toes on the floor. I can feel a significant stretch along the full length of the ITB all the way from the hip down to the knee.

Glad to hear you're having some success anth73.

Thanks also eeksll, I've taken note of your tips for the techniques when using the roller and will be trying 1 or 2 of the methods that I've not used yet. I did twig to relaxing and resting on the same point for 30 sec, also the point between the side and front of the upper leg being 1 of the sore points. Ouch!! :D

Regards
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Re: ITB

Postby Sia » Wed Apr 14, 2010 8:26 pm

cavebear2 wrote:Here's another ITB stretch Try this - centre bottom of page 2



That is fantastic, thanks!!
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Re: ITB

Postby cavebear2 » Fri Apr 16, 2010 4:33 pm

cavebear2 wrote:Thanks also eeksll, I've taken note of your tips for the techniques when using the roller and will be trying 1 or 2 of the methods that I've not used yet.

Update:
I've tried the roller on my quads and EEEEK :!: pain plus, close to and then past my threshold for pain, but it's all good - obvious beneficial results for the ITB and leg musculature generally, even off the bike! I find it extremely interesting that use of the roller in this way almost exactly replicates pain down the outside of the lower part of the leg that the Occ. Therapist I used to visit can elicit using his hands to massage. :D
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Re: ITB

Postby ft_critical » Wed Apr 28, 2010 3:28 pm

I really think that the massage is not the answer. If you are going to really stress the body - hill repeats in a big gear - massage will not allow you to do that for long - IMO. You need to fix the problem not try to treat the symptoms - understand where the problem is and translate this into an improved bike fit. It is interesting that this is the journey that the Op and I have been on.
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Re: ITB

Postby cavebear2 » Wed Apr 28, 2010 7:47 pm

ft_critical wrote:You need to fix the problem not try to treat the symptoms - understand where the problem is and translate this into an improved bike fit.
The 3 physios, sports doctor and the OT I have seen over the last 2 years have got it wrong, they don't understand the relationship of my back injury and how it causes/affects my hamstring/ITB problems. Obviously, neither do you, after all you're not me are you? I seem to be the only one who understands my body which I suppose is hardly surprising, after all, medical persons mostly either specialise or only have a general knowledge which often does not relate to specific sports injuries. As for bike fit, believe me it's all been done. Sometimes you come to realise that not all injuries are solved by bike fit some injuries such as mine are a result of my individual skeletal muscular makeup.
It is interesting that this is the journey that the Op and I have been on.
A very different journey to mine. I naturally have very tight ITB's and unless I go under the knife, I just have to learn to live with it and treat it accordingly with methods that I have, over time found to work. ie. customised stretching methods and the roller. Learning how to stretch the ITB effectively has been the number 1 thing that has helped me to recover. For other individuals other methods will be successful.
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Re: ITB

Postby Dr_Mutley » Tue Jul 26, 2011 10:09 pm

Any followups from the long term ITBS sufferers?

I have been fighting my ITBS for nearly 5 months now... Prior to this I never really had any ITB issues, even on big training periods (ie 800km/week blocks)...
I competed in the 3 Peaks ride in March and injured my ITB, and the rest is history. With about 60km to go I stopped for a rehydration stop and got my cleats full of mud. After some trouble clipping in, I had to quickly unclip 20km down the road, to avoid a kamikazee rider, and had terrible trouble getting out of my pedals. One violent twist to get out of my pedal was enough to tweak my ITB a little. Then, the next 40kms on the climb up the back of falls was enough to completely roger it.

A MRI a few weeks later showed severe ITBS with several partial thickness tears though the tendon. Two months off the bike with lots of massage, stretching and 7 cortisone injections finally got me to the point where i could walk without a limp. My pedal stroke however was still not pain free, so i had to drop my saddle 25mm and put my saddle a further 20mm forward to get pain free. Further to this, about 2 weeks of fine tuning my cleat position also helped significantly. The last 2 months i have been slowly building up to being able to do regular 80kms rides without much pain. Rides consisted of being in the saddle 100% of the time. In the last few weeks i have increased the intensity of my rides back to around 35km/h avg, added some out of the saddle stuff, and added a short hill climb to the route (800m of 8% avg). My ITB seemed to handle this ok until i started to lift my saddle height back towards where it should be. As soon as i lifted my saddle up 5mm, then 10mm, my power started to returned, but so did my ITBS. Tonite, after 30kms the crepitus (grating) in my ITB insertion got to the point where i pulled the pin and made the dreaded call to be picked up.

If I am going to be any hope of doing decent hill rides over summer I might have to bite the bullet and have an ITB release sooner rather than later. Unfortunately, with the genetic biomechanical makeup of my knee, I cant really see myself shaking this any other way (I am a little bow legged or genu varus). Did any of the long term suffers go down this track? or has anyone gotten back to full intensity? Some followups would be interesting...
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