Tuesday 19 February 2013

somebody put me together....

Ever heard of an iliotibial band?

Nah. Me neither. Well, until about 0730 this morning anyway.

Yes. You’ve guessed it: I'm injured again. You might remember that I was moaning about a minor case of knee ouch a few months ago, but that moaning was soon superseded by much more whining about calf ouch and tendon-under-the-foot ouch. Well, it seems the knee ouch is back with a vengeance.

So what is the iliotibial band, I hear you cry. Is it a muscle?

Well, thanks for asking. As it happens, the IT band is not a muscle. It is a thick band of tissue called fascia that starts on the outside of the hip, passes down the outside of the thigh and inserts into the side of the patella (knee cap) and the tibia, (shin bone). It helps to stabilise the knee joint. Fascia is a sheath-like tissue that surrounds muscles. The ITB has the tensile strength of soft steel, which explains why it is so difficult to mobilize. As well as arising from the iliac crest, (hip bone) the ITB attaches into the gluteal muscles at the back and tensor facia lata muscle at the front. When these muscles contract, they increase tension on the band. Often, one muscle dominates the movement pattern causing an imbalance to occur, which may lead to injury.

Well, it may have the tensile strength of steel, but apparently I've still knackered mine. The one in my left leg anyway.

Why does it hurt? Well, I’m glad you asked that too.

It hurts because, as the knee bends, tension acting on the band, causes it to be pulled backwards over the lateral femoral epicondyle, (a bony prominence of the thigh bone on the outside of the knee). When the knee straightens, tension on the band pulls it forward again. A thin bursa, or fluid filled sac, separates the ITB from the femoral epicondyle, to decrease friction between these structures. Repetitive bending and straightening of the knee can cause inflammation of the bursa and the band itself, or irritation of the bone due to recurrent rubbing or impingement. For me, weekly mileage interacted with a combination of biomechanical issues, training strategies, and the variables imposed by my own particular specific muscle imbalances; once a critical threshold is met, tissue breakdown occurs and you have knee ouch. It is not necessary to sustain a specific traumatic injury to the knee for the ITB to become a problem.

A recap: one of the things caused by my MS is a weakening of the left-hand side of my body. When I get tired, I seem to “drop” a leg. As I do a fair bit of running, this seems to be causing mechanical issues in that side of my body: cramps in my calves; micro-tears in the cartilage of the knee; plantar fasciitis. Now, apparently, it’s affecting my ITB. Why now? Well, the day after we got back from holiday, I went on an 8.5 mile run. After about 5.5. miles, I could feel that my left leg had “dropped”. Clearly, I was still 3.5 miles from home, so I had little choice but to carry on, adjusting my running style so that I was “carrying” the dropped leg. It didn’t feel too bad at the time, but I could feel a twinge in my knee on my next couple of (shorter) runs. I’ve learned to ignore the messages coming from my body, so I just kept going. I went on an 8 mile run this Sunday, and although it didn’t hurt whilst I was running, when I stopped, my whole knee stiffened up immediately, and I’ve been hobbling around ever since.

As I’m going skiing in 4 weeks, I was quite keen to understand what was wrong and what could be done about it. At the physio this morning, Carly confirmed that she didn’t think it was an issue with my cartilage (good – that might have required surgery) but that instead I was going to need to do some laborious stretching and rolling of my IBT to get myself back into shape. This is a sports physio clinic, so Carly has worked with plenty of runners before. She made me promise – promise – that I wouldn’t go out running before she sees me again on Friday afternoon. If I’ve been a good boy and I’ve been doing my exercises, then she might – might – allow me to go running at the weekend. Swimming is okay, but ABSOLUTELY NO RUNNING.

If I am allowed to run as a special treat at the weekend, perhaps I should avoid doing an 8-miler, eh?

Curse this weak, fallible, fragile human vessel of mine. I’m determined not to let fatigue or pins & needles or numbness stop me from running, but it seems that MS has been rather more devious than that and has devised a fiendish route to a general mechanical breakdown instead. I guess I’ll just have to swim obsessively for the next few days instead…..



  1. I've got one of those foam roller things - great for massaging the calves and itb. I'm just building my mileage back up after my last relapse - up to 6 milers and hoping to reach double figures by the summer. Good luck with the skiing, we're hoping to get a late deal at Easter - hope I can stay upright!

  2. Foam rolling a cramped calf is bad enough, but itb is a whole new level of ouch!