No more marathons
Sorry, this has probably been worked to death.
Is ITBS the diagnosis when there is nothing else specific that can be determined? Is its what’s left after other things have been ruled out?
There’s a short and a long version of my situation below, but here are my questions without reading either version of my tale of woe:
Is either a cortisone shot or dry needling effective with this time of “injury”?
I’m going to see my PT, and possibly an ortho next week – but would like to hear the comments (or commiserations) from those with similar experiences.
Short verision: my butt hurts, and has hurt since the beginning of June. Went to PT about a month ago, diagnosis was possible ITBS – prescription was a couple of specific exercises and rolling. It’s getting better and I can run 4 or 5 miles easily, as long as I run slowly, and keep my stride somewhat short. But as soon as I try to pick it up, the pain returns, sometimes with a vengeance.
Race horizon – I have three track events in three ½ weeks at the NC State Senior games and I want to do well enough to qualify for the National senior games next year. Under normal circumstances that would not be too difficult – looking at the past few years my times would place me in either first or second in all three events (800, 1500, 5000) and all I need is a fourth place finish to go to nationals.
Plan is to continue with exercise and slow runs for the next two weeks – take two or three days off and show up for my events. 5000 is Thursday morning, 800 is that afternoon, and the 1500 is Friday morning.
In the meantime, I’m wondering about either a cortisone shot, or dry needling.
Long version: My butt hurts. I ran (not raced) a marathon on April 21 – felt tired after like a good long run. Took about a week off and got back into training, but for shorter distances. First set of paced workouts was on April 30th with 4 X 400 at 5K pace minus 10 seconds (average). The next week was our local senior games and I competed in the 1500 on Monday and the 5000 and the 800 on Wednesday – winning my age group in all three (OK, there was only one other guy in my age group). The following two weeks I did three track workouts with 400s, 800s, and 200s all at 5K minus 10 to minus 20 pace. At the end of the second week I raced a local 5K and set a new old man PR at 21:02. But during that last week I began to feel a twinge in my left hip – high up on the iliac crest. The twinge was with me in the race, but not enough to slow me down. Two days later I went out for a medium long run and at about 7 miles the twinge turned to pain, and by mile 8 I was walking. Walked the last mile home. But the pain had migrated to the connection of the hamstring and the glute.
I took 5 of the next six days off and then resumed regular runs of 4 to 7 miles over the next two weeks. I then ran a time trial mile and got an old man PR of 6:12; I hit the 1500 meter mark in 5:42 – a time I would be delighted with at the senior games.
That was the last time (June 24) that I've run pain free. I took a week off after seeing a PT who diagnosed possible ITBS and gave me some exercises to do. Have run 21 of the 31 days in August, but all much slower than my normal workout pace, and only about 20 miles per week.
Other quirks – can work out on an elliptical machine with no pain. Going up and down steps is not a problem. Running slow is mostly pain free – running fast, not so much. Sitting causes discomfort about 80% of the time. And that discomfort can radiate from glute to calf. (weird).
Boston 2014 - a 33 year journey
Lordy, I hope there are tapes.
He's a leaker!
Hip Redux
ITB is not typically a diagnosis of elimination - it is a tight or irritated ITB throwing things out of alignment and increasing inflammation in the knee, etc. In my experience, at least.
So the ITB runs along side the leg - people usually complain of high hip pain over butt pain. Is it more the side of your butt that hurts? Or really the glutes? You mention it's as high as the ilium - the other thing to consider is something like bursitis, which can be in a similar side-of-the-hip location (yellow spot in the below diagram).
Active release techniques help - graston, ART, etc definitely help with an irritated ITB (been there, done that). I have no experience with cortisone or dry needling in the IT band, but treatment for bursitis can be a cortisone shot to reduce the inflammation of the bursa sac.
Oski - Great illustration.
The initial symptom was pain at the very top of the IT Band - at the top of the Iliac crest.
But that went away after about a week. Then after some too frequent speed work and racing the pain returned (or maybe it was all new) and presented as pain in the glute and tightness in the hamstring. Now, the pain that comes on with any amount of speed is a sharp pain at the very base of the glute or top of hamstring.
Sitting on a hard chair, or a bench seat that cuts into the leg about mid thigh seems to cause discomfort in the entire glute and can radiate all down the leg. It's not much, say 2 on a scale of 10. And just shifting weight off of that cheek can eliminate the discomfort.
Could it be piriformis? That hurts in the butt and when sitting.
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Traci
If it is in the glutes, dry needling could help - people swear by it.
I've seen some discussion on that also. That's why I kind of wondered if all/any of those have a specific diagnosis or if they happen to be what the particular healthcare professional settles on
MTA: I'll google that now and see if matches many of my symptoms.
I've been having similar pain recently (well, off and on for years, actually.) It's deep in the glutes, and sometimes the hamstring. Sometimes it radiates all the way down my leg into my foot.
Last week I went to see my massage guy. I told him that one thing I noticed, it hurts lying on my back in bed, but if I bring my foot up to my knee and let my leg flop to the side, it goes away. He worked a long time on my psoas muscle. It attaches to the spine, runs through the pelvis and becomes part of the hip flexor. If it gets wadded up, it can pull all sorts of things out of place. He said that if you can relieve the pain by bending the leg (taking the stretch out of the psoas), and the pain goes away, start with the psoas. Mine was considerably better after he worked on it, although it didn't completely fix it and I need another session.
Just a thought, I often find that the thing that hurts is not the source of the problem.
Thanks little blue - I don't think it hurts lying in bed, but maybe just never noticed. I"ll keep that in mind.
uʍop ǝpᴉsdn sǝʇᴉɹʍ ʇI
Once I thought I had ITBS and I went in for a massage. I had big knots that he worked out. Apparently the knots in my upper glutes were pulling on the ITB giving me symptoms of ITBS. The massage fixed it and since then I have been getting a massage every two months or so. I didn't read your whole long version, but try a good deep tissue massage if you haven't already.
Little Blue - nope, no pain lying in bed
Jack, you didn't miss anything in the long version - just a list of the workouts that lead to the injury. I'd think that all the rolling I've done would have worked out any knots in the glute, but who knows. Plan to get an appointment at a sports clinic this week.
This is no help to you but I will throw it out there in case anyone else had what I had, which was severe ITB pain on the outside of the knee.
Basically I had to start running with orthotics and/or stability shoes while working on strengthening my weak ass hips, which are the root cause for my ITBS.
I have found a combination of stability shoes, light stability shoes and inserts that work great for me and allow me to run and race my ass off. I have also finally found a program that really works on hip and core strength but I am not quite ready to take another shot at neutral shoes right now.
Most massage and physical therapists will tell you that runners are tight as fuck through the hips, glutes, quads and hamstrings. You could start there but that is not a quick fix but rather a lifestyle change that could take time to bear fruit.
Just got back from a 6 mile run that hurt the whole way, but was manageable.
The pain is now isolated to the upper leg in the back. As I'm sitting here typing this it's noticeable right where the chair puts pressure if you are sitting up straight and leaning forward - so not on the glute.
I'm beginning to think maybe piriformis is the more likely diagnosis.
Gotta love Dr. Google for self diagnosis.
Local Sports medicine group has walk in clinics from 7:30 to 8:30 weekdays. If I can't get an appointment I'll go that route.
This is no help to you but I will throw it out there in case anyone else had what I had, which was severe ITB pain on the outside of the knee. Basically I had to start running with orthotics and/or stability shoes while working on strengthening my weak ass hips, which are the root cause for my ITBS. I have found a combination of stability shoes, light stability shoes and inserts that work great for me and allow me to run and race my ass off. I have also finally found a program that really works on hip and core strength but I am not quite ready to take another shot at neutral shoes right now. Most massage and physical therapists will tell you that runners are tight as fuck through the hips, glutes, quads and hamstrings. You could start there but that is not a quick fix but rather a lifestyle change that could take time to bear fruit.
LRB - just found a post you had on piriformis here: http://www.runningahead.com/groups/BF_and_Beyond/Forum/Post/34a0191c690c4e7b97fd952c1a748484#focus
I had found those stretches earlier today when I was searching for alternatives to the ITBS exercises my PT gave me. That third one is impossible for me - no way I can get my leg to lay completely to one side like that - it just won't bend that much.
Just got back from a 6 mile run that hurt the whole way, but was manageable. The pain is now isolated to the upper leg in the back. As I'm sitting here typing this it's noticeable right where the chair puts pressure if you are sitting up straight and leaning forward - so not on the glute. I'm beginning to think maybe piriformis is the more likely diagnosis. Gotta love Dr. Google for self diagnosis. Local Sports medicine group has walk in clinics from 7:30 to 8:30 weekdays. If I can't get an appointment I'll go that route.
No, I totally diagnosed you!
Anyway sit and roll around on a tennis ball and if you roll over a spot that hurts so intensely that your eyes immediately tear up then you prob have a pissed off piriformis.
If you do have piriformis the stretch called "thread the needle" (sitting on a chair) really helped me and rolling on a tennis ball.