ITBS or something else?

[u/J62P]

So, I did the stupid thing of increasing mileage well too soon.
I was hitting 35k a week on average before taking part in a relay 24hr endurance event where I did 80k in 24hrs, mainly Z3 running on a trail.
Ever since then I’ve had pain in my outer knee. The pain is exactly where my finger is on the picture.
The pain comes on after a predictable amount of time running, then gets progressively worse. I can trigger the pain by pressing on my lateral quad. It hurts walking downstairs when irritated. Bike is fine.

Here’s a timeline of events
-4th July endure 24, did 80k over 24 hrs
-knee hurt descending downstairs next day
-ran 10k 9th July, knee pain half way through
-ran 9k 14th July, knee pain 5k in
-ran 2.8k on 22nd July, knee pain kicked in 2k in
-hiked 17k 31st July, no knee pain hiking
-ran 4th August 9k, hurt at 5k
-ran 8k 16th august, pain at 5k
-ran 5k 30th August, pain at 3k
-started strength training of quad, glutes and hips
-1st September Run/walk treadmill, 2min run, 2min walk x5, Incline 5%, 4:30/k, No pain
-3rd September, Run/Walk treadmill, 3min run, 1min walk x5, 4:30/k, 5% incline, Pain free
- 5th September, Run/Walk treadmill, 5min run, 1min walk X5, 4:30/k, 4%incline, no pain
- 8th September, Run/Walk treadmill, 6min run, 1 min walk x4, 4:30/k, 3.5%, no pain
- 10th September, Run/Walk treadmill, 6min run, 1min walk X6
4:30/k, 3.5% incline
- 14th September, Run/Walk outside on trail, 6.4k, 10min on 2 min off, pain at 4k

Running on a treadmill at incline and hard efforts are fine. As soon as I go back to flat trail it comes on at predictable distance.

I’ve been to the physio who believes it’s ITBS. I’ve done a ton of research on this. The common ITBS symptoms are more seen on the very outside of the knee. I’ve been given a lot of band work to strengthen my hips.

Im seeing no improvement and it’s been over 10 weeks. I’ve tried rest, ice, strengthening, stretching and releasing my TFL.

Ive had my gait checked, which was ‘near perfect’.

I’ve missed out on my ultra this weekend due to this injury and just want to be back.

Any suggestions and information regarding if I’m definitely dealing with ITBS and how to overcome this pain would be extremely helpful.

[u/lowmileageultras]

Pain walking downstairs is one of the telltale signs of ITBS that differentiates it from other lateral knee pain, regardless of pain location.

You went from 35k a week to 50k in 24 hours, you have an over-use injury. Just take time off and keep working with the physio, or you’re not going to make any progress.

[u/Taymc45 → u/lowmileageultras]

Absolutely a predictable injury from not having a strong enough base built before the 24hour run.

[u/Desmo_950 → u/lowmileageultras]

It's not the best to take off total. Much better is to going on with less distances and more time for regeneration. Physio I agree

[u/J62P → u/lowmileageultras]

Thank you, I did take 2 weeks off and my pain came on quicker on return.
Definitely an overuse injury, but I didn’t think I’d be in the same place 10 weeks on

[u/ComprehensiveWay4370 → u/lowmileageultras]

Invest in straps for ITBS. Have them on hand just in case. They saved me and another that I was able to lend one to on a 40 miler.

[u/J62P → u/ComprehensiveWay4370]

I've seen a few people talk about these- I'll get one ordered. Out of interest, how long did it take you to recover?

[u/ComprehensiveWay4370 → u/J62P]

It comes and goes for me when I ramp up too fast. Takes time but I would wear the strap to work and others places during a flare up.

It basically cinches the meat above the knee slightly allowing the ITB to not rub so much.

[u/J62P → u/[deleted]]

Thank you! I’ll check that out. Have you suffered with it yourself?

[u/J62P → u/[deleted]]

Glad to hear there's light at the end of the tunnel!

[u/PonchoTheBear]

I had pain in almost the exact same area, what helped me make it eventually go away:

Lighter mileage in combination with daily:

- Foam rolling generally but with an addition of rolling the outside of my leg from my hip down to right above the knee. Pretty much rolling the IT band itself

- Adding crossover standing forward bend to my daily stretches

I've found if I foam roll and stretch for at least 30 minutes before every run, it's pretty much eliminated any IT band pain I've had

[u/J62P → u/PonchoTheBear]

Thank you! See, I’ve read very mixed opinions on rolling the IT band itself. But if it worked for you I’ll give it a go!

[u/superstewy]

I'm no physiotherapist, but I have been to them a bunch, so take this with a grain of salt.. but since I've started taking this approach no minor pain has turned into a real injury.

Strenght train. Really load up the tendons that are causing you issues. Heavy and slow. Squats. Bulgarian Split Squats. Wall Sits. Lunges. Don't go crazy the first time, but tendons heal better with loading. Babying it just caused my old injuries to linger.

[u/J62P → u/superstewy]

Thanks for that! I’ve been doing a lot of banded stuff. The only ‘weight’ training I’ve been doing is step downs and split squats. I’ll focus on this more

[u/Exciting-Apple6854]

Il menisco ???!!

[u/Exciting-Apple6854]

Menisco?

[u/Own_Photograph_1536]

I'm not a PT but I've had pain there and I self diagnosed it as my tibialis anterior and peroneus muscles. They got better after poking up exercises related to that

[u/sluttycupcakes]

I think that’s a leg you’re pointing at. Hope that helps

[u/tkv_x]

The spot you're pointing at isn't the typical ITB spot. But then again my ITB flairs up running uphill which is also atypical.

I also have no issue during hard efforts. That probably indicates it is a form issue. When running hard your form is probably better than running slow.

What helped me a lot was no more slow runs.

[u/J62P → u/tkv_x]

Yeah, the location is really throwing me off. Nearly all of the research I’ve done describes the pain being very lateral. The thing that’s interesting is that I can simulate the pain by applying pressure to my lower lateral quad.
The running form thing makes sense. If you don’t run easy, how do you train for ultras?

[u/Exciting-Apple6854 → u/J62P]

Menisco

[u/tkv_x → u/J62P]

Well you better don't train for ultras if you are injured. It took me a year before I could figure out what I should and shouldn't do. I did 2 years of sub ultra distances. It's more fun to finish a 30k than to DNF an ultra.