While strengthening the legs before having ACL surgery on the left knee, I started feeling some mild pain in the side of my right knee. Of course at first I ignored it because I tought it would eventually go away, especially with the rest and pain medication that would go along the surgery..

I was only right for a brief period of time because eventually then the pain came back and since then I’ve tried almost everything to make it go away. At first I tought it was a patellar syndrome so I started strengthening the vastus medialis muscle, of course with little to no result.

Then looking around on the internet I found that I could have the iliotibial band syndrome. After watching some videos on YouTube I learned that it could be cured with stretching so I tried every stretch in the book but all my efforts were to no avail. I’ve also tried strengthening the abductors and adductor muscles but I didn’t solve a thing.

With no easy solution in sight and the frustration mounting I had to do some deeper research to really know what I am dealing with. The following information is from various websites and YouTube videos.

Symptoms of IT Band Syndrome
Because the most notable symptom is typically swelling and pain on the outside of the knee, many runners mistakenly think they have a knee injury. The best way to tell if you have ITBS is to bend your knee at a 45-degree angle. If you have an IT band problem, you’ll feel pain on the outside of the knee.

from: http://www.runnersworld.com/tag/it-band-syndrome

Ok so this at least confirms my auto diagnosis! Searching further for information I found these two YouTube videos that I find very very helpful and easy to understand.

Resolving Iliotibial Band Syndrome – ITBS by Brian Abelson
https://www.youtube.com/watch?v=l-4klP_BpE8

and the one and only Jeff Cavaliere
https://www.youtube.com/watch?v=5YYb9vyj6zQ

After watching the videos I just wanted to know more..

IT band stretching is just another obsolete bit of simplistic conventional wisdom, like a million other bad ideas that have been repeated infinitely on the Internet. Stretching your iliotibial band is probably only a slightly helpful treatment, at best. At worst, IT band stretching is a complete waste of your time, and reinforces an incorrect understanding of how IT band pain works.

[…]

  • The iliotibial band itself is just too tough to be stretched. Even smaller tendons that are easy to pull on are extremely difficult to elongate, requiring long hours of painful stretching such as dancers and gymnasts do. But the ITB is the longest and most massive tendon in the human body! It’s also not free to move like most tendons: it’s anchored along the length of the femur!6 Imagine bolting a 2-foot strip of thick tire rubber to a plank of wood in several places. Now try to “stretch” it! You might be able to apply some tension to it, but it’s certainly not going to elongate significantly.
  • The tensor fasciae latae, the muscle that most directly controls tension on the iliotibial band, is the most promising target for stretch. But it is a hip abducting muscle, so to stretch it you primarily have to adduct the hip: that is, the leg must move towards the midline. Unfortunately, there is relatively little movement available in that direction: the other leg is in the way. About the best that anyone can do in this regard is to cross the (stretch-side) leg over the other leg, and push the pelvis out. It is possible to stretch the TFL and IT band in this manner … but not strongly.
  • The gluteus maximus is essentially unstretchable: a surprisingly long muscle, it is just impossible to flex the hip enough to apply much tension to it, because the thigh meets the belly too early … even in a skinny person. In someone with a little bit of belly fat, it’s hopeless.

[…]

In 2010, Irish researcher Dr. Eanna Falvey and her colleagues measured the mechanical effect of a basic IT band stretch (like the standard one illustrated at right) plus a more sophisticated stretch, and found virtually no difference: the IT band was effectively unaffected, making it one of the unstretchables. And that was including knee flexion, in a stretch carefully applied to corpses by anatomists!9 If that doesn’t move the IT band, certainly runners don’t stand a chance.

from: https://www.painscience.com/articles/iliotibial-band-syndrome-stretch.php

This article if promising but of course to go on reading you have to pay, so I moved back to the runnersworld website, to be precise to this page: http://www.runnersworld.com/injury-treatment/treating-itbs. There they have some exercises for both stretching and strengthening to fix ITB syndrome.

Stretching aside (we already established that it isn’t of much help) as I’m writing this post I can only do two of those exercises without pain, I’m copying the descriptions here but please refer to the original page as it also has some images:

CLAM SHELL
Begin with a clamshell exercise using a resistance band. Perform the exercise slowly with emphasis on good form. Build up to 10 repetitions of three sets on each leg. When this exercise becomes easier and the leg remains pain-free during the process, you can move on to more advanced strengthening.

SIDE LEG LIFTS
Lying on your side, raise your top leg straight up, then pull the leg back in that plane, move it forward and return it to the starting position. Form is very important. Check that you have a straight line from shoulder to ankle with the top hip slightly in front. (Do not let the top hip rotate backward.) Perform the sequence slowly with toe pointed down. Build up to three sets of 10 repetitions for each leg.

from: http://www.runnersworld.com/injury-treatment/treating-itbs

All in all I think (and I hope) that in my case the problem coul be weak glutes muscles, I read that it’s common for people who spend a lot of their time sitting and that’s exactly my case! Runnersworld also has some easy exercises for glutes strengthening but you can find many more on youtube or google:

Single-Leg Stance Test
Stand with your hands over your head, palms together. Lift your right foot off the ground and balance. Watch the left side of your hips to see if it dips down. If it does, it’s a sign of glute weakness. Try it on the other side, too. Next, do this: While in the same position, lean to the right of your body, checking to see if your left side dips. Move your hands to the left of your body and see if your right side dips. If your hips dip, it’s a sign that your glutes need work. Try this test also after a long or hard run to see how your glutes perform when fatigued.

Hip Hike
Stand sideways on a step, box, or bench at least four inches high with one leg held free of the bench, and keep both hips squared forward and shoulders level. Keeping your standing leg (the one on the bench) straight (no knee bending!), raise your free hip directly upward and then drop the leg.

Single-Leg Deadlift
Stand on your right leg with your left leg behind you and in the air. Keeping your shoulders back and your back straight, hinge forward and reach your hands toward the ground. Return back up and repeat. Hold weights or a medicine ball for an added challenge.

Three-Way Leg Raises
Place a resistance band just above your knees. Separate your feet and bend your knees, lowering down into a slightly crouched position. Balance on your left leg.
With slow, controlled motions, move your right leg forward against the band’s resistance, then back to the starting position.
Without placing your right foot back on the floor, move it out to the side, then return to the starting position.
Move your right foot behind you, then back to the starting position. That’s one repetition.

Lunge Stretch
Tight hip flexors can inhibit the firing of glute muscles. Do this stretch after every run. Step forward and lower your back knee. Keep your knee over your ankle. Hold for 30 seconds on each side.

Single-Leg Squat
Stand on your left leg. Lift your right out in front of you. Stand tall (don’t round your shoulders), and keep your left knee over your ankle as you lower down into a squat. Your hands can extend out for balance. Push into your heel to come back up and repeat. Start with shallow squats; go deeper as it becomes easier.

Side-Lying Leg Lift
Lie on your side with your legs extended out straight. Your lower arm can rest under your head; your top arm can rest on your hip. Lift the top leg up while keeping your hips steady and facing forward (do not rotate backward). Lower down and repeat. For an added challenge, wear an ankle weight.

from: http://www.runnersworld.com/workouts/glute-strengthening-workout

I’ll try strengthening those and if I don’t solve the issue I’ll be back updating this post.

[update 15 feb 2017]

I’ve found this video: https://www.youtube.com/watch?v=pRKvszxpSSs it has nice and precise explanations on how to do some exercises correctly.

[update 23 feb 2017]

Turns out that glutes weakness was just a part of the problem. The other part of the problem is having a hyper-tonic, slightly contracted, inner thigh muscle chain, also slightly contracted are the femur extra-rotator muscles.

The good news is that now I’m close to feeling no pain at all. What I’m doing is a lot of foam roller for the vastus medialis and sometimes for all the inner part of leg. As for the other muscles I’m stretching them real hard with this stretching (right leg):

from exercise #33 at http://besport.org/sportmedicina/stretching_in_coppia.html

You don’t really need a partner to do this and if you are as tight as me you will feel the stretch just by bending the leg in the hurdle position stretch. You can increase the tension on the muscles by bending backwards slowly supporting yourself with your arms as pictured here.

After just a few days of this I feel almost 100% ok!!

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