Tuesday, April 30, 2013

ITB - Training and Injury Update

It was bound to happen, I DNF'd my first race last weekend as a result of my now two-month-battle with ITB Syndrome. The looming question is where do I go from here? Unfortunately, I have two constraints pulling at me from both ends -- this injury seems to really need time and I have a race to prepare for in eleven weeks.

A quick little recap: I realized I was injured during the Old Pueblo 50 mile run in March. At the time, it was more of a dull ache/tingle in my upper hip/thigh area (sort of the tensor fasciae latae and upper portion of the ITB). I wouldn't describe it as pain, but I knew it wasn't "right". A few days after OP50, I tried to run again and that is when the knee kicked in -- extremely painful, particularly on downhills and stairs, classic ITB. My initial response was to approach it with relative rest (see below) and I did well for awhile. Along with rest, I did some active release and started doing even more cross training. I had not had any knee discomfort in several weeks, but the hip discomfort remained. My patience went out the door and I pushed things a little the week of April 15th, running three days in a row for the first time and running five days total for the first time. I had a flare up the following week, then my DNF, both severe knee pain. The odd thing is that my knee typically goes back to normal within 12-24 hours and I am unlimited until it flares up again.

I have researched ITB tirelessly for the past two days and have come to only two solid conclusions: 1) for all the great medical research and advances out there, there isn't much conclusively known about it and 2) the only thing that appears to be a sure fire cure is time. If you Google ITB, you will get answers all over the map -- stretch it, strengthen your hips, ice, etc... But the truth is that there is very little that supports any of those things as "cures". Many of those cures are found after relentlessly trying to rid of the injury, but time is likely the greatest cause to healing.

Time is the enemy of the training runner. How much time? All indications are that mild cases could be a few weeks and more complicated cases could be several months. Chronic cases may take surgery. My inclination is to believe (hope maybe a better word) that I have a pretty mild case. After all, I've run for 2.5 - 3 hours four times in the past month with only one flare up. The other difficult question is whether I need to give it full rest or "relative rest". Full rest being no running at all and avoiding any activities that irritate either my hip or my knee (nothing seems to bother it other than running). Relative rest is what I was doing most of the month of April -- running every other day, about 50% of my normal weekly miles, and shutting down at any sign of pain. Of course, the risk with relative rest is that it prolongs the injury even if you can train through it.

There are lots of turns that this post could take, like discussions about the potential "root" cause or whether I am "meant to be a runner", but I'll just leave you with some details of my plan for now. Here is my plan:


I aim to have full rest for at least one week and maybe as much as three weeks. With eleven weeks to go before my race, I think I can recover from a two week layoff and still train enough to run at high level.

Cross Training

As long as it doesn't bother either my knee or my hip, I will cross train 4-6 days per week during my rest period, and then 3-4 days per week once I resume training. While there is relatively little evidence to suggest that it cures ITB, it is still good work for me to be doing. Plus, I enjoy lifting weights. I have consolidated the overwhelming amount of cross training stuff that I've discovered into three things:

The exercises in my favorite book, Anatomy for Runners. I discovered a convenient and structured workout designed using the exercises from this book. This stuff is great because it distills things down to relatively few exercises to cover a broad spectrum of total body health: posture, stabilization, power and strength.

Another group of exercises that I plan to mix in are from the book Run With No Pain. The exercises in here are very similar in nature, but add a circuit component and just a little more flavor to mix things up.

Finally, I will continue to incoporate some of the work done by Jay Johnson. In addition to the general strength stuff, I really like using his Myrtl routine for dynamic stretching before both running and weight training.

That is pretty much it. During this next few weeks, I will continue to re-evaluate and see if I can find reasons to change my strategy. And I will likely continue to formulate other plans in case my body doesn't respond to several weeks of rest. But, I sure hope it does because the will to fight through more injuries is really starting to wane. My absolute nightmare scenario is either showing up with more half-assed training or with a worry that I might DNF again. I need to get by this thing for good.

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